Florian Vock, Margaret Daramola and Elisabeth Nash at the MMS/aidsfocus.ch conference 2019. Photos: Daniel Rihs / © Network Medicus Mundi Schweiz
We have to be aware of the progress we’ve made: Thanks to the AIDS-activists in the 80s and 90s, and thanks to three decades of commitment, young gays can relax for the first time when having sex – at least when it comes to HIV. What a success!
The generation that has gay sex for the first time today, knows about HIV and AIDS from sex education at school, but no longer from the sad experience that closest friends die from it.
This is changing the community and sexuality of young gay, bisexual and queer men. In general, identities and practices are changing – every generation has its cultural, social, economic and personal questions, concepts and peculiarities.
Whoever wants to give the young generation of today the necessary resources for a positive health behaviour cannot ignore or even deny the environment they live in.
Statistical bad luck
Most teenagers and young adults are not well informed about sexual health when they experience their first sexual pleasures, compared to those who are 5 years older. However, gay, bisexual and queer adolescents have a statistical disadvantage when it comes to sex: the chance of getting infected with HIV (or any other STIs) is higher.
80’000 men in Switzerland have sex with men. About 10% of them are HIV positive. The majority of HIV-positive men are successfully treated and therefore do not infect anyone with HIV, not even during condomless sex.
Nevertheless, all men who have sex with men must be aware of one fact: 1 in 45 sex partners can transmit HIV because the virus has not been detected yet, either because it is not or inadequately treated. This average rate of 2.2% is higher in two cities in Switzerland: Zurich 3.5% (1 in 29) and Geneva 3.3% (1 in 30).
Thus, 11% (1 in 10) new HIV infections in Switzerland occur in men aged 15 to 24 and 34% in men aged 25 to 34.
Presentation by Florian Vock at the MMS/aidsfocus.ch conference 2019. Photos: Daniel Rihs / © Network Medicus Mundi Schweiz
No healthy generation...
While today we are fulfilling our tasks in the field of HIV/STI prevention with serenity, it is even more important not to forget one thing: Those who experience stigmatisation, devaluation and discrimination during their childhood and adolescence show a poorer health status.
We identified three main stress factors:
- Mobbing: Young queers are very often victims of verbal or physical violence in their schools, families and communities.
- Institutionalised prejudices: So called "curriculum gaps" – the concealment of LGBTIQ content in class – contribute to ambiguities and uncertainties, making young queer less confident and visible. They do not get proper access to the information they need. This also applies to health professionals, social workers, or teachers. Virtually all those who work with young people do not sufficiently assume their responsibilities.
- This and homophobia in general leads to internalized homophobia: Internalized social prejudices and inner conflicts with one's own sexuality and in the context of coming out lead to greater challenges for a healthy development of identities.
Young queers in Switzerland are at least 1.5 times more likely to suffer from a mental illness compared to straight teenagers. Six out of a hundred gay and bisexual 20-year-olds have attempted suicide in the last twelve months – five times less heterosexuals (1.2 out of 100) have attempted suicide.
... But a generation who wants to take care of itself
The swiss LGBT-youth is not healthy. However, they know how to help themselves. Even in times of Grindr and Tinder there are still youth groups, parties and weekends. Offers from "Milchjugend", "du-bist-du" or local groups show that today's youth also takes their fate into their own hands and creates the space they need.
Institutions and services must also develop further: "Take a condom" is not enough as a tip. Sexual health is so much more. Protection strategies and sexual preferences must fit together. If you just want to cuddle, you do not need a condom. If you want to fuck bareback, you might. Either way you need to learn about adequate protection strategies.
Over-cautious and risky
Unfortunately, too often we fail because of unawareness. This is not only true for teenagers, but for many people who have sex. One example: Gay men have oral sex with a condom to protect themselves from HIV and think that this also protects them against gonorrhoea. This conclusion is wrong: HIV cannot be transmitted during oral sex, the risk is insignificant. However, gonorrhoea can be transmitted by a tongue kiss as well as by rimming. A condom may reduce the risk, but never protects sufficiently.
Overcautious and yet risky: Young adults are sexually active and do not always protect themselves against HIV and STIs. The right information does not reach them. We, the established organisations and health agencies, failed queer people in Switzerland. We failed with regards to their mental health. We are not capable of meeting their needs for sexual health.
Sexual health is a prerequisite
There is one reason for that: Sexual health is a prerequisite. Prevention requires not only that the right facts end up with the right young people. Decision-making competences are also needed to integrate this knowledge into a young lifestyle.
Those competences arise in informal structures, in peer-to-peer situations, and are composed of individual, socio-structural or socio-political conditions. But they hardly arise in an expensive campaign for Instagram, softened sexual education or a paternalistic morality.
In order to be healthy and stay healthy, young queers do not only need appropriate access to information or individualised counselling. They need a stable community with self-confident peers. This is a crucial prerequisite for information to flow, problems to be adequately dealt with and in the end a low-risk behaviour to become an everyday occurrence.
Development of prevention work is necessary
This is where the Swiss AIDS Federation wants to make a point: Queers have to get information when they need it. Prevention does not work in isolation. It has to happen in their environment for example at a party, at school, on Grindr or in families.
However, the aim is to better understand this generation. Are the prices for testing too high? Do young people even know that they should get tested? How do they assess a risk? How do they have sex if their parents are not allowing it?
Enjoy sex!
Because in the end, it is all about one thing: everyone should have as much sex as he/she/they want. Decisions during sex should be made consciously – this needs the necessary knowledge in order to make a self-confident decision. Moreover, it also needs courage and strength to be self-determined.
Sexuality is between people and is exciting because of new experiences, crossing boundaries and finding out what you like. This sometimes requires a lot of trust in your sex partner. That is why we have to cultivate a sexual culture where crossing of boundaries of previous experiences – if at all – is always consensual.
That does not mean that there are no bad experiences, because sometimes we try out something only to find out that we did not liked it. However, it means that even unsatisfactory experiences are made in a safe and decent environment. The main thing is that sex happens with the consent of everyone involved. Such a sex culture needs a community where asking, "Is that OK for you?" is part of it.
Nothing works without the community
The community must be our safety net. Together we catch young LGBT people and make sure that they get all the means they need to become self-confident and self-determined members of our community.
Nobody needs protection from sex – especially not young people. If we consciously decide for sex and the matching protection strategy, sex is liberating and full of relish.
The queer community is a place where social norms and expectations are reshaped, not only in a sexual context. Young people end up in the community because they are looking for a safe place without stigmatisation and devaluation, because they are looking for girlfriends, boyfriends, because they want to have sex and organize great parties.
Only an open, diverse and honest approach to sexuality allows an adequate health response for those young people. It is our task to provide them with these resources. It is not to us to decide, what to do for young people. If, however we succeed, they will challenge our societies and claim their rights – for their sake and ours.
