Strange Bedfellows: Bridging the Worlds of Academia, Public Health and the Sex Industry to Improve Sexual Health Outcomes

"Negative messages about sexuality can undermine, rather than promote, safer sexual behaviour....[R]esearchers and sexual health practitioners working within a wide range of contexts and cultures have been calling for a more pleasure-focused approach to sexual health....This research could benefit from some engagement with or learning from the sex/pleasure and erotic entertainment sector."

This paper is a case study of The Pleasure Project (TPP), which is involved in countering sex-negative approaches that focus on risk, disease, unintended pregnancy, etc., and, instead, bringing pleasure and eroticism into sexual health programming around the world. The paper gives a brief background on the public health approach to sex and sexual health and outlines some of the barriers faced when challenging deep-set and commonly-held norms around these issues. It then explains how TPP communicates messages about eroticising safer sex to influence diverse audiences - from researchers to public health practitioners and from the mainstream media to the porn world. Finally, the paper assesses what has worked well, and less well, in efforts to put the "sexy" into safer sex and sexual health promotion.

As described here, TPP has worked since 2004 to influence both policy and practice through research, advocacy, and skills building that incorporate positive motivations for sexual activity into safer sex and sexual health programming and research agendas. TPP communicates sexual health research and information using edgy and erotic language and images - techniques used largely in advertising and marketing - to make sexual health information more enticing. It also takes a "show, don't tell" approach - for example, by demonstrating the use of a safer sex method using erotic language and describing condoms as sex toys rather than medical devices. TPP's research and communications tools provide real-world examples of how safer sex can be (and in many cases, already is) eroticised in practice, and its case studies and other research are used as the basis for participatory exercises at workshops and trainings with sex educators, counsellors, non-governmental organisations (NGOs), health care providers, and programmers. For example, TPP has: published articles in professional journals such as The Lancet; spoken at the Royal Society of Medicine in London and annually at international conferences in many countries (including international and regional AIDS conferences from 2004 to 2009); and is researching a literature review on safer sex and pleasure. According to TPP, as of 2011, more than 1,500 practitioners/decision makers have been exposed to pleasure training techniques and concepts and many more at conferences and through the media. TPP has also worked with pornographic film directors and actors in the United Kingdom (UK) to help them integrate male and female condoms into their films as a part of the sexual storyline and sex play, rather than as "necessary evils".

The authors outline several challenges to communicating about the potential of pleasure in sexual health promotion, such as the lack of existing indicators for measuring constructs of sexual pleasure. Another challenge is finding images for communications materials which appeal to both the pleasure and health worlds, will not be viewed as discriminatory, and will be seen as "sexy" by a diverse global audience. An example is provided of focus group discussions and interviews that TPP conducted across India and Europe.

In conclusion, "by combining all levels of evidence - from the rigorous experimental to the anecdotal - with experiential knowledge from the sex industry and our own work as safer sex proponents, TPP hopes to continue providing a medium for skills transfer, thereby continuing to bridge the health-pleasure divide."