Walter L. Williams, Ph.D.
Professor of Anthropology and Gender Studies
University of Southern California
Los Angeles CA 90089-4352 USA
last updated December 25, 2005
There are several methods by which HIV, the virus that leads to AIDS, is transmitted. However, the most common way that HIV is transmitted is by sexual intercourse.
In reaction to the scourge of AIDS, many governments have responded by encouraging abstinence. Especially for young people, the message has been to delay sex until marriage. And, for those uninfected people who are already married, the message is to be faithful, and engage in sex only with one’s partner in a mutually monogamous relationship.
At first glance, these messages may seem obvious. After all, it is clearly correct that the most effective way to avoid getting HIV sexually is to abstain from sexual intercourse. It is also evident that another effective way to avoid HIV infection is to marry an uninfected person and engage in sexual intercourse only in a mutually monogamous relationship.
Despite the seeming sensibility of these messages of abstinence and marriage, there are limitations to this approach. For example, studies have shown that despite a professed public vow to remain abstinent, most young people sooner or later break their vow of celibacy. Deep biological instincts for sex kick in, if only at a subconscious level, and a majority of individuals become sexually active. This is a basic reality of all primate species, including homo sapiens. The desire for erotic pleasure is part of our natural heritage. Strategies for HIV prevention that ignore this basic reality are doomed to failure.
In many schools and churches where the only message taught to high school students is to be abstinent until marriage, there is evidence that such teachings can lead to students delaying sexual activity. On average, students of abstinence-only education programs delay becoming sexually active for a number of months. Yet, study after study has shown that, in the long run, HIV transmission rates are not reduced by abstinence-only education. In fact, because these teenagers are not taught about safer sex practices, once they do become sexually active they are MORE likely to be infected with HIV or another sexually transmitted infection than the average teenager.1
Because of this reality, the approach of preaching at people to abstain from sexual enjoyment simply does not work for the majority. Beyond that, even a person who wants to be abstinent might not be able to avoid HIV infection if they are forced to engage in sex against their will. This trend is particularly true for young girls in many countries, who are often raped or coerced into engaging in sexual intercourse.
Likewise, telling people to get married is not effective if it does not encompass all persons. For persons who are attracted to their own sex, only Spain, Canada, Belgium, the Netherlands, and the state of Massachusetts (and soon to be joined by South Africa) have legalized same-sex marriage. If a government really wants to encourage marriage as public policy, they should equalize marriage rights so that all people (not just restricted as special rights to heterosexuals) will be able to marry the person they love. In countries where homosexuality is stigmatized, men who are attracted to other males often marry women as a way to hide their inclinations. Hidden sex is a surefire way to spread HIV, since sooner or later most of those men will act out their same-sex desires. Many unfortunate wives of closeted homosexuals have been infected with HIV after their husbands gave in to their desire and secretly engaged in anonymous sex. Such tragedies could be avoided by changing social expectations that every person should conform to a heterosexual norm. Instead of males who are secretive about their orientation having furtive secretive sex with other secretive males, society should encourage such persons to settle down into a recognized marriage. Legalizing same-sex marriage is one way that nations can encourage monogamy and help to lower the rate of HIV infection. Marriage for everyone should be encouraged.
Unfortunately, encouraging marriage is not enough to save people from HIV infection. If their spouse secretly uses I.V. drugs or has intercourse with another person, HIV transmission is possible. In many cultures, married women have no right to reject the sexual advances of their husband, even if they suspect that their husband has been unfaithful. But even if their spouse is faithful, the spouse may still have been unknowingly infected with the HIV virus from an earlier time, and could pass HIV on to their partner. This potential for spreading the virus is one reason why it is so important that people should get regularly tested for HIV antibodies. It is always better to know one’s HIV status as quickly as possible, because early treatment with newly developed medicines can help a person with HIV to remain more healthy and live longer. Yet the vast majority of people in the world who have HIV have never been tested. Many of them are unintentionally infecting their spouses without even realizing they have it.
Given these realities that many people do not remain abstinent or are not being faithful in a mutually monogamous relationship, many HIV educators have argued that a third alternative needs to be offered for people who are sexually active. This three-part strategy is called the “ABC” approach.
A tells unmarried people to practice Abstinence, and for young people to delay their first sexual initiation until they marry.
B tells married people to Be faithful, and engage in sex only with one’s uninfected partner in a mutually monogamous relationship.
C tells people who are sexually active with more than one partner to always use Condoms Correctly and Consistently. The message has been “use a condom every time,” and “safer sex means use a condom.”
This message promoting condom use is indeed valuable, in that many studies have shown that correct and consistent use of condoms during sexual intercourse does in fact bring about a very significant reduction in HIV transmission. However, like the messages promoting abstinence and marriage, the message of always using a condom has many drawbacks. First, condoms decrease sensation and are unpleasant to many people. They can interfere with sex, especially for males who are uncircumcised. Therefore, those persons often will not use them at all or do not use them consistently. Second, because a number of Christian churches teach young people that using a condom is a sin, many persons of faith are reluctant to use them even though they realize the condom might save their life. Even having condoms in one’s possession may be taken as evidence of immorality and sinfulness.
As a consequence of these two factors, condom use is not popular with many people. A study of sexually-active adolescents aged 14 to 19 that was sponsored by the U.S. Center for Disease Control and Prevention found that about 40% of ninth graders (age 14-15), 48% of tenth graders (age 15-16), 57% of eleventh graders (age 16-17), and 72% of twelfth graders (age 17-18) had already engaged in sexual intercourse. Yet, only 58% of those adolescents who were sexually active used a condom during the last time they had sexual intercourse. Even more frightening, another CDCP study reported that only 41% of high school students who had sexual intercourse with four or more partners used condoms. Condom use was especially low among sexually-active teenagers who regularly attended church.2
Beyond these factors, even if condoms are used consistently, they are not 100% effective. Sometimes condoms break or slip off. It is not physically possible for a thin sheet of latex to be foolproof. Some studies suggest that condoms are 97% to 98% effective in preventing HIV transmission or pregnancy, but other studies suggest that this effectiveness rate is closer to 90%. Without a doubt it is much better for a person to use a condom during intercourse, than to engage in intercourse without a condom. Still, a failure rate of two percent to ten percent is enough to convince many people that they should not put all their hopes on condoms alone.
This three-part ABC approach of promoting abstinence, being faithful, and using condoms is more effective than any other strategy that has heretofore been instituted on a national level. Nevertheless, the ABC approach still has crippling limitations. Millions of people are infected with HIV, and every day thousands more continue to become infected. This is the reality of the world in which we now live.
What is particularly tragic is that most of these new infections occur among young people. There is a common misperception that if kids are taught about safer sex techniques they will become sexually active at a younger age. Because of fear that their child might become sexual, and because of puritanical religious taboos, most parents do not feel comfortable giving specific instruction on safer sex to their children.
Meanwhile, children around the world are bombarded on a daily basis with a glorification of sex in the mass media. Because market surveys prove that sex sells, companies advertising their products try to attract a large audience by sponsoring sexually-charged movies, television shows, music videos, and song lyrics. Advertisements themselves often stress sex appeal. But, while young people are inundated with sexually-explicit images in the media, it is very difficult for them to get accurate information on how to avoid HIV infection and pregnancy.
The logical place to expect this information to be imparted is in the schools. Yet, in many countries children attend schools that are sponsored by religious groups that oppose sex education. In addition, many parents are in total denial that their child is sexually active, and they do not allow even secular schools to provide a comprehensive sexual education. Teachers and other adults are afraid to educate young people about sexual techniques, even though they know this instruction might be life-saving.
Having been deprived a practical education, when youngsters do become sexually active they usually have no knowledge of how to engage in sex safely. As a direct result of this denial of knowledge by parents, schools, and churches, in the United States eighty percent of new HIV infections occur among people younger than age twenty-four. This statistic constitutes a national disgrace for Americans. However, in many other countries the numbers are equally dismal. For years the governments of China, India, and Russia tried to deny that AIDS even existed in their populations. As a result of this head-in-the-sand approach, HIV infection rates are skyrocketing in each of these large nations.
Small nations are not exempt from the scourge of AIDS, and many have been overwhelmed by the pandemic. In Sub-Saharan Africa, which is the locale for over 80% of all human beings who are infected with HIV, it is not uncommon for over 20% of the population to be infected. Economies are on the verge of collapse as so many young adults are sick and dying, and thousands upon thousands of children are orphaned because their parents succumbed to the disease.
No area of the world is exempt. In a tiny nation like Belize, which now has the highest rate of HIV infection in Central America, a study that is cited on the web site of the Belize National AIDS Commission reported that the average age of initial sexual intercourse for Belizean youth is thirteen. That statistic means that half of those kids are having sex before age thirteen. In such an atmosphere, HIV infections are running rampant among Belizean youth. That, plus a high teenage pregnancy rate, are problems that threaten the very future of the nation.3
Given these realities in many countries around the world, it is simply not realistic for religious leaders and moralists to expect young people to remain abstinent until marriage, and it is not realistic to expect that all married people will remain totally monogamous. Government officials and other responsible spokespersons need to recognize that sexual activity is a fact of life, for adults and for youth, and any HIV prevention plan that refuses to face that fact will never be successful.
Most HIV educators recognize the limitations of an abstinence-only approach, but where they are being unrealistic is to expect that condoms are the solution to the AIDS pandemic. Too many HIV prevention educators place all their attention on promoting condom use. It is no more realistic to expect that everyone will “use a condom every time,” as it is to expect all people to remain celibate or monogamous. None of these approaches has proved to be sufficient to end the spread of HIV. Other alternatives need to be offered to people.
What, then, can people do if they don’t want to use a condom but do want to enjoy the pleasures of erotic stimulation and orgasm? Is it just a matter of time before they catch HIV?
My answer is NO. I will suggest alternatives below that are safer than using condoms in intercourse, and more pleasurable. I will present a model by which an uninfected person can have a full and enjoyable sex life without catching HIV. With care, even a person who already is infected with HIV can have an active sex life without infecting others.
How can this be possible? For people who already have the virus, how can they enjoy sexual pleasure without threatening the health of their partner? For people who are not infected with HIV, what can be done to have a full sex life while also protecting themselves from HIV infection?
To answer these questions, it is necessary to specify exactly what sexual behaviors are dangerous for HIV transmission. There is a great deal of misinformation about this subject. Even the web site of the United States Centers for Disease Control and Prevention states flatly that “HIV is spread by sexual contact with an infected person…”4 This statement is misleading and wrong.
As I will specify below, there are many forms of sexual contact which do not put a person at risk for HIV. In order to describe these practices, it is necessary to use plain and precise descriptions so that readers can understand exactly what they can do to preserve their health and save their life. Anyone reading this text who feels uncomfortable in discussing sexual practices should stop reading now. I feel that it is more important to get this information out to the people whose lives are at risk, than to censor my words in deference to those who would rather avoid sexual issues. The times demand nothing less than a clear and accurate presentation of the facts.
The first and most important fact about HIV transmission that needs to be clarified is that many studies have demonstrated that the most high-risk sexual behavior-by far-is intercourse. That is, a penis inserted into a vagina or into an anus is the most risky sexual practice. Vigorous intercourse commonly makes tiny cuts or tears in the vagina, penis, and rectal lining. These tiny ruptures can result in the direct blood-to-blood or semen-to-blood contact that is necessary for HIV transmission. Because of this danger, for an HIV prevention plan to be effective, I propose that the message needs to stress other erotic alternatives besides intercourse.
At the present time, most HIV prevention programs assume that erotic pleasure equals intercourse. Slogans like “safe sex means use a condom” and “use a condom every time” are built upon the assumption that when people want to enjoy themselves sexually that means they are going to engage in intercourse.
In fact, what many HIV prevention programs ignore is that there is a whole range of erotic behaviors that can be safely engaged in that are not conducive to HIV infection. To contrast with high-risk intercourse, I propose that these safer behaviors should be labeled and widely publicized as “outercourse.”
I define outercourse as any erotic activity that does not involve the insertion of a penis into a vagina or anus.
The new model I am suggesting is to add to the standard ABC approach other alternatives for people to follow. I am proposing a new model that I call the ABCD approach, in which D stands for “Do outercourse.”
The ABCD model, with an emphasis on educating people to engage in various forms of outercourse, offers a more flexible and expansive range of behaviors for people to enjoy. Because more alternatives are presented beyond just telling people to be abstinent, faithful, or use condoms, the ABCD model will be more effective in reducing HIV transmission than the ABC approach by itself.
As an anthropologist I have traveled the world doing research in different cultures to discover sexual practices that are not dangerous for HIV transmission. My suggestions for outercourse are not just theoretical speculation, but are based on actual realities that have been practiced by real people for thousands of years. Let me introduce some examples here, and suggest that as a matter of health-indeed, of saving lives-it is important to start thinking very differently about these practices in the twenty-first century.
By far the most common erotic practice among humans worldwide is masturbation. Anonymous surveys show that well over 95% of people engage in masturbation, usually secretively. Many people are embarrassed to even mention the subject of masturbation, much less the fact that they themselves do it. If masturbation is so universal, why is it such a secretive and embarrassing topic?
My research suggests that masturbation began to get a bad reputation after the invention of agriculture about seven thousand years ago. What in the world, you might ask, does masturbation have to do with agriculture? The answer is very practical. Why do agricultural cultures stigmatize masturbation?
In the nineteenth century, medical doctors began a crusade against masturbation. Prompted by their desire to make a profit by selling potions that they claimed would cure the desire to masturbate, doctors speculated that frequent masturbation would bring about blindness and numerous other maladies. They were particularly worried about masturbation among children and adolescents. Medical authorities worked to develop anti-masturbatory foods. What famous foods were developed to prevent masturbation?
Today we know that such gimmicks are
useless at preventing masturbation. And more importantly, modern
medical research has established that masturbation does not in fact
cause blindness or the many other medical problems claimed by earlier
generations of doctors. All the fears of nineteenth century Americans
about masturbation were more reflective of agricultural values than of
medical realities. In sharp contrast to the past, recent medical
research suggests that regular orgasms are actually beneficial for
What are the medical benefits of having orgasms more than twice a week?
This new medical evidence suggests that, far from being a threat to health, for adolescent and young adult males in particular regular ejaculation is a benefit for lifelong good health. The implications of this new knowledge are awesome. Far from being a topic that is only referred to with embarrassment, masturbation should be destigmatized. Doctors and other health educators should encourage people to ejaculate regularly. Parents should encourage their children to masturbate, saving them untold torment and guilt as they do this behavior secretly. Some non-agricultural peoples intuitively understood the benefits of masturbation. For example, shocked early European explorers reported that some American Indian tribes held public masturbation contests for adolescent boys, in which the boys would compete to be the first one to ejaculate. The villagers would cheer on their favorite candidates, and celebrate the winner.5 Such practices fostered a guilt-free approach to masturbation, in contrast to the anti-masturbation values of agricultural societies.
Perhaps it is time for people in the twenty-first century to drop the inhibitions of the past, and to positively encourage masturbation. Not only is masturbation healthy, but it is totally risk-free in terms of HIV transmission. If people can be encouraged to indulge without guilt in the pleasures of self stimulation, masturbation can be transformed from an embarrassing vice into a civic virtue. Public campaigns to encourage masturbation are needed to promote good health and prevent the spread of disease.
If masturbation is good, then mutual masturbation is also good. As much as a person can enjoy masturbating him or her self, it feels doubly good for them to do it with another person. Just as long as a person does not have a cut or open bleeding sore on their hand, they can engage in masturbating another person without any fear of HIV transmission. If they do have a cut or bleeding sore on their hand, they should either use the other hand or wear a latex glove while masturbating the other person. Lubrication might also be used.
There is something about bare skin to bare skin contact that is fundamental to human sexual enjoyment. This feeling goes back to the basic skin-to-skin contact involved in the mother nursing her infant. The pleasure received in breastfeeding is wired into the brains of human beings for the rest of their lives. Besides the brain, skin is the most important sexual organ of the body. Fortunately, HIV cannot generally be transmitted by touching, hugging and rubbing bodies against each other. As long as no sperm gets inside the vagina or anus, a person can feel free to touch any part of the body to any part of another person’s body, and to ejaculate on any other part of the body besides the vagina and anus. Of course, if a person has a bleeding cut or open sore on their body, they should avoid getting blood or semen or other bodily fluids into that cut. Likewise, unless one has a cut or open bleeding sore in the mouth, HIV cannot be passed by kissing another person on the mouth or other parts of the body. Kissing, touching, hugging and body rubbing, combined with mutual masturbation, can be an extremely arousing and pleasurable erotic experience. All of these forms of outercourse, sometimes referred to as petting, can be enjoyed without worry about HIV transmission.
Since ancient times, human beings have enjoyed getting another person to massage their body. Massage is described in some of the earliest historical records of ancient cultures as diverse as Egypt and China. By rubbing the hands over the body, stretching and kneading the muscles, great relaxation can occur. Numerous health benefits result from regular massage, including relief of spinal pain, muscle aches, and psychological well being. The ancient religion of Buddhism recognized the spiritual benefits of massage, and incorporated this practice into its religion. In a Buddhist country like Thailand, massage is taught in the Buddhist temples and is considered a method to help people reach fulfillment in life. Giving a massage is considered as a spiritual act, to help another person achieve happiness. As a consequence of this religious encouragement, massage is a common practice in Thailand. Because it is so common, massage is not expensive and is not just a luxury for the wealthy. People of all ages, from children to the elderly, commonly enjoy this experience.
Massage can involve any part of the body. A masseur might concentrate on the head, the back, the legs, or the feet. There is also erotic massage. If massaging all parts of the body is pleasurable and healthy, then massage of the sexual organs is seen as doubly so. For both females and males, the genitals, the buttocks and the nipples are filled with nerves that generate intense pleasure when touched and manipulated. An intense orgasm can be experienced just from the manipulation of these parts of the body. Just as with mutual masturbation, as long as the masseur does not have an open cut or bleeding sore on their hand, there is no reason for either the masseur or the person being massaged to fear HIV transmission. If the masseur does have a bleeding wound, it is best if they wait until the skin has healed before they give another massage. Otherwise, a latex glove should be worn.
Massage needs to be promoted as a major social activity. Friends should be encouraged to give each other massages. Paid professional masseurs should be given high status, similar to doctors in that they are providing a necessary and important public service. And erotic massage should not be looked down upon, stigmatized, or treated by law enforcement officials as prostitution. Why should massage of the genitals be treated any differently from massage of any other part of the body? All parts of the body deserve attention. If erotic massage is socially encouraged, people who feel sexual desire will be less likely to engage in high-risk intercourse, and can feel total satisfaction with a loving massage.
In many cultures a common sexual practice either for male-female couples or male-male couples is to insert the penis between the legs. This form of erotic behavior is referred to by sexologists as intercrural sex, but that term sounds so medicalized that I prefer to use the word “legging.” I first heard this term in Belize, where I was told that one person could ask another person, “Do you want to get legged?” and it is understood what that means. How is legging done in Belize?
Legging was a standard practice for lovers in ancient Greece. Learn more about legging in ancient Greece.
Legging is still common in Indonesia today, with a special twist to make it more pleasurable. How is legging done in Indonesia?
In the age of AIDS, it is valuable to promote legging. Other related outercourse behaviors.
Another practice that has a bad reputation is the use of fingers or physical objects to insert into the vagina or the anus for the purpose of sexual pleasure. Learn more about inserting fingers and sex toys.
Sexual excitement for many people involves fantasy and role playing. Going beyond that, some people enjoy the stimulation of being tied up, pinched, spanked with a hand or a paddle, or otherwise forced to do the will of a domineering partner. Learn more about bondage and discipline.
Thus far we have been discussing outercourse practices that have practically no chance of HIV transmission. What about oral-genital contact? HIV prevention programs commonly list vaginal or anal intercourse as “high risk” and fellatio (sucking a penis) and cunnilingus (licking a vagina) as “moderate risk.” If someone has bleeding gums, or a cut or open bleeding sore in their mouth, or a throat ulcer, obviously they should not engage in direct contact with another person’s genitals. In such cases, oral sex is indeed somewhat risky for HIV transmission. Practically every one of the relatively few cases of HIV transmission that have been documented for oral sex have indicated that some kind of bleeding was going on in the mouth of the person who was doing the sucking or licking. But if a person does not have such bleeding in the mouth or throat, studies show that it is extremely difficult to be infected by HIV by way of the mouth. The mouth is designed by nature to be a tough receiver for many different types of plant and animal parts that are inserted and chewed. The digestive acids present in the throat and stomach are so powerful that a fragile virus like HIV has virtually no chance of survival. And, of course, for the person who is being sucked or licked, the chance of getting infected with HIV is virtually nil. Overall, with the exception of someone who is bleeding in the mouth, oral-genital contact should be accurately characterized as low risk. Yet, many existing HIV prevention education campaigns, in their desire to be overly cautious or moralistic, have often overemphasized the dangers of fellatio and cunnilingus, and made them seem more or less comparable to intercourse. The most important point to remember is that almost all sexual transmission of HIV results from penile insertion in a vagina or anus.
The conclusion that must be highlighted is that outercourse is a much, much lower risk for HIV transmission than intercourse. In fact, outercourse without a condom is generally safer than intercourse with a condom. Yet, each of these outercourse practices are commonly considered embarrassing, unnatural, sinful, kinky, or downright repulsive.
For females in particular, outercourse practices are advantageous in that they do not involve a risk of pregnancy. The real danger for females, both in terms of pregnancy and HIV infection, is penile penetration. When there is no penis involved, as is the case with all forms of erotic interaction between females, the risks are extremely low. It needs to be explicitly pointed out, especially to adolescent girls, that females who have sex only with other females have a great advantage over females who have sex with males. Consequently, both to prevent teenage pregnancy and to prevent HIV infection, young women should be positively encouraged to establish a relationship with another female rather than with a male. Female-female eroticism should be destigmatized, and accepted as a respected alternative especially for young women who are still in school or are establishing themselves in a career.
Female-female eroticism is a means by which young women can totally avoid the risk of pregnancy. Many studies show that if an adolescent girl manages to avoid getting pregnant during her teenage years, her chances of lifetime economic success are VASTLY increased. She has a significantly greater chance to experience a higher standard of living throughout her life. In contrast, teenage girls who have intercourse with males and give birth often find that they have to drop out of school to take care of their babies. They often have great difficulty getting good jobs and taking care of their infants. Children of unwed mothers are much more likely to be raised in poverty, to drop out of school when they reach adolescence, and to become juvenile delinquents or unwed mothers themselves. Because of these factors, teenage pregnancy increases both poverty and crime. Encouraging adolescent girls to engage in outercourse with other females is an effective means of lowering both the teenage pregnancy rate and the rate of HIV transmission.6
Delaying pregnancy among young women is also an effective method of population control. Some cultures recognized this, and allowed females to marry men only after they were in their late twenties. In various areas of Africa, for example, a number of traditional cultures delayed male-female marriage and recognized woman-woman marriage for younger females. Until such practices were suppressed by European colonialists a century ago, woman-woman marriages were socially accepted and respected. Some girls might continue with their female spouse for their whole life, but most young women chose to marry men once they approached their thirtieth birthday. A young woman who was in a woman-woman marriage could easily shift to a marriage with a man later on, with no damage to her reputation. She was not stigmatized as “a lesbian” but was accepted as an individual who happened to have had a female former spouse. Such customs prove that youthful same-sex relationships do not forestall a heterosexual marriage when the person matures.
In today’s overpopulated world, it is time that we take another look at these traditional non-reproductive outercourse practices. Humanity’s numbers are spiraling out of control. Look at the numbers. It took all of human history, from the earliest humans in prehistoric times to the year 1830, for the world’s population to reach one billion people. After that, it took only one century, from 1830 to 1930, for world population to double: from one billion people to two billion people. Yet, in the seventy-five years since 1930, human population has skyrocketed to six billion! That is an increase of four billion human beings in only one lifetime.7
Humanity cannot keep on expanding like this. We have become like a cancer that is spreading rapidly across the earth. As human populations increase, many environmental disasters are becoming increasingly severe What disasters are happening due to the vast increase in human population?
Even though the number of births per woman is at last going down, at least in some countries, the total number of people in the world is continuing to climb because there are so many more people living to maturity and reproducing. Family planning agencies talk only about reducing the rate of increase, and few deal responsibly with the fact that there is already much too large a human population for the earth’s ecosystem to support. We need to REDUCE the world’s population, not merely lower its rate of expansion.
In the past, as part of our agricultural value system, people have looked at procreative penile-vaginal intercourse as the only “right” and “natural” form of sex. Churches reflect outdated agricultural values by telling us over and over again that “The only purpose of sex is reproduction.” If you think carefully about this statement, it is clearly not true. Anthropologists have discovered many purposes of sex, including relaxation, stress relief, mentoring, and creating intimate ties that assist survival through food sharing. Sexual desire brings benefits to people far beyond reproduction. In the context of an overpopulated world, we can no longer afford to uncritically accept these outdated agricultural ideas. In the twenty-first century it is absolutely necessary that we start thinking in a different way, to promote and favor non-reproductive sexuality over reproductive sexuality. Obviously, most people will still continue to be heterosexual and will continue to favor penile-vaginal intercourse. Humanity is hardly threatened with extinction because of a change in attitudes toward sex. But a popularization of outercourse might be able to help stabilize human population.
Outercourse may have a long-range effect on human overpopulation, but its more immediate effect is to save lives by reducing HIV infection. The proposal presented here is to construct an HIV prevention education campaign by not just tolerating, but actively encouraging, young people especially to engage in outercourse behaviors rather than intercourse. As noted above, this can be accomplished by warning people about the dangers of sexual intercourse, while encouraging them to enjoy outercourse. Rather than being limited to the ABC approach that promotes condoms as the only alternative for sexually active people, the ABCD alternative model presented here should be offered to encourage as many people as possible to do outercourse.
It is true that some of these outercourse behaviors can possibly allow transmission of other sexually transmitted infections (STI), but it needs to be kept in mind that engaging in intercourse puts a person more at risk for most of these other infections than a person who does only outercourse. More importantly, other STI’s are nowhere near as serious as HIV. The approach that should be taken for STI is for national governments to offer comprehensive public STI treatment programs. The really horrific danger facing nations right now is HIV, and the main focus should be kept on HIV as the major life-threatening concern of public prevention campaigns. With modern medicines, and with publicity to encourage people at risk to get treatment, outbreaks of other STI’s can be effectively treated by public health clinics.
In order to make outercourse popular, a few things will need to be done.
First, the law will need to be modified.
What should government and law enforcement officials do?
What should religious leaders and the media do?
What should educators, parents, and other concerned citizens do?
At present, outercourse behaviors are stigmatized. Government, the media, religious organizations, educators, and parents need to start thinking responsibly about what they can do to destigmatize outercourse. The new realities of AIDS and teenage pregnancy require radically different ways of thinking about how to promote safer behaviors while discouraging unsafe intercourse. Outercourse behaviors need to be accepted as good and legitimate behaviors that are beneficial for humanity. It is a simple matter of saving lives.
Rather than offering the ABC approach, with condoms as the only choice for sexually active people, the ABCD model emphasizing the benefits of “Doing outercourse” allows for more flexibility and choice for the majority of people who are not celibate or monogamous. At the same time, while it gives more freedom for people to fulfill their erotic desires, doing outercourse does not subject people to the risk of HIV infection and pregnancy that sexual intercourse entails. If outercourse could become the social norm -- especially for youth -- that would go a long way toward reducing the contemporary twin crises of teenage pregnancy and HIV infection. People who engage in non-reproductive outercourse should therefore be seen as doing a patriotic act to help humanity survive and prosper in the future.
Of course I realize these ideas will be controversial to many people, but decisive and responsible leadership can help to change public opinion to the point that outercourse is socially accepted and valued. I am convinced that many people recognize that something drastic must be done to reduce the high HIV transmission rate and teenage pregnancy rate. This outercourse strategy is an approach that can make a dramatic difference. The future of the world, indeed the survival of the next generation, is at stake. You need to act responsibly, and swiftly, before the crises lead to even worse catastrophes in the near future. The youth of the world await your decisive action.
2 Preventing HIV/STD Among Adolescents, Rural Center for AIDS/STD Prevention Fact Sheet. Number 1 - 1994
3 A Situational Analysis of HIV/AIDS in Belize – 1999, National AIDS Task Force, Belize, November 1999. See also HIV/AIDS (Belize), Pan American Health Organization.
4 HIV and Its Transmission, U.S. Centers for Disease Control & Prevention
5 The Spirit and the Flesh: Sexual Diversity in American Indian Culture by Walter L. Williams, Beacon Press, Boston, 1986
6 Many websites detail the problems brought about by teenage pregnancy, including: Planned Parenthood, MedlinePlus, Almanac of Policy Issues, and TeenPregnancy.org.
7 The World Population Explosion by Eddie Rose, Yale-New Haven Teachers Institute, 1998
8 The World at Six Billion, United Nations, October 12, 1999, Figure 1