Mandating Tests for Sex Workers Doesn't Get a Passing Grade

Often when I engage in conversations with folks about sex work and public policy, I'm asked how I feel about mandatory testing of sex workers for sexually transmitted infections (STIs). And, when I answer that I don't support such measures, they're frequently astonished. "I thought you said that you support harm reduction methods! So why not this? Wouldn't requiring sex workers to be regularly tested reduce the spread of HIV and other STIs?"

No. Testing doesn't "prevent" anything. It provides information towards that end, and only if it's done right.

Let's take the argument for mandatory testing to its logical extreme. Sex workers are a relatively small segment of the total number of sexually active people out there, and according to the best studies out there, contribute very little to STIs overall, and virtually none of HIV transmissions. So if we were to mandate STI testing, then it makes sense to do that for all sexually active adults and adolescents, not just sex workers. Of course, it's reasonable to assume that a significant number of people would lie about being sexually active, in order to avoid being tested. The answer then would be to test everyone from the age of thirteen up.

This would, of course, be met with a number of objections, from cost to loss of freedom to invasions of privacy. And yet, some would still argue that, since STIs constitute an "occupational hazard" for sex workers, then mandatory testing therefore qualifies as an occupational health and safety measure.

But again, this doesn't make sense when applied to comparable circumstances. Hospital workers, for example, are exposed to far more diseases, some of them far more dangerous, and far more often. Yet hospitals do not regularly test every employee for every disease they might have been exposed to. Instead, they find it more effective to implement preventative measures, much as full-service sex workers use condoms and other safer sex measures to reduce the risk of contracting HIV or other infections.

There's also the question of how such measures are best mandated and enforced. More often, they are mandated as a condition of employment rather than by legal regulation; even when laws or government regulations are put in place, it is usually left to employers to maintain and enforce, with government agencies making spot checks or responding to employee complaints. Also, the most effective systems are when lawmakers institute a general mandate to assure health and safety, while leaving specifics to another body which may adapt more quickly to changes in evidence as to the best means of assuring this.

An example of which I'm personally aware is cardiopulmonary resuscitation (CPR). I've been trained and recertified many times over the years, and have noticed how the protocols change as new evidence comes in, most significantly the use of an automated external defibrillator (AED). While there are laws determining who may train and certify people, those laws do not specify the protocols for performing CPR; instead, the groups that train and certify pay attention to new scientific data, and update protocols accordingly.

Compare that system to how Nevada mandates STI testing for sex workers in their legal brothels. The Centers for Disease Control and Prevention recommend that people with multiple sexual partners should be screened every three to six months, based on the best available medical studies; more frequent tests do not produce more reliable results. Nevada's legal requirements, relatively unchanged since 1937, are that women working in brothels are required to weekly medical exams, and at their own expense. With consistent condom usage, and STI rates reported at zero, where is the sense in having sex workers required to be tested at thirteen times the rate recommended by public health officials?

There is no good reason to impose such a requirement on sex workers when other people in similar circumstances are not similarly required. To impose such a burden is nothing more than discrimination, rooted in stigma and unnecessarily perpetuating it. Sex workers have long known how to minimize these risks, as proven by empirical studies. They need neither bureaucrats nor moralists to require anything further. If anything, the rest of us would benefit from listening to their collective experience.

Sex, Science, and Fiction

This past weekend, I watched a TV movie from 1994 called "Island City" – a post-apocalyptic science fiction tale where an eternal youth drug had worked for some humans, while mutating many others into immensely strong and violent primal brutes. Many of the former live in a protected city, sending patrols to find other "normal" living among the brutish "recessives" in the "badlands" beyond. To avoid giving birth to more potential recessives, every adult inhabitant of the city has a special colored crystal implanted on their chest, and is only allowed to have sex with someone with the same color.

Forget how simplistic and gimmicky it seems, or that we're now beginning to understand the complexity of human genetics. Such a "solution" ignores the realities of human psychology. Did the writers of this story really think that everyone would just say: "Well, I like you, but I'm a green and you're a blue, so no dice"? Yeah, right.

It reminds me of a similar shortcoming in the Star Trek: Enterprise episode "Cogenitor" – an alien species treats members of its third sex as mere means to the end of procreation, depriving them of choices and education and even personal names. Imagine being the parent of such a child, wondering why they shouldn’t be able to make more of a contribution than simply being "assigned" to one couple after another. And as the series Alien Nation demonstrated in its storyline, it's not impossible to conceptualize a more respected social role for cogenitors.

As Isaac Asimov pointed out, a good science fiction writer must know science, and I would contend that this includes the so-called "soft" social and behavioral sciences. Human beings ultimately questions rules and find ways to work around the diverse barriers put in front of them. That is especially true when it comes to sexuality and intimacy. We may seek to find and create some rational and orderly way of choosing mates and expressing affection, but ultimately such decisions are impelled by passion and desire, even to the point of affecting what we perceive to be "rational and orderly".

There is no better real-life example than the disagreement over the hypothesized invention of "sexbots" for erotic release. Proponents see the potential for custom-made sexual partners, perhaps even doing away with sex trafficking and prostitution. Those opposed to this hitherto nonexistent technology, such as British academic Kathleen Richardson, speculate that the "unequal power relationship" between humans and robots would somehow bleed over into relationships between humans as well. Both extremes are to be congratulated for pushing the envelope of imagination, yet they do so by blithely ignoring the realities of technology, materials science, economics, and sexual psychology. Assuming that sexbots were to become a reality, it follows that they would be incredibly expensive, prohibitively so for most mere mortals. And while things like transportation and cleaning are made more efficient with cars and washing machines, erotic satiation and fulfillment demand a complexity and nuance which no artifice has come close to meeting.

Sex, like much of human and animal nature, is chaotic. That may not sound very scientific, and yet science has its own definition of chaos: sensitivity to initial conditions. Each individual is indeed sensitive to the conditions surrounding us, from birth to death, and no more so than when we interact with those around us. We may develop social and cultural structures to help us navigate, and science may provide data and insight, but in the end the course we take is our own choice to make.

Stone Age Sex, Modern Polyamory

The new book Sex at Dawn: The Prehistoric Origins of Modern Sexuality has been getting a great deal of buzz lately, especially with the co-authors' strong refutation that monogamy is not natural for humans. A number of polyamorists and sex radicals have been posting "told-you-so" commentary on blogs and social network pages -- and I can only imagine what more conservative folks are thinking.

Having studied social and behavioral science, I'm always skeptical of any extreme claims about human nature, whether it's about being "hard-wired" one way or another, or the old-fashioned "blank slate" theory. Neither is entirely accurate, even when talking about something as instinctive as sexuality.

For one thing, humans have enormous variability, even in the most basic elements. Some individuals have powerful libidos, while others have little to none. The question of sexual behavior -- how we channel that desire -- is as much molded by culture and psychology as it is by hormones and neurons.

Sex at Dawn provides great scientific insights, and challenges long-held preconceptions about human sexuality. But it's far from a handbook on sexual ethics. Even if we are "wired" for promiscuity, that doesn't mean we're compelled to get it on with anyone and everyone who turns us on. Our brains are also wired for more complex emotional relationships, and to anticipate long term consequences. And a sound ethical approach is one which finds a balance between primal instinct, social necessity, and individual variation.

Human nature is complex, including human sexuality. Just as we need to be skeptical about the false dichotomy of biological determinism versus tabula rasa, we also need to reject the either-or fallacy of "traditional morality" versus "moral chaos". Hopefully the buzz around this book will open people's eyes to the ethical approach adopted by polyamorists and others -- one based on consent and respect, including respect for the realities of human diversity.

The Impact of Porn ... May Actually Surprise You

For years, anti-porn activists on the Right and Left have been arguing that porn leads to increased levels of sexual violence. Some have even claimed to provide scientific evidence to support this view.

Now, a recent study by Professor Milton Diamond at the University of Hawaii says otherwise. Looking over data collected over many years and across many countries and cultures, Diamond's research finds no evidence showing a correlation between the two -- and that in some cases, rape and other sex crimes have decreased as availability of porn has gone up.

I'm typically skeptical whenever a sex study hits the headlines, and respond by taking a good hard look at the methodology and data. From what I can see, Diamond's work is thorough, and his critique is sound. Some may want to believe that porn is inherently bad for us, but belief and evidence are two different things. And it looks like the evidence just isn't there.

If anything, how we teach our children to think about sex is an even more important factor. Diamond cites research showing that: "rapists were more likely than nonrapists in the prison population to have been punished for looking at pornography while a youngster, while other research has shown that incarcerated nonrapists had seen more pornography, and seen it at an earlier age, than rapists. What does correlate highly with sex offense is a strict, repressive religious upbringing. Richard Green too has reported that both rapists and child molesters use less pornography than a control group of 'normal' males."

Time to put away puritanical legalism, and embrace a spirituality which celebrates our bodies and our erotic capabilities. And if more people do that, then maybe we'll even see a higher quality of erotic media out there. Wouldn't that be something!

The Great G-Spot Debate: Not That Simple

In the minds of many, it is one of the great mysteries of science. Some say it doesn’t exist, others insist it does, and those who do still debate where it may be.

No, it’s not Atlantis. It’s the G-spot.

According to this British article’s headline, the famed Grafenberg spot is not really there. Well, until you read the article itself:

“While 56% of women overall claimed to have a G-spot, they tended to be younger and more sexually active. Identical twins were no more likely to share the characteristic than non-identical twins.”

Wait a minute. If women don’t have G-spots, how is it that over half of them say that they do?

According to the scientists who did this study, it’s all in their heads. They just think they’re getting stimulated in that part of the vagina, but it’s really just a subjective feeling.

And I’m sure “pro-G-spot” folks are saying that the other 44 percent simply never learned how to locate and/or properly stimulate themselves.

The problem with both of these perspectives is that neither takes into account how diverse is the reality of human perception and sensation. Each person’s sense of smell, touch, taste, sight and hearing can fall along a wide spectrum, from highly acute to none at all. Younger people usually have more acute senses than older; and those who use a particular sense more intensively tend to develop a greater ability to discern more subtle differences.

So why can’t the same reasoning be applied to this part of the anatomy? If so, then it should be no surprise that younger women with more sexual experience would be able to find and stimulate their G-spots better than their older and less experienced counterparts. Not to mention that our sensations and responses to stimuli can change over time and according to various circumstances.

The whole problem with this study is that it reduces this wonderfully complex reality to a simplistic yes-or-no question. As a result, the only way to accept either answer is to deny the reality of nearly half of the women in the survey. But it doesn’t have to be that way. We can see all of those experiences along a continuum, and in so doing cultivate a deeper understanding of – and appreciation for – the rich diversity of human sexual experience.