last updated December 25, 2005

There are several methods by which HIV, the virus that leads to AIDS, is transmitted. A person can be infected by HIV by sharing needles in I.V. drug use, by blood transfusions with unsterilized needles or tubes, by an infected mother to her unborn child or breastfeeding an infant. 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

A MORE EFFECTIVE MODEL

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."

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.

MASTURBATION

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. In agricultural societies, it is extremely important for people to reproduce the maximum number of offspring. Having many children is important for two reasons. First, children’s labor is crucial for the survival of the family. Children are put to work in the fields usually before age seven, and they are expected to labor throughout their childhood and adolescence. Farming is hard work, and children are not exempted. In many agricultural societies, wealth is measured in how many children one has. When I was doing ethnographic research among farmers in Java, I repeatedly heard the phrase "children are your wealth." Children are strongly disciplined to mind their parents, because it is a matter of the family’s survival.

Second, parents in agricultural societies want to have lots of children to make sure that at least some of their children survive long enough to take care of the parents in their old age. Until the twentieth century, infant mortality rates among most humans were very high. The majority of infants died before they reached age five. Multiple diseases, many originating from the farm animals that lived in close interaction with farming families, killed off large numbers of young children when they were first exposed to these pathogens. Only the strongest survived to grow up and become adults.

In such a situation, pressure was put upon people to reproduce the maximum number of children. In the first census of the United States, taken in 1790 when over 95% of Americans were subsistence farmers, the average number of living offspring recorded for each American woman was nine children. And the average woman had given birth to many more infants who had not lived. Women were expected to get married soon after puberty, become pregnant, give birth, wean the infant within a year or so, and then to become pregnant again as soon as possible. Death in childbirth was the most common reason for young adult women’s mortality.

With this strong social pressure to reproduce the maximum number of children, a non-reproductive behavior like masturbation was condemned in agricultural cultures. Hindu religion, for example, which arose among agricultural peoples of India, sees a man’s semen as something valuable and limited, a bodily resource that needs to be preserved only for procreation. Because Hindu religion stresses reproduction, and says that anyone who does not have children is cursed, masturbation is seen as a harmful behavior. Likewise, among the ancient Hebrews masturbation was referred to in the Bible as "wasting seed." For an agricultural society like the Hebrews, for a male to ejaculate his sperm outside of a vagina was considered as wasteful as throwing plant seeds into a river. Both practices were wasteful, and condemned. Through the Bible, these agricultural values entered Western religion, and ever since then Christianity (spread through agricultural societies in Europe and the Americas, and more recently into Africa, Asia and the Pacific Islands) has condemned 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. In the 1880s Dr. Sylvester Graham invented a sweetened cracker that he claimed would inhibit the desire to masturbate. The Graham Cracker became a popular treat for parents to purchase for their children, which made Dr. Graham a rich man. Another man, John Kellogg, claimed that the flakes of corn that he invented would inhibit masturbation. Kellogg’s Corn Flakes quickly became the most popular breakfast food in the United States.

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 health.

Orgasms significantly lower stress levels and promote a serene feeling of happiness. Happy people live longer and suffer fewer diseases. While more research is needed to see if there are additional health benefits for female orgasm, at least for adolescent and young adult males regular orgasms are important for lifelong good health. Each male produces millions upon millions of sperm in his testicles. If older sperm remains in the testicle without release, it sours over time and can actually lead to the promotion of cancer-causing cells. If the sperm is regularly flushed out by orgasm, it allows new sperm to grow healthily. Studies have shown that males who ejaculated over two times a week during their teens and twenties suffered significantly less prostate and testicular cancer disease later in life, than males who did not often ejaculate during their teens and twenties. Similarly, other studies have shown that heart disease rates are lower among older men who ejaculated regularly in their youth.

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.

MUTUAL MASTURBATION

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.

KISSING, HUGGING, PETTING, AND BODY RUBBING

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.

EROTIC MASSAGE

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.

LEGGING

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. As the activity was described to me, some lubricant or saliva is usually rubbed on the inside surface of the thighs of the person getting legged. The male inserts his penis between the thighs and thrusts until he has an orgasm. In the case of a male-male couple, they can exchange positions. In the case of a male-female couple, before he ejaculates the male can masturbate the female until she climaxes. Females can experience multiple orgasms as the male thrusts against her body. As long as no sperm gets into the vagina or anus, this outercourse behavior is totally safe in regards to pregnancy and HIV transmission.

Legging was a standard practice for lovers in ancient Greece. It was common for a man to court a boy, and if the boy accepted the overtures of the man they would establish a mentor relationship. Many of these courting relationships became sexual, and the typical practice was for the man to insert his penis between the legs of the boy. Penetrating the boy anally was condemned in ancient Greece, but outercourse was considered acceptable behavior. These loving intergenerational male relationships were highly honored in ancient Greece, and were the basis for the way boys were educated. The man was responsible for seeing that the boy grew up to be a well-educated and respectable man. Famous Greek men like Socrates and Alexander the Great were known for their devotion to their boyfriends. Most Greek men would also marry a woman, so that the norm in ancient Greek society was bisexuality. See William Percy, Pederasty and Pedagogy in Archaic Greece (Urbana: University of Illinois Press, 1996) and Louis Crompton, Homosexuality and Civilization (Cambridge: Harvard University Press, 1998) ]

Legging is still common in Indonesia today, with a special twist to make it more pleasurable. When I was doing my research in Indonesia in 1987-88, I found that legging was a common practice. The secret to making the practice as pleasurable as possible, my Indonesian informants told me, was for the bottom person to cross their legs at the ankle. By crossing the legs at the ankle, the thighs can be squeezed more tightly together than if the legs are side by side. Because many Indonesians considered anal intercourse to be a disgusting and unsanitary practice, and because there was a strong social disapproval if a woman got pregnant outside of marriage, for unmarried couples intercourse was avoided. Instead, legging was the preferred practice. Legging was also the standard among gay men, and as a result HIV infection was extremely low. About the only gay men who were getting infected were those who were attracted to foreigners, and unfortunately they might be infected by HIV if they were persuaded by the foreigner to engage in anal intercourse.

In the age of AIDS, it is valuable to promote legging and other related outercourse behaviors. Besides legging, some males enjoy doing the same kind of penile insertion below the armpit of their partner, who squeezes their arm tightly to their side as the penis thrusts back and forth. Some males enjoy inserting their penis between a woman’s breasts, and thrusting while she squeezes her breasts together. Wherever the body can be squeezed, there is a potential location for outercourse. Many commercial sex workers, who are quite justifiably worried about HIV infection, prefer to do these kinds of outercourse behaviors with their clients rather than intercourse. They feel a great sense of relief if they can lead a man to orgasm without having to be penetrated.

SEX TOYS

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. Before inserting anything into the vagina or anus, it should be thoroughly washed in hot soapy water. As long as the hand is clean, the fingernails are clipped closely and smoothly, and there is no cut or bleeding sore on the hand, gently inserting a finger into the vagina or anus is not conducive to HIV transmission. With physical objects, as long as the object is smooth and well lubricated, and is inserted gently, it can be quite pleasurable. Obviously no object made of glass or any other breakable material, or with any jagged edges, should be utilized. A wide variety of sex toys are manufactured and sold specifically for erotic uses, but simple vegetables like carrots or cucumbers (which should be washed before use, in hot soapy water) can also be safely used as sex toys. Common sense should be used in regards to any choice of object, and nothing should be inserted so deeply into the orifice that it cannot be easily pulled out. For those persons who strongly desire the sensation of penetration, but who do not want to take the chance of disease transmission that comes with intercourse, a sex toy is a viable alternative. Each person should use their sex toy exclusively, and should not insert it into another person’s body. If a sex toy is shared, however, before being used it should be washed again with hot soapy water and covered with a new condom for each person.

BONDAGE AND DISCIPLINE

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. In particular, individuals in powerful professions who have control over many employees or other people in their job, often seem to get sexual arousal by being treated as a subordinate or even as a submissive prisoner. They eroticize a different role that is opposite to what they usually do in their regular daily life. They may masturbate while being bound or disciplined by a person who does a role play as a dominatrix or dominator. Typically, such consensual sex play is nothing more than acting, and the submissive person should retain the option of stopping the action if it gets too painful. Some people enjoy taking the role of sadist, while others prefer to play the masochist role. Just as long as there is no cutting or bloodletting involved, such erotic practices are not conducive of HIV transmission. People may experiment, for example by having their nipples pinched with a clothespin, and unexpectedly find that something they might have considered painful to be exciting instead. The only boundaries are what the persons involved consent to do, and what they can do without endangering their health or their partner’s health.

FELLATIO AND CUNNILINGUS

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

OUTERCOURSE AS A METHOD OF POPULATION CONTROL

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

Long-term world population growth, 1750 to 2050 ⁸

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

1. Forests are being cut down to supply timber for housing, heating, and other human needs,

2. More forests are being burned to convert into farmlands to provide crops for the increased numbers of people, and

3. Still more forests are destroyed to make pastures to raise cows for all these additional people to consume.

4. The rivers and seas are polluted with the waste of all these increased numbers of humans and their domesticated animals.

5. Fish populations are plummeting around the globe as the seas are overfished to feed the increased number of humans.

6. Many species of wild animals and plants have already become extinct, or are threatened with extinction in the near future, because of this explosion of numbers of homo sapiens. No species can have such an extreme population explosion without eventually producing catastrophic results.

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.

WHAT ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

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.

WHAT MUST BE DONE?

In order to make outercourse popular, a few things will need to be done.

First, the law will need to be modified. Because of the dangers of intercourse, legal inhibitions on sex, such as anti-prostitution laws and age of sexual consent laws (also called "statutory rape" and "corruption of a minor") should continue to criminalize vaginal and anal intercourse. However, lawmakers and law enforcement officials should put outercourse in a radically different legal category. For all other erotic behaviors besides intercourse, government officials need to seriously reconsider, reevaluate, and reprioritize what behaviors they decide to prosecute.

Specifically, the ABCD model suggests that outercourse behaviors should not be prosecuted under the legal definition of "sex," A sex worker should be charged with prostitution only if sexual intercourse occurs, and anyone who engages in outercourse behaviors for payment should be considered no different than, say, a professional masseur. Whether that professional massages the back or the legs or the genitals should make no difference as far as the law is concerned, just as long as "sex" (ie: penile penetration of the vagina or anus) is avoided. Likewise, young people should no longer be involved in prosecution under age of consent laws, if they engage willingly in outercourse behaviors with another person. Of course, laws should continue to protect both youths and adults from rape, unwanted sexual assault, or sexual harassment. No one, of any age, should be forced to engage in any kind of erotic behavior against their will. Rapists should be prosecuted for assault, to the fullest extent of the law. In most countries, people can be protected by enforcing existing rape and sexual assault laws.

Religious groups and the mass media can continue to condemn sex outside of marriage, if they wish, but they should be careful to keep their focus on sexual intercourse alone. They should continue to stress both the danger of pregnancy to young women and the danger of HIV infection to everyone, when a person engages in sexual intercourse outside of marriage. If a national HIV prevention public education campaign is going to be successful, religious groups and the media need to participate. This may involve a lot of soul searching for religious leaders who presently equally condemn all kinds of erotic behaviors. For the good of their congregations and for humanity as a whole they will need to stop condemning outercourse in order for it to become a valued and socially acceptable behavior for youth as well as adults. To create a new social norm that sees outercourse as a social good, media leaders and religious groups will need to understand that this public health education campaign is in the public interest. To continue as in the past will invite catastrophe, as the one-two punches of HIV infection and teen pregnancy combine to push many impoverished nations further and further behind.

There needs to be a widespread public education campaign to encourage people, especially young people BEFORE they become sexually active, to consider safer alternatives to intercourse. Since young people are having sex at younger ages, on average in the early teens, this means publicizing outercourse in society in general and educating young people about outercourse by the time they reach ages ten or eleven. The goal is to provide youth with another alternative so that they will more likely avoid or delay engaging in dangerous sexual intercourse.

It is particularly important to persuade youth that, if they are going to become sexually active, they should do outercourse before they experience intercourse. Studies have shown that the first pleasurable sexual act that a person engages in, is the behavior that they tend to prefer for the rest of their life. This favoritism of erotic inclinations does not happen when a person experiences unwanted sex or rape; it must be a pleasurable experience to lead to deeply subconscious psychological favoritism.

If young people engage in outercourse as their first erotic activity, this would help to popularize these safer behaviors in society for the future. Sexual intercourse would no longer be the ONLY behavior that people assume they must do when they want to experience erotic pleasure.

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.

CONCLUSION

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.

Footnotes

² Preventing HIV/STD Among Adolescents, Rural Center for AIDS/STD Prevention Fact Sheet. Number 1 - 1994 (www.indiana.edu/~aids/fact/fact1.html)

³ A Situational Analysis of HIV/AIDS in Belize – 1999, National AIDS Task Force, Belize, November 1999 (www.belizenac.bz/toppage2.htm). See also HIV/AIDS (Belize), Pan American Health Organization (www.blz.paho.org/aids.htm).

⁴ HIV and Its Transmission, U.S. Centers for Disease Control & Prevention (www.cdc.gov/hiv/pubs/facts/transmission.htm)

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 (www.plannedparenthood.org/pp2/portal/files/portal/medicalinfo/teensexualhealth/fact-teen-pregnancy.xml), MedlinePlus (www.nlm.nih.gov/medlineplus/teenagepregnancy.html), Almanac of Policy Issues (www.policyalmanac.org/health/archive/hhs_teenage_pregnancy.shtml), and TeenPregnancy.org.

⁷ The World Population Explosion by Eddie Rose, Yale-New Haven Teachers Institute, 1998 (www.yale.edu/ynhti/curriculum/units/1998/7/98.07.06.x.html)

⁸ The World at Six Billion, United Nations, October 12, 1999, Figure 1 (www.un.org/esa/population/publications/sixbillion/sixbillion.htm)