Talking About Sex Is the Only Way to Stop HIV

This week the world's experts on HIV/AIDS will gather in Seattle for their annual meeting and to gloat, a little, over their remarkable accomplishments. Globally, the rate of new annual infections dropped from 3.4 million in 1997 to 2.7 million in 2010.

For the United States, however, there is much less to celebrate. We have been stuck at about 50,000 new infections each year for more than a decade. Compared with the challenges facing places like sub-Saharan Africa, our failure is particularly galling: we have plenty of drugs that work, the money and systems to administer them, and effective, if not particularly popular, ways to interrupt the spread (condoms, clean needles, abstinence).

So why aren't we doing better? The answer is blindingly simple: sex. Almost all HIV in the U.S. is spread by sexual intercourse, yet when faced with this fact, we act like a bumbling junior-high-school kid hearing about the birds and the bees for the first time. As a result, we have before us an unabated 30-year epidemic of a sexually transmitted disease.

Not that sex doesn't get discussed in the U.S. Smirking sexual jokes by Jay Leno and the gang? No problem. Blush-worthy innuendo when selling cars, razors, or chewing gum? You bet. But actual sex? The most prominent person in the public eye who is still allowed to talk about sex as sex is Dr. Ruth Westheimer, whose jolly demeanor somehow gives her a pass.

Coincidentally, the meeting will open just as the Washington state Republican primary ends, concluding the latest installment of the traveling show that has focused intensely on sex—mostly in the form of debate over same-sex marriage and birth control. Many Republicans seem to develop a case of the vapors at the idea of anything other than procreative sex, underlining just how unprepared we are as a country to discuss that dangerous yet familiar territory of penis, vagina, mouth, and anus.

To be sure, plenty of people on the left are equally complicit in creating this fiasco. They have long held that any advice from the government about bedroom behavior, including messages about safer sex, is a Big Brother–ish overreach, an invasion of constitutionally protected privacy. It's worse than the nanny state—it's the prude state! For them, preserving the right to go about their sexual business is more important than anything, even their own health.

The facts, though, are straightforward: people always will have sex, and lots of it (sorry, Republican candidates). Most people don't have a clue about their new sexual partner's HIV status, making unprotected sex risky (sorry, left, but sex, like an election, has consequences). This year 1,000 people a week will acquire HIV infection in the U.S., and some will eventually die from it. A combination of safer sex, fewer partners, and frequent testing is the only sane way to proceed.