Under the Covers: Unpacking Sex Ed

Talking Sex with Noe and Clay

There are the three questions we chose for our first Sex Talk on InstaLive or somewhere. We are both health educators, who primarily teach about sexuality.  Each question is frame as academic or accessible; so that nuances and particularities can be discussed alongside universal commons. The goal is to bridge the gap between what people are thinking and discussing among themselves and their peers, and what has been built by scholarship. 

☭ All we want is a cutsie revolution ☭

HIV & Stigma 

How can we teach about HIV in a way that breaks down stigma, instead of making it seem more shameful or different than other STIs?

Answer: 

For me, the distinction itself distracts from the primary points I want people to take away from lesson on HIV. Currently, I talk about HIV in the context of other STIs, because that is the lesson. I typically break them down into 3 categories: vaccine preventable, cureable, and treatable- which is Hepatitis and HPV; HCV, gonorrhea, chlamydia, and syphilis and trich; and lastly, HIV and HSV, respectively.

Mostly, I see them categorized by cause; and this is not helpful for anyone learning about STIs other than academics. If I am teaching STI prevention to a group of 7th graders, to freshman in college, to folks with disabilities, or in the jails- what is helpful about knowing whether syphilis is a virus or a bacteria? literally nothing. I focus on what I know is going to stick in their minds and be helpful in navigating the futures of their sexuality. 

So, when I'm teaching about HIV, I describe it first as incurable but treatable, serious by won't kill you if you take medicine, and is transmitted through 5 fluids. It's always the last thing I cover in the lesson, because it requires a more nuanced approach. The topicality of HIV engendered with stigma, misinformation, and fear, and imbricated in moral political rhetoric that characterized the epidemic from the beginning. That's why I model my lesson the way I do. It's like in geometry when you teach about parallelograms. Everything with four sides is a parallelogram, but each of them have different names and characteristic. Then you get the the square, which is a rectangle; and the rectangle that can never be a square. You don't remove the square from the lesson, and make separate it rom the other parallelograms, you just teach the facts on.

Blood, Semen, pre-cum, breastmilk, and vaginal/anal mucous/fluid. When the 5 fluids are reinforced, then people can figure out the behaviors. I normally follow up with a question asking which behaviors can lead put you in contact with these fluids? 

Activity/Areas:

Sex: then I ask, what kind of sex? Anal, oral, vaginal- that's when I talk about the low risk of contracting HIV through oral sex. 
Foreplay: precum that gets inside the anus or vagina.
Medical settings- a stick by a needle
Syringe-sharing with - someone who has HIV
Breastfeeding- reduced risk 
Giving Birth- with medication, babies can be born without HIV even if the mother has it.

To prevent contact with these fluids, image what precautions you would take. The goal is for them to cover the ABC+ model for sex, new syringes for drugs, monogamy + routine testing, and following ID prevention protocol for occupational risks+PEP. This is all you really need to know about HIV and prevention. Everything else is a function of stigma, and that requires an entirely different pedagogy. 

Stigma is enculturated 

Stigma is part of the culture. Culture is a system of symbols used by individuals to conceptualize the world around a collective of individuals as the source of meanings and practices a part of the larger social unit. When we talk about addressing stigma, we are talking about changing culture; which, in this context, operates as a function of communication, seperate from, but including, language. So, we're really talking about changing language. To change the language coalescing around the topicality of HIV, we have to shift the epistemic domain in which stigma is textualized. It means more than just correcting someone when they say something incorrect (and stigmatizing) about HIV, or express an moralistic judgement rooted in the principles that perpetuate stigma. We have to address the blueprint used to build these knowledge structures to start, and reengineer them to align with truth and justice. 

What does this look like in practice?

Basically, it's me asking a lot of questions to prompt critical thinking and doing so in a way that is confrontational. If someone has something to share then they should be able to defend it; and if they can't the lesson is that we should question the source of our information. It all begins with teaching the elementary forms of epistemology. Get the learner to question: how do I know what I know?

Once I get folks to think about where knowledge comes from, then I can shed light of the history of the pandemic and how stigma was articulated in different contexts around the world. By highlighting when and how HIV stigma became an anthropological phenomenon, we can better point to the various functions stigma has in reducing the human capacity of people living with HIV. And, once we can deduce the effects of stigma on the person, it comes full circle back to morality: whether you believe people with HIV deserve to be treated differently? 

Ultimately, the lesson is more about changing the operating system that produces stigma more so than identifying stigma as an object. 

Pharmaceutical Futures

As medicines like PrEP and puberty blockers change how we experience sex and gender, do they give us more freedom—or create new limits we need to watch out for?

Answer:

My experience: I began thinking about this about 6 months into my HIV diagnosis. It was hard to remember to take a pill everyday at the same time, with food. I literally had to wear a sport watch with an alarm set to remind me of when I needed to take my medicine. Forever an anthropologists, I was familiar with the term "medicalization," so that's how I described it then. I felt like I was forced into a relationship without my consent, that I didn't want to be in; and I expressed this to others who had HIV and those who were curious for more knowledge about it, or about me living with it. 

Nonetheless, I was using the term incorrectly. What I meant to say was that I was experiencing pill fatigue and the elementary forms of governmentality. Whereas, medicalization refers to the process by which human conditions, behaviors, and social problems are defined and treated as medical issues, (often in ways that extend biomedical authority into more and more domains of life; Pill fatigue refers to the weariness, frustration, or burnout people experience from having to take medications consistently over long periods of time, (like for HIV or diabetes). 

Governmentality, however, refers to how power is exercised through the subtle shaping of how people think, act, and regulate themselves (including, but not limited to rules, rubrics, and regulations.) It speaks to how the system is structured in such a way that we govern ourselves, notwithstanding the law and policies of the state.  For me, it was discipling my body because I had to, not because I wanted to- a struggle that I still struggle with today.

Daily pill-taking is itself difficult because of the temporal and spatial dimensions involved; having to remember exactly what time to take it and around whom you are safe to do so. Then, there are cultural elements involved; it is framed as a moral responsibility, that likens "being a good patient” to adhering to medication regimes without fail. This frames  adherence as not just medical, but ethical: missing pills can be narrated as irresponsible, careless, or even dangerous to public health (via resistance). Officially retired in most clinical spaces, the term used to describe missing doses was "noncompliant." 

So, you see how the diagnosis is more than just a health condition but a identity transformation based on the embodiment of new practices, rituals and subjective experiences.  We internalize the discipline of living-with-hiv, monitoring ourselves and sometimes even policing others. The longer I've lived with HIV the more I am annoyed by the biopolitical management and pharmaceutical dependency involved. My survival is tied to access to drugs produced and priced by a multinational drug company called Gilead. The paradoxical idea that I should be empowered through treatment, and simultaneously tethered to global supply chains, patent politics, and corporate profit motives is burdensome. If I want to live, I must enlist myself in the system. The promise of health, in this way, becomes inseparable from participation in pharmaceutical capitalism.  

High Risk HIV Negatives 

What a term that is. Like noncompliant, it has been retired and replaced by "prioritized," which is used to describe the populations that are identified by health authorities as needing prevention, intervention, and funding development. The original term and the current term mean the same thing, semantically, which is why I still use them interchangeably (mostly because that how I learned, but also it's a cute little jab at the folks who wallow in showcasing their progressiveness). 

"High risk negatives," or health people, are taxonomized by biomedical authorities according to a hierarchy of behavioral, demographic, and geospatial "risk." Risk is public health is not a abstract term, it is an epidemiologic calculation. It refers to the probability that an individual will develop a disease, HIV in this case, within a specified period of time. So when a population is located within this hierarchy and categorized as high risk; they are then prioritized (or targeted) by public health authorities for prevention interventions- including, education, increased testing, peer support and increased access to services and  resources. This is the original model but that model is standing on its head with the 2012 approval of PrEP. Unlike any program before it, the roll out of PrEP for HIV prevention was groundbreaking. It was truly a "disruptive intervention," as was former CDC Director Robert Redfield said. Tom Freiland was Director when PrEP was approved by the FDA, and together with Dr. Fauci, the once daily pill to prevent HIV was made available to the public. 

This is known as a biomedical intervention or the use of medical practice, in this case pharmacotherapy, to address a health problem. However, think about that sentence. What health problem do people without HIV have? The reuse of HIV-drugs for prevention purposes was a paradigm shift in public health. 

As Truvada, the only available drug at the time (which, was patented such that you could not make a generic version for distribution without Gilead's explicit permission, leaving Africa, Asia, and S. America to fight the epidemic without PrEP,) and concepts like U=U (established in 2018) moved across continents and into local formularies, traditional methods of HIV prevention were wholly destabilized. For 40 years, under CDC and WHO guidance, prevention was primarily focused on the ABCs: abstinence, behavior-change, and condom-use. The biomedical shift changed the narrative and the funding sources with it, leaving long standing prevention infrasture without anyway to continue the work.  

ARV drugs can reduce infectiousness in PLHIV by about %96, it's called treatment as prevention and is the foundational concept of U=U. These same drugs can be used to reduce the risk of being infected with HIV in the context of fluid (pre-cum, cum, vaginal/anal) exchange during sex. This is the scientific basis for PrEP's rise to paradigmatic dominance. 

So, the benefits are clear from an interventional efficacy standpoint; but it's effectiveness in reducing incidence of infection depends on adherence and routine follow-ups with infectious disease clinicians. Thus, the high-risk negative, or healthy people, are enrolled in the same biomedical routine as PLHIV. 

For HIV-negative people taking PrEP, the key move is that risk itself, not disease, is problematized and treated as such; which is the definition of medicalization. Healthy people enrolled into a biomedical regime. Sex, intimacy, and desire are framed through the lens of HIV risk, turning prevention into a pharmaceutical responsibility. This creates a "pharmaceuticalization of prevention," where drugs are used to manage potentiality. 

PrEP becomes embodied in the subjectivity of HIV-negative individuals as they become responsible risk-managers of their own sexual health; a paradigm shift in itself, considering previous prevention paths focus on keeping sick people from causing harm. Adherence disciplines bodies and behaviors; while routine clinical visits, lab monitoring, and counseling becomes internalized as forms of surveillance and regulation that extend beyond themselves, informing how they evaluate partners, sexual practices, and identities. 

On a population level, PrEP operates as a biopolitical strategy to reduce HIV, targeting communities and groups for prevention regimes. The "risk group" becomes a pharmaceutical population governed by epidemiological data and clinical protocols. At the same time, inequalities surface: access is stratified by race, class, geography, and insurance. The biopolitical approach never simply promotes life equally- it always privileges certain groups while leaving others vulnerable.  

Conclusion: PrEP users occupy a paradoxical space: they are both “healthy” and “at risk,” both protected individuals and biopolitical subjects, governed not just through prohibition but through pharmaceutical freedom. While, PLHIV have to learn to self-regulate around medication schedules, food requirements, clinic appointments, and side effects (and this is only in the specific context of HIV-drugs); and over time, this becomes naturalized. Life itself is reorganized around pharmaceuticals, making medicine not just a cure but a way of governing existence. One interrelated issue outside of the Gilead pharmaceuticals connection is the shared subjectivity of self-regulation. The alternative of which is a community-based system that centers the collectives power over itself for preventive measures  

Toward a Sexual Revolution

What would a radical kind of sex education look like—one that doesn't just include more people, but actually challenges the idea of what's “normal”? Who should it center?

Answer:

When we say the "center"  or inclusion, we miss the mark; because these terms have already conceded to the logic of the circle, of the circumference that expands only to preserve its center. The "normal" persists, protected by our benevolent extension of the same toward its other. To dismantle the cage of "normal" is not to draw a larger cage, no matter how inclusive and humane it is, but to let the bars dissolve into the undecidable spacing of difference and contextuality. And I know that seems abstract, but if we do not actually change the domains in which our minds operate, we will never move beyond the representational strategies used to placate revolutionary thought. 

Sex education is a site of power "sui generis." To achieve a truly "revolutionary sexuality education," would not be an education about sexuality but an exposure to its unteachability: to the expanse of desire, to pleasure as excess, to the always already contamination of every identity by its other. It would resist the curriculum's impulse to stabilize, to normalize, and even to name. It would not speak of "the body" but of bodies in multiplicity, textual and intertextual, never reducible to anatomy, biology, or law.

The question "who must it serve first?" I wholeheartedly reject the affirmative action logic here. There is no one group that should be popularized and propelled above another. The question isn't suggesting equity, it's asking for preference (and I though we all agreed that having preferencing on your profile was a no no- I remember the "no fats, no fems, no Asians" movement"). The very notion of a "first" summons hierarchy, sequence, order- it's literally the very architecture of normality. 

Once again, no matter how hard we try to build a better world for ourselves and others within the confines of this one, the outcome will always be the same: we will reproduce the very structures we sought out against. Only by deconstructing the domains we see as natural or prediscursive can we truly approach and revolutionary sexuality education that doesn't require demonstrable inclusions because it is inherent. 

But, we cannot begin there at first. For now, we should attend to those whose existence has been render unintelligible within the pedagogical (or curriculum research and development) space: queer, youth, trans bodies, the disable, sex workers, the racialized, the seropositive, the veiled Muslim, the African matriarch, even AI. Not because they are "first" but because they are already inscribed as being outside, the constitutive exclusion without the "inside" would never appear. 

The task is not inclusion, not expansion of the circle, but the deconstruction of the very border that says inside/outside, normal/deviant, teacher/learner. These dichotomies are the source of the disparity and inequities in sexuality education and sex, itself, as a site of control. 

What is the task then? It is to defer the answer, producing not knowledge but unlearning, an openness to the decidability of desire- an education in the impossibility of sex education. We have come full circle to my original point. We have to rethink sex entirely. - A great and truly foundational book in sexuality studies from the 1950s entitled "thinking sex" by Gayle Rubin articulates a true paradigm shift. Well, I propose we begin "rethinking sex" and turn our understanding of sex, the body, and desire on its head. 

A curriculum built upon radical, non-normative practices, would explore that which is typically marginalized or pathologized, like bareback sex, BDSM, and public sex. These "radical sexualities" that resist convention public health and normative moral political frameworks are sites of revolution sui generis. Sex ed would therefore center these practices, not to normalize them, but to de-center "normal" as a framework itself, presenting them as sites of desire, resistance, and assemblage. The bringing together of heterogeneity.

Revolutionary sexuality education requires a curriculum that holds together queer theory, Marxism analysis, feminist perspectives, and post-structuralist ideations with empirical investigations. It must piece together the dichotomies in a way that makes use of their tensions, and understand relationality and how each constituent element exists only as its opposite. It must accept contingency as a core value, acknowledging that coherence isn't apart of the design; as is always already suspending in a process of becoming. Ultimately, and most importantly, it must realize its own agency in shaping the subjectivities, practices, and possibilities of others without centralized control. 

BDSM

We can borrow from the world of BDSM to develop concepts like "deterritorialize bodies and pleasures," moving beyond anatomical definitions towards assemblages of power, desire, and ethics.Education would then shift from emphasizing reproductive or “healthy” sex to facilitating spaces where bodies, desires, fluids, and performances are read as assemblages. 

A revolutionary curriculum must have people analyze how normative discourses frame and exclude sexual practices, cultivating critical literacy rather than prescriptive morality. An example is the rhetoric around bareback sex. They should question how forbidden desires is socially constructed and policed. 

What is "deterritorializing" the body?

A “territory” is a set of rules, boundaries, and functions that make something recognizable and stable. In sexuality, this is the cage of “normal”: heterosexual coupling, monogamy, reproduction, safety as conformity, even certain “gay respectability” politics. To deterritorialize is to undo these fixed coordinates, to open bodies and desires to new assemblages: BDSM scenes where pain is pleasure, bareback sex where risk is erotic, public sex where intimacy is collective. It's not simply “transgressions” but creative, generative ways of producing desire and reconfiguring power.

Beyond anatomy & reproduction: Bodies are not just organs and functions; they are surfaces, flows, intensities. Education would invite people to explore desire as relational and experimental, not as fixed roles or reproductive ends. 

Against “risk-only” frames: Instead of making danger the only lens for bareback or BDSM, education would teach how risk, trust, and vulnerability are part of erotic ethics—how communities already create their own harm-reduction strategies.

Multiplicity over identity: Rather than teaching “what gay sex is” or “what straight sex is,” deterritorialized sex ed would teach that sexuality is always becoming, always multiple. Labels are tools, not cages.

Learning from radical practices: Instead of presenting BDSM, barebacking, and public sex as fringe, the curriculum would start there—because these practices expose the instability of “normal” most clearly.

Now what?

HIV stigma , a significant driver in new HIV infections, HIV-drugs becoming the standard for prevention through government-corporate/ public-private partnership, and a call for revolutionary sexuality health education that centers the infinite expansive sexual subjectivities and desires experienced by human and nonhuman actors are not disparate topics, or simple relational pairings under the umbrella of sex; they are linked by a single question: What sort of social theory (political economy, or culture, it's all theory) would actually be of interests to those who are trying to help bring about a world in which people are free to govern their own affairs?

There are other ways of doing this, all of it. "The ultimate, hidden truth of the world is that it is something we make, and could just as easily make differently."  We have agency, we can exercise our will in the world to create change. The existing social, political, and economic structures are not inevitable but instead the result of choices and actions made by humans in various contexts and throughout history. It is through our agency that we have built an unwanting-accumulation machine that defines our cultural matrix, at the present time. We have to say it, name it, not just critique everything and then cover it in sugar to make this shit taste better. Alternative societies and ways of living are possible and achievable. We just have to resolve to promote a better vision of the future; and at the same time, encourage and center creativity as a vital tool for imagining and actualizing a more just and equitable world. 

I'll end on this, public intellectuals have a responsibility to question the status quo and to recognize the underlying assumptions and processes that shape the world they inhabit.