UNITED STATES – Efforts to make sex safer almost always focus on the bad stuff: what to do to avoid a terrible infection or potentially deadly virus. They rarely acknowledge the good stuff: usually the reason people have sex in the first place.

And that is why safe sex campaigns throughout the world are not as effective as they could be.

Research shows that when safe-sex campaigns acknowledge pleasure – by talking about sex as something that makes life good, or showing how condoms can be erotic – more people use a condom the next time they have sex.

That is what the World Health Organisation (WHO) and a small non-governmental organisation, The Pleasure Project, found when they reviewed the results of safer-sex trials and experiments over the past 15 years. They assessed more than 7,000 interventions for their treatment of pleasure (and lack thereof). The peer-reviewed findings were published in the journal Plos One.

“Sexual health education and services have traditionally promoted safer sex practices by focusing on risk reduction and preventing disease, without acknowledging how safer sex can also promote intimacy, pleasure, consent and well-being,” said Dr Lianne Gonsalves, a co-author of the paper and an epidemiologist who researches sexual health with the WHO. “This review provides a simple message: Programmes which better reflect the reasons people have sex, including for pleasure, see better health outcomes.”

The stakes are high. Sexually transmitted infections are at record levels in the United States and are rising around the world since Covid-19 pandemic closures set back testing and treatment. Globally, 1.5 million people were diagnosed with human immunodeficiency virus (HIV) in 2021, a rate of new infections that has hardly budged in the past five years.

Taking a daily pill known as PrEP, or pre-exposure prophylaxis, offers the promise of preventing some infections, but condoms remain a simple and surefire way to do it.

The Pleasure Project has for years maintained that recognising the role of pleasure would have a major impact on condom use, reducing not only sexually transmitted infections but also unwanted pregnancies. Still, Ms Anne Philpott, a British public health specialist who founded the initiative in 2004, said the strength of the results of the analysis came as a surprise even to her.

“If you had a pill or a vaccine where you could show this kind of effect, everybody would be talking about it, it would have all the headlines,” she said. “Now we have evidence: Ignoring this blind spot, all the way through the Aids pandemic, has led to less condom use, and deaths we could have prevented.”

The pleasure message, she noted, is a comparatively cheap and easy addition for programmes. It is a change in conversation, rather than a new drug or device that needs regulatory approval and infrastructure to be delivered to far-flung places.

Her message is only slowly taking root in the vast sexual and reproductive health community that delivers safer-sex messages and technologies in much of the world.

There is some progress. In September, the International Planned Parenthood Federation, the largest sexual and reproductive health organisation in the world, endorsed what are called the Pleasure Principles, guidelines for centring enjoyment in healthy sex. It was the first move by a global sexual health organisation to embrace the P-word explicitly in delivering its services.

So why, given the millions of dollars spent globally every year to change how people have sex, is the actual point of sex mostly left off the agenda?

Ms Philpott has a theory.

“People who work in sexual health often come from a biomedical background, and they focus on death, danger and disease,” she said. “They’re not encouraged to think of themselves as sexual beings.”

That most sexual and reproductive health programmes are delivered by big aid agencies does not help, she added. “There’s an international development narrative that historically comes from a very sex-negative place or a Christian colonial perspective aimed at saving the ‘poor unfortunates’.”

Ms Sonali Silva, who until recently did advocacy work for The Pleasure Project in Sri Lanka, said that during the years she worked on sexual health-related issues, including abortion rights and HIV, with big international organisations such as the WHO, she kept running into the same phenomenon.

“The big elephant in the room that nobody wants to make eye contact with is why people have sex in the first place,” she said. “We’re all just going to act like it’s only for reproduction. As long as people have been alive, they’ve been having sex for pleasure, but the world of international development is not having that conversation.” NYTIMES