By Pierre Brouard

So Charlie Sheen is in trouble again — this time because he has been forced to disclose his HIV status to be one step ahead of the tabloids, and to cut off the money supply to extortionists who had him over a barrel. The competing narratives around his disclosure have been fascinating:

* The drug-using, sex-worker patronising womaniser gets HIV — a no brainer.
* Brave celebrity outs himself and is freed from the prison of a shamed and fearful silence.
* Heterosexual HIV gets a new cover guy.
* Women sue ex for not disclosing he was HIV positive.
* Treatment is HIV prevention, get informed!

Sheen’s story is not new but it’s a chance to get to grips with some profound questions. Like, what is it about sex that can make us a bit mad? After all, if only humans stopped having sex, HIV would disappear off the face of the planet. Since this is not likely, the next best thing is to try and understand the complexities of our sexuality. This understanding can both deepen our insights into the human condition and enlighten HIV-prevention work, while also embracing the sexual lives of people living with HIV, and the messiness of all of us.

It’s tempting, for the general public and some people working with HIV, to adopt a narrow view of sex, seeing it as easily controllable and needing a moral frame. In this view, if you know about HIV and you still have unprotected sex, well then you might deserve what you get. Like Charlie Sheen, who is now cast as the bad guy, and his partners as the “innocent victims”. Ah, nothing like a good binary to make us rest easy.

A more complex view, informed by social science and the humanities disciplines, would see sex as informed not only by our personal psychology but by the relational meanings sexual actors bring to their encounters.

These meanings are shaped by our personal histories, the families and communities we grew up in, the (gendered) beliefs and values we were marinated in, the laws and rights that governed our sexual activity and whether we were exposed to thoughtful education, health and other services that were sex positive and non-judgemental.

A sex act is not simply about body parts, sexual fluids and easy decision making, it is simultaneously rational and irrational, informed by power dynamics, in the service of complex desires, and sometimes represents a necessary surrendering of autonomy and boundaries.

So whether we are working with an individual in a counselling room, counselling a couple where one is living with HIV and the other not, running a support group for gay men living with HIV, conducting a trial for a vaginal microbicide, capacitating a sex worker around condom use, or developing a safer sex messaging campaign on “sugar daddies“, we need to embrace complexity and curiosity, and assume very little!

What are some of the things we know about the relationship between HIV, sexualities and gender?
It is useful to think about gender (the socially-constructed diversities around maleness and femaleness) as about power — that is patriarchy and male privilege give many men control over women. This power and control often makes women more vulnerable to HIV than men, and many of these are young women. This is not to deny women agency, or to see men as inevitably dominant, but power inequality is real, and often drives gender violence. Power, violence and HIV make good bedfellows.

And anyone who challenges masculine privilege, including gender non-conforming men and women (including lesbian and trans women and gay men), is also vulnerable to sexual violence from some men. But it would be useful to acknowledge that narrow gender scripts are bad for men too — especially men who feel a need to act out forms of heterosexual masculinity that require them to be sexually voracious and experienced, and “strong“ enough to avoid acknowledging vulnerability and any form of health-related help. In a sense, men too are victims, as societal requirements to “man up“ trap them in behaviour that is personally and socially unfulfilling, and often risky for HIV.

HIV has also brought the diversity of human sexual practice and identity to the fore. HIV was in fact first identified when gay men in cities like New York started presenting with rare illnesses, and brought gay sex and sexuality out of the shadows. While this did result in shaming and multiple stigmas aimed at gay men (and other alternative sexualities and practices, including sex work and drug use) empowered and politicised gay communities mobilised and found ways to eroticise safer sex and shrug off messaging that seemed not only to be aimed at preventing HIV, but introducing a narrow moral code of acceptable behaviour. Recent debates about PrEP (the giving of ARVs to HIV-negative persons to prevent HIV) have shown that we easily slip into moralism around sex: opponents say this licences free sex without consequence, proponents suggest pragmatism saves more lives than proscriptions on desire.

When we think about HIV prevention, it is tempting to think of HIV in the context of stable family life and conventional household arrangements. In fact this is not the South Africa of today, a South Africa that has seen much social change, partly due to HIV.

Along with the rise in same-sex marriages and parenting, including cross-race adoptions, interesting questions arise about new and emerging family configurations. I am not advocating a return to a mythical state or an imagined time that was good for all citizens, rather I suggest we embrace these changes and forge new ways to acknowledge diversity and build resilience.

Seeing HIV as a catalyst and consequence of change is both necessary and invigorating. A focus on the diversities around sex, sexuality and gender can create space to think about HIV in new and interesting ways, and HIV has shone a powerful lens on these complex phenomena, informing our understanding and practice, perhaps making us a tiny bit less judgemental. This is surely a good thing.

Pierre Brouard is co-director of the Centre for Sexualities, Aids & Gender at the University of Pretoria and an executive member of PsySSA’s Sexuality and Gender Division. An earlier version of this article first appeared in the Sunday Tribune, Nov 15, 2015.


  • PsySSA, the Psychological Society of South Africa, is the national professional body for psychology. Committed to transforming and developing psychological theory and practice in South Africa, PsySSA strives to serve the needs and interests of a post-apartheid country by advancing psychology as a science, profession and as a means of promoting human well-being. This blog hopes to engage psychologists and citizens in debating issues, from mental health to the socio-political. Visit


Psychological Society of South Africa

PsySSA, the Psychological Society of South Africa, is the national professional body for psychology. Committed to transforming and developing psychological theory and practice in South Africa, PsySSA strives...

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