Negotiated Safety When couples go without condoms

Many are familiar with that moment when heavy petting turns to sex — and it's time to reach for the condom.

Some don't pause for latex; others would never consider going bare. Though health experts are unwilling to recommend giving up condoms, some acknowledge there is another option.

It's called "negotiated safety" — the structured process of ceasing condom use. But it is something that does not come easily, and requires monogamy, honesty and commitment to what can be at least a year-long process.

"Negotiated safety seems to be appropriate for couples in a long-term relationship," said Judith Greenburg, a health scientist with the Centers for Disease Control and Prevention.

"If neither of us has anything, then why not?" said Patricia, a graphic designer in San Francisco. "What we're talking about is trust, and if I didn't trust my boyfriend I wouldn't be with him."

But prevention professionals say that although condoms may seem to imply mistrust, couples must have explicit conversations about monogamy, past exposure to sexually transmitted diseases and risky sexual behavior to be sure they're not making assumptions. The risks are sobering: pregnancy, disease, even death.

Step by Step

If a couple feels the time has come to take the plunge into barrier-free sex, there's a three-step process, according to advocates:

- Step one involves an ongoing discussion about giving up protection. "If people are going to stop, it's very important to have an open, honest conversation about what the expectations are in the relationship," says Leslie Kantor, vice president of education at Planned Parenthood.

- Step two is the testing phase. The couple gets screened for HIV and other sexually transmitted diseases; if the tests come back negative, they agree to retest in another 3-6 months.

- Step three, if all of the tests are still negative, is the time for ground rules. Monogamy is the cornerstone of negotiated safety. But both partners must agree to come clean immediately if they ever stray. Since a partner is less likely to admit a sexual indiscretion if it's going to end the relationship, there is an implicit understanding an admission of cheating does not signal the end. But it does signal the end of barrier-free sex and the start of negotiating safety all over again.

It may seem like a drawn-out process — but STD prevention professionals say if you can't be completely honest and committed

to your partner, then you definitely shouldn't stop using condoms. "Testing doesn't tell you anything about what is going to happen tomorrow night," warns Kantor.

'Negotiated Danger'?

From the moment it was set down in writing by the Australian Federation of AIDS Organizations in 1997, negotiated safety drew fierce criticism from some HIV/AIDS specialists and other STD experts. The idea was denounced as "negotiated danger" in the journal AIDS by researcher Maria Ekstrand of the Center for AIDS Prevention Studies at the University of California-San Francisco.

Health education campaigns tend to be effective only if their message can be drilled into the public consciousness, said Ekstrand, who believes the process is unreliable and difficult to explain to a large audience. "If you have a 10-point program on a poster, that is ineffective," she said. "The bus is gone before people have a chance to finish reading."

The program was initially designed for gay men, but has gained a following with heterosexual couples. And that could be a problem. "Straight men are awful in terms of condom use," Ekstrand argued. "Studies show less than 20 percent use condoms. Sex with women is their risk reduction," she said, since many erroneously consider HIV to be no threat to heterosexuals.

"There's a lot of deceit and a lot of high-risk couples have very fleeting relationships," said the CDC's Greenburg, which is why the agency concentrates on trying to get people to use protection in the first place.

Room for Trust

Still, many sexual health experts — though far from recommending people stop using condoms — believe there is a place for negotiated safety, with many caveats. "Trust takes years and respect takes a long time," said Mark Gossin, a physician's assistant at Always Your Choice, a New York City medical office that does STD and AIDS screening and counseling. "I encourage people to really get to know each other."

"Couples must be willing to ask hard questions. Does either person have problems with sexual addiction or honesty or monogamy? They must spell out the costs, because this could mean death," Gossin added. "I think it's something people need to learn; to negotiate safety. But going through the process is definitely a plus in helping to solidify a relationship."

Robert, who works in online marketing and went through the negotiated safety process six months into a two-year relationship, agrees. "We actually got tested together and got the results in person, together," he said. "That experience of actually walking the stairs and sitting in the office together was so sobering."

The rewards of negotiated safety, say proponents, are a greater emotional and physical connection between couples. It may be a good option as long as you're willing to honestly weigh the risks. The process asks couples to consider their trust against the consequences of that trust being broken.

Robert summarizes the issue this way: "If you're not afraid to be honest, you don't have to be afraid."