Content area
Full text
There is not one single solution to stop this epidemic. If [there] were, we would have ...found it a long time ago.- Peter Piot, former executive director of UNAIDS1
"It saved me." This emphatic, unrestrained declaration was the response of our young black South African driver to my query about masturbation, as we passed the time discussing HIV en route to Soweto on an AIDS-related field trip. Although he had a steady girlfriend, he earnestly believed that the sexual outlet provided through masturbation enabled him to avoid seeking multiple partners, which would have exposed him to HIV infection.
He is far from alone. Masturbation is very common. In a recent representative survey of the British population, 73% of men and 37% of women said they had masturbated in the past four weeks.2 And while we tend to connect masturbation with adolescence, among Americans aged 57-64, 63% of men and 32% of women reported masturbating in the 12 months before they were interviewed.3 Evidence from developing countries is scant. However, a representative survey from urban China found that masturbation was common, albeit at lower levels than these.4 In a small study in Zimbabwe, male and female student nurses and midwives commonly reported having ever masturbated,5 and the practice was also found to be fairly common among unmarried adolescents in Tanzania.6 That masturbation is widely practiced is not surprising. Though not the most fulfilling means of sexual expression, it has the distinct advantages of being pleasurable, accessible, expeditious, inexpensive and safe.
But unlike our driver, who discussed masturbation so readily, as a global health community we too often obediently bow to the social taboo that masturbation is a topic to be avoided. For example, UNAIDS' extensive Practical Guidelines for Intensifying HTV Prevention does not even mention masturbation (though it is alluded to in passing, lumped with abstinence into the phrase "abstinence from penetrative sex").7 Thus, as a professional community, we are neglecting a safe and widely acceptable alternative to risky sex that could play a significant role in the fight against not only AIDS, but other STIs and even unwanted pregnancy.
Yet if masturbation is already commonly practiced, what is to be gained...