What is dry sex, and why do you need to know about it?

Two events occurred this summer that introduced me to one of the few kinky sexual practices I'd rather not hear about.  First, I spent three months in Zambia, one of the countries where dry sex is regularly practiced.  Second, I read Elizabeth Pisani's incredible book on AIDS and the AIDS industry, The Wisdom of Whores.  Because some of the language in this post is necessarily graphic, and because the content here makes me feel somewhat ill and you might be eating lunch while reading, click through if you would like to learn more.

Dry sex is the practice of using herbs, antiseptics, absorbents or other means to dry vaginal secretions before intercourse. Dry sex aids are the inverse of lube.  The idea is that it makes sex feel hot, tight, and rough, and presumably increase the enjoyment for the man.  In practice, it can also make sex extremely painful for women, create vaginal swelling and peeling, and lead to a reduction in the body's natural protection from HIV.  (The effects are three-fold: vaginal tearing from dryness, elimination of naturally disease-fighting vaginal mucus, and increased condom rippage.)

A friend of mine who worked as a Peace Corps volunteer and HIV educator in Zambia told me that in her experience, neither men nor women expressed enjoyment of dry sex.  It was just a tradition.  The way things were supposed to be done; the way things were supposed to feel.  Women were also under the impression that their husbands enjoyed it.  To combat this, she hosted separate meetings with village men and women, getting each to vocalize their distaste for dry sex, then brought the groups together and shared what was said.

Tradition is obviously one barrier, but it seems that some men out there do enjoy dry sex, as evidenced by the high percentage of sex workers reporting being asked to engage in the practice.  It's also easy to underestimate the persistence of the part that is purely tradition.  Cultural practices evolve for a reason, and quickly become deeply ingrained in an individual's sense of self.  Women, who appear to be the "victims" of dry sex practices, will describe wet sex as "dirty," "smelly," and even uncomfortable.  Because of this, dry sex continues to predominate in many areas where risk of HIV infection is highest, including Southeast sub-Saharan Africa.  One 2009 study found that as many as 50% of women in Lusaka, the capital of Zambia, were practicing dry sex.  In rural areas, prevalence tends to be much higher.

One of the reasons learning about dry sex, and its remarkable overlap with areas in Africa that have high HIV infection rates, was so enlightening to me is that the need for HIV prevention and treatment is easy to dismiss due to its association with "wickedness."  Pisani makes this point in her book, where she notes that popular support for AIDS programs was only mobilized after epidemiologists started claiming (falsely) that the AIDS epidemic was a huge threat to the general population (as Pisani says, "women and babies").  We look at the huge infection rates in South Africa and Zambia and think "those people must be having lots of promiscuous sex without condoms--why should I care about them?  Why don't they just stop?"  But there's no evidence that rates of concurrent sexual partnership or unprotected sex are any higher in Lusaka, Zambia than in Los Angeles, California.  Rather, a complex amalgamation of risk factors, partner choices, and other health problems have combined to create a situation where infection is particularly likely on any given unprotected sexual encounter.  The areas in Africa with high HIV infection rates overlap with areas where dry sex is practiced, and don't overlap with areas where circumcision is the norm.  Pisani discusses HIV as an opportunistic virus, looking for an "open door" into the human body.  Sex is actually more like a window crack, when not accompanied by additional risk factors.  Lack of circumcision creates one such open door, through the foreskin's Langerhans' cells.  Dry sex creates another, through vaginal tears that allow the virus to enter.  Pisani's book is mostly focused on Southeast Asia, where high rates of commercial sex and intravenous drug use make it no mystery why AIDS has spread quickly.  Africa presents more of a puzzle, and is therefore more subject to dismissive "put a condom on" thinking.

Although condoms are the best way to prevent HIV transmission in an individual sexual encounter, there may be many ways to slow HIV's spread in a highly endemic region.  One interesting one is advertising the risks of inter-generational sexual encounters to teenage girls who frequently engage in "sugar daddy" relationships with older men.  Another is widespread circumcision campaigns (although I fear these carry the risk of making circumcised men feel "immune" to infection).  Still another is education about dry sex and its dangers.  Changing cultural norms to accept that wet, slippery sex is not only safer, but more fun, would undoubtedly be difficult.  It also might be an important opportunity in our fight over AIDS.  Moreover, I wonder if changing this particular interaction, from one of the man forcing and the woman enduring to one based around mutual pleasure, might not subtly alter gender roles in a positive way overall.  To find out, it's time you, I, and the community of people who want to help start talking about dry sex.