Pleasure and Prevention: When Good Sex Is Safer Sex

Abstract

Most sexual health education programmes use fear and risk of disease to try to motivate people to practise safer sex. This gives the impression that safer sex and pleasurable sex are mutually exclusive. Yet there is growing evidence that promoting pleasure alongside safer sex messaging can increase the consistent use of condoms and other forms of safer sex. To this end, the Pleasure Project created The Global Mapping of Pleasure, a document that identifies projects and organisations worldwide that put pleasure first in HIV prevention and sexual health promotion, and sexually provocative media that include safer sex. This article summarises some of the findings of this mapping exercise and what we learned about incorporating pleasure from it. We found that there are a variety of organisations, including religious and youth groups, and HIV/AIDS organisations and NGOs, promoting pleasurable safer sex. The techniques they use include promoting sexual techniques and dialogue about sex, teaching married couples how to have better sex and putting images of desire in sexual education materials. This paper focuses on ways of eroticising female and male condoms as examples of effective ways of using pleasure in HIV prevention and sexual health promotion.

Résumé

La plupart des programmes d’éducation en matière de santé génésique tablent sur la peur et le risque d’infection pour inciter les couples à se protéger lors des relations sexuelles, donnant l’impression que la protection et le plaisir s’excluent mutuellement. Pourtant, on comprend de mieux en mieux que promouvoir le plaisir avec des messages sur les relations sexuelles protégées, peut accroître l’utilisation régulière de préservatifs et d’autres formes de relations protégées. À cette fin, le Projet Plaisir a dressé la carte mondiale du plaisir qui recense les projets et les organisations qui donnent la priorité au plaisir dans la prévention du VIH et la promotion de la santé génésique, et les films érotiques avec relations sexuelles protégées. Cet article résume certaines des conclusions et des enseignements de cette initiative. Nous avons constaté que des organisations diverses, notamment des groupes religieux et de jeunes, des organisations sur le VIH/SIDA et des ONG prônent les relations sexuelles sûres et agréables. Pour cela, elles encouragent les techniques sexuelles et le dialogue sur les rapports sexuels, elles apprennent aux couples mariés à améliorer leur sexualité et introduisent des images du désir dans le matériel d’éducation sexuelle. Cet article décrit en particulier les moyens d’érotiser les préservatifs masculins et féminins, afin d’illustrer l’utilisation du plaisir dans la prévention du VIH et la promotion de la santé génésique.

Resumen

La mayoría de los programas de educación sexual utilizan el temor y el riesgo de enfermedades para motivar a las personas a tener sexo más seguro. Esto da la impresión de que el sexo más seguro y el sexo por placer son mutuamente exclusivos. No obstante, cada vez existen más pruebas de que la promoción del placer con los mensajes de sexo más seguro pueden aumentar el uso sistemático de los condones y otras formas de sexo más seguro. Con este fin, el Proyecto Placer creó el Mapa Mundial del Placer, un documento que identifica proyectos y organizaciones internacionales que anteponen el placer en la prevención del VIH y la promoción de la salud sexual, y medios de comunicación sexualmente provocativos que tratan sobre el sexo más seguro. En este artículo se resumen algunos hallazgos de este ejercicio y lo que se aprendió respecto a la incorporación del placer. Encontramos que una variedad de organizaciones, incluidos los grupos religiosos y de jóvenes, y ONG y organismos dedicados a la lucha contra el VIH/SIDA, promueven el sexo más seguro placentero. Algunas tácticas empleadas son promover diálogo y técnicas sexuales, enseñar a las parejas casadas cómo mejorar sus relaciones sexuales e incluir imágenes del deseo en los materiales de educación sexual. Este artículo se centra en las formas de erotizar los condones masculino y femenino como ejemplos de medios eficaces de utilizar el placer en la prevención del VIH y la promoción de la salud sexual.

Key Words:

• pleasure
• sex
• HIV/AIDS
• condoms
• lubricant
• Asia
• Africa

Sexual pleasure is the physical and/or psychological satisfaction and enjoyment one derives from any erotic interaction. This broad definition of pleasure attempts to capture the variability of individual experiences of pleasure, which are shaped by personal, sociocultural, financial, religious and political contexts. It also attempts to avoid prescriptive and generalised ideas that normalise certain forms of pleasure but marginalise others.

Research suggests that the pursuit of pleasure is one of the primary reasons that people have sex. According to a recent study among heterosexual men in Mombasa, Kenya, for example:

“…most people who engage in sex (particularly those who purchase sex) are not thinking about disease, they are thinking about enjoying themselves.” ¹

A recent study of sex and relationship education points out that in STI/HIV prevention “public health outcomes may benefit from a greater acceptance of positive sexual experiences”.² Other studies have argued that denying the possibility of pleasure in sexual relations, especially for women, has a negative impact on their active negotiation of safer sex.³⁴

The Pleasure Project is an educational resource whose aim is to ensure that sexual health trainers include pleasure as a key element in their work, that training materials include pleasure and that erotic materials include safer sex. In December 2004, the Pleasure Project facilitated a training course called “Sex, Safer Sex and Pleasure Training” in Cambodia, in conjunction with CARE Cambodia, to explore the potential for HIV prevention methods to make sex both safer and more pleasurable. To facilitate the training, we compiled The Global Mapping of Pleasure, which describes projects and organisations worldwide that combine pleasure and safety in HIV prevention, sexual health promotion and sexually-provocative media.

The Global Mapping was conducted through postings on sexual health listserves, personal communication at conferences and contacts provided by initial contacts. It is based primarily on grey literature and personal accounts of programme strategies, and has not been peer-reviewed. To date, the Mapping includes sex-positive resources for young people; examples of working with churches to promote better sex among married couples; sex-positive information materials for gay men; examples of pleasure and harm-reduction counselling with sex workers; examples of erotica for HIV-positive people; how to open up a pleasure dialogue; how to eroticise condoms and other barrier methods; and safe and sexy erotic films. These programmes and organisations are largely isolated in their work because pleasure is not widely accepted as a component of sexual health promotion⁵⁶.

Eroticising condoms

There is growing evidence that promoting pleasure in male and female condom use, alongside safer sex messaging, can increase the consistent use of condoms and the practise of safer sex.^{7 8 9} This is the “power of pleasure”.

Since condoms are generally perceived to reduce sexual pleasure,^{10 11 12} it is vital for public health campaigns to address how to increase sexual pleasure when promoting condoms. There are many reasons why people choose not to use condoms, and instead practice riskier sex. For example, many are concerned about the cost of regular condom use (especially sex workers). Sometimes there is a feeling of not being at risk (often spurred by ignorance or myths about HIV and AIDS), or the belief that condoms are not effective in preventing HIV or that requesting condoms means you do not trust your partner. Many see condoms only as an awkward and unpleasant necessity.

Similar reasons explain why the use of female condoms remains low throughout the world, especially in resource-poor settings. Policymaker bias, limited supplies and access, relatively higher cost, lack of understanding of how to use them and general discomfort on the part of both men and women with touching the woman’s body to insert the condom, are all factors. Perhaps the most common reasons for not using condoms is that they are perceived as awkward, uncomfortable and not sexy.

Eroticising male and female condoms is therefore key to increasing condom use: making condoms more comfortable and pleasurable transforms them from being strictly disease-prevention and public health tools into erotic accessories. Since the beginning of the HIV pandemic, the male condom has been widely promoted as the number one means of prevention. Unfortunately, many people still choose unprotected sex rather than condoms. It is clear that demand factors such as risk perception, reduced sexual sensation, increased dryness, decreased spontaneity, partner resistance and reluctance, and the feel of the condom are at least as significant in determining condom use as supply factors.¹³

Yet condoms can be very sexy and pleasurable, good sex can be safer and safer sex can be very good – especially when you know some erotic ways of sexing up male and female condoms for penetrative sex. Some quick and dirty ways to illustrate the erotic benefits of male and female condoms include the following.

First, one of the best-keep secrets of good (and safer) sex is water-based lubricant (lube). Water-based lube can make sex feel wetter and better, prevent condom breakage during dry or rough sex and enhance safety. For example, dropping a bit of water-based lube into the tip of a condom will increase sensitivity as a man penetrates, by creating a squishy feel around the head of the penis. And adding flavoured lube to the outside of a condom can make safer sex blow jobs taste better.

Alternatively, male condoms can be much more fun when a person rolls the condom onto a penis using his or her mouth. A person can gently suck the teat of the condom between his or her teeth (being careful not to tear the condom) and then roll it down the penis, licking all the way down. This can be practised on a dildo, vibrator or vegetable (e.g. cucumber) before doing it on a man. Also, putting the male condom on very slowly and relishing the process shows a man how much his partner appreciates his penis. Alternatively, a person can ask a man to put the condom on himself and, in the process, show his partner how to touch him just the way he likes it. If a person is having sex with a regular partner, research shows that regular or thinner condoms are no more likely to break during anal sex than thicker condoms. So, sexual health and public health educators can tell people to get some extra-thin condoms and enjoy the closeness!

Moreover, simply opening a male condom packet can be a sign that a person is ready for sex. Carrying condoms in a pocket or handbag when going out – and showing them to a potential partner – can illustrate how interested the person is in sex, while also encouraging condom use. For some people, when a man puts on a condom forcefully and with conviction, it can be a real turn-on. Finally, many people admit they like the lack of “mess” with male condoms – the semen stays inside the condom, not on the bed or dribbling out. But for those who like it “messy”, watching a man come can be pleasurable. In this case, a person can get the man to pull out before he comes, take off his condom, and have him come on his partner’s chest, breasts or back. This too can be a great turn-on.

Female condoms can also be “sexed-up”. Many people find the deeper penetration of the female condom’s inner ring to be super-stimulating. A woman can insert the female condom while her partner watches, telling her partner that he can look but not touch. The outer ring can be used to rub on the clitoris using fingers and the man’s penis. Many men report enjoying the feeling when their penis hits the inner ring of the female condom as they thrust into their partner.⁷ Female condoms can also be used vaginally and anally by removing the inner ring and placing the condom over the penis before penetration.

As for lube, oil-based lubricants do not damage the female condom the way they do male condoms because female condoms are made of polyurethane or nitrile rather than latex. So any oil-or water-based lube can be used.

Many gay men’s organisations in the US, UK, Canada, Australia and other developed countries have taken a pleasure approach to HIV prevention and teach men how to make condoms feel better and integrate them into sex play. The Australian Federation of AIDS Organisations, for example, created Sex in Queer Places, an interactive video game that follows a fictional gay man through a variety of sexual encounters (e.g. sauna, dance party) and lets the viewer make a set of sexual and drug-use choices. With each choice a dialogue box pops up with health promotion and harm minimisation information. An electronic booklet that takes a sex-positive approach to issues about sex for HIV-positive men is also included.¹⁴ Many projects targeting gay men operate from the realistic perspective that most gay men will not stop having sex because of fear of disease. This perspective represents relatively unexplored avenues for HIV prevention in resource-poor settings and among sex workers, heterosexual couples and women.

Tips for sexual health educators

Based on the findings of The Global Mapping and other relevant sources, we offer the following tips to sexual health educators, which have been gleaned from successful efforts to eroticise male and female condoms, increase their use and ensure better, safer sex.

•	Start with a realistic attitude about why people have sex This requires honesty and upfront messaging that helps people to have better and safer sex.
•	Get tips and advice from the target audience Pleasure and sexiness are often culturally specific, so it is vital to tailor pleasure-focused HIV prevention to the needs and desires of target communities. For example, in Mumbai, India, the Sambhavana Trust reported that some of the hijra (transsexual) community were inserting the female condom anally before sex and explaining to their penetrative partner that they were using the female condom as proof of their femininity (Personal communication, Jasmir Thakar, Executive Officer, Samabhavana Society, August 2003). Often, the target audience have their own innovative ideas for eroticising condoms and increasing their use.
•	Get comfortable talking about sex and pleasure Efforts to eroticise condoms require detailed discussions about how to make condoms feel better. This requires learning to “talk dirty” outside the bedroom. If trainers or programmers are not comfortable talking about sex and pleasure, or if they have a low level of knowledge about aspects of pleasurable sex, the project may suffer. One highly effective way to overcome discomfort with sexual topics is to find members of target populations (e.g. sex workers, gay men, young women) who are willing to train or counsel project staff. Another way is to open up internal dialogue about sex and pleasure. For example, in Namibia, the HIV/AIDS programme manager for Ibis included sex and pleasure dialogues as part of in-house awareness training on AIDS and development. The approach encouraged all staff to look, first, at their own reality with regard to sex, and to help lift the taboo on talking about sex and sexuality among colleagues and friends. The workshops mixed all levels of staff, from top management to cleaners, in sessions. This helped to explode the myth that people cannot talk about intimate things across race, age and status hierarchies. In one session two teams were asked to list as many body parts as they could think of that can be used in a sexual way, and as many sexual positions as they could imagine. This broke down inhibitions as people laughed and thought of more daring and risqué answers. The games were followed by an in-depth discussion. According to the organisers, this helped participants to overcome inhibitions about talking about sex, sexuality and the pleasure possibilities beyond penetration.
•	Keep your focus on pleasure and sex rather than disease Some male condom social marketing projects provide coloured, flavoured or textured condoms that increase sensation or comfort for one or both partners, and packaging that appeals to particular ethnic or social groups. However, their messaging sometimes still focuses first and foremost on disease prevention. It is important to strike a balance between promoting pleasure and promoting health.
•	Eliminate messages and attitudes that promote shame or fear about sex, sexual preference or pleasure Empowerment Concepts (<www.empow.co.za>), a non-profit organisation based in Nelspruit, South Africa, carried out a highly successful programme called Vida Positiva in Mozambique, which went a long way towards eliminating the shame and fear associated with sex in many religious contexts. One aspect of the project was to promote safer sex among couples by tackling one of the primary reasons that married men were having sex outside marriage: boredom with their sex lives at home and with their wives’ reluctance to try new sexual positions. The project worked with key community gatekeepers to promote pleasure-focused couple counselling. Local Catholic priests and nuns, who were included, facilitated better communication between married couples to encourage them to talk more openly about what they did and did not like about sex.

Gay Men Fighting AIDS UK launched a media campaign in March 2006 with posters showing photographs of gay men individually or in couples holding up positive, frank, sex tips or tips for healthy, fun relationships. (<http://www.metromate.org.uk/iframes.php?page=/jobs/index.phtml>.)

And the Naz Foundation International also took steps to eliminate shame from safer sex messaging. Naz aims to improve the sexual health and human rights of marginalised men who have sex with men and their partners and families in South Asia. Although cultural restrictions limit sex-positive projects in the region, Naz encourages its project partners to arrange discussions on sexuality, safer sex and pleasure. A sex positive flyer is available with descriptions and diagrams about pleasure and safer sex, positions and body awareness (<www.nfi.net>).

Innovative condom and lube promotion in Cambodia

Cambodia is one of the few countries in the world where targeted HIV prevention and condom use campaigns have been documented as major reasons for the decline in HIV prevalence.¹⁵ The government’s 100% condom policy in commercial establishments, primarily brothels, is widely recognised as a major reason for this decline.¹⁶ Population Services International (PSI) Cambodia introduced its Number One brand of condoms in 1994 along with an awareness-raising campaign; they are the most widely used condoms in Cambodia, representing 80% of the condom market. In 2002, they were available in 97% of all brothels in Cambodia.

During the campaign, many NGOs working with sex workers and men who have sex with men in Cambodia identified the need for affordable, water-based lubricants to help to increase the comfort and effectiveness of condoms and thereby encourage their use. The need for lubricant among both male and female sex workers was most pronounced during festivals such as the Water Festival, when sex workers have more clients per night. According to Dr Chawalit of Family Health International (FHI): “With no lubes, they do not use condoms, in order to shorten sex acts with drunken clients.” When PSI staff visited a Khmera clinic in Svay Pak, a brothel area near Phnom Penh, the clinic staff expressed an urgent need for lubricants for local sex workers. PSI Cambodia learned that when having multiple and rapid sex acts in a short period of time with different clients, sex workers could experience discomfort, even pain, when consistently using condoms, because they were unable to produce adequate natural lubrication. Lack of stimulation and psychological depression contributed to vaginal dryness as well. This sometimes led to condom breakage and an increase in vaginal tearing, thereby increasing the risk of STI/HIV transmission.

Men who have sex with men were also a significant high-risk population because of high levels of unprotected sex, due at least in part to discomfort with and failure of condoms. Anal sex requires lubrication because the anal lining does not secrete natural lubrication to ensure ease of penetration. Without lubrication, there is a risk of condom breakage and tearing of the anal lining, which increases the risk of HIV transmission. Anecdotal evidence from two non-profit organisations working in sexual and reproductive health in Cambodia, FHI and Khana, the Cambodian partner of the International HIV/AIDS Alliance, suggested that men commonly used oil-based lubricants with condoms, such as hair oil, cooking oil or petroleum jelly, to ease penetration. This is dangerous because oil-based lubricants damage latex and increase the risk of breakage.

Water-based lubricant does not prevent HIV transmission as a stand-alone product. Hence, PSI Cambodia packaged a lubricant together with the Number One condom to create Number One Plus. PSI packaged two sachets of water-based lubricant with a packet of four Number One condoms. Each 6 cc. sachet was enough for two sex acts using two different condoms. This was an ideal way to build on the popularity of the Number One brand, and reinforce the use of water-based lube with condoms. The money saved by combining the products also reduced the cost.

One of the challenges in many countries, especially among high-risk groups, is not simply making products available, but high quality, affordable versions of these products. The success of the Number One Plus campaign hinged on the fact that the lube worked better and lasted longer than others. As reported in a workshop on lubricants, it did not stain, it had an appealing taste and scent and the least negative effect on latex; it was not harmful and was easy to clean up.¹⁷

The price of Number One Plus was determined through a willingness-to-pay survey, and is highly subsidised. The product was considered affordable by users. Less than 5% of the packets are given away free, primarily for training purposes. Distribution points include pharmacies, supermarkets and market stalls, as well as high-risk, hard to reach venues such as brothels, beer gardens and karaoke bars. Peer education networks are also a means of distribution, as are NGOs working with men who have sex with men, sex workers and the gatekeepers of these communities. PSI’s sales force also worked to ensure product availability to brothels, massage parlours, guesthouses and cruising areas and entertainment venues frequented by men who have sex with men. They also educated trainers and consumers about the proper use of lube with condoms and how much to use.

The key messages of the campaign were that Number One Plus water-based lubricant, when used with a Number One condom, makes sex better and safer. Other messages emphasised that lubricant must be used with a condom, not alone; lubricant increases the durability of condoms; lubricants are NOT a luxury item; and oil-based lubes can break down latex condoms and decrease their effectiveness. The campaign emphasised the pleasure benefits, as well as safer sex and HIV prevention, including increased pleasure for the penetrator and reduced vaginal and anal friction for the receptor.

The product was initially targeted at sex workers and men who have sex with men, but was also mass marketed. Advertising included television and radio spots, as well as point-of-sale marketing. In the first six months, sales of lube increased by 500% and exceeded expectations. Research demonstrated that the product was reaching the target population as well as the general population. However, stock ran out due to a six-month gap in donor funding. Once funding was again secured, sales levels resumed. PSI is currently trying to expand sales and access in rural areas.

Training was conducted with the PSI Cambodia staff and sales team to sensitise them to working with men who have sex with men. While there was some resistance at first, sales increases can be attributed to a change in attitude among many staff towards marketing and selling products to highly stigmatised populations (Personal communication, Supriya Pillai, July 2006).

Based on consumer satisfaction surveys, PSI Cambodia learned that it was difficult for consumers to retain lube from one sachet to use with another condom. They are therefore considering packaging four sachets of lube with four condoms. In addition, they are considering selling their lubricant as a stand-alone product for customers who want to use more than half a sachet with each condom.

PSI has not studied whether marketing the product as a pleasure product made it more successful than a traditional public health approach. However, television and radio campaigns were well received, and PSI staff involved believe that the pleasure aspect contributed to the increase in sales.

Female condoms and pleasure

Imagine a new sex toy. It costs less than a dollar, is available all over the world, comes in its own discreet package and offers limitless pleasure for both men and women. It has two rings. One is inserted deep into the vagina, where it rubs against the back of the vagina, especially when having sex or pushing your fingers against it, causing a deeper thrust and harder penetration. The other ring sits outside the vagina. Some women report that the rubbing of the outer ring on the clitoris can cause increased pleasure and even orgasm. Men report that the knocking of the penis against the inner ring feels good as well. The whole toy is made of a heat-conducting material that enables the partners to feel each other through it, especially when this toy is covered inside and out with lubricant. You may have guessed that this is, in fact, a description of the female condom.

The female condom is a strong, soft, transparent polyurethane sheath inserted in the vagina before sexual intercourse, providing protection against both pregnancy and STIs, including HIV (see <www.femalecondom.org>). It forms a barrier between the penis and the vagina, cervix and external genitalia. Polyurethane is stronger than latex, odourless, causes no allergic reactions, and, unlike latex, may be used with both oil-based and water-based lubricants. It can be inserted prior to intercourse, is not dependent on the male erection and does not require immediate withdrawal after ejaculation. With correct and consistent use, the female condom is as effective as other barrier methods and has no known side effects or risks.¹⁸

One factor that has aided female condom promotion is the increase in sexual pleasure and the opportunity to eroticise the condom, reported by many users. Others were that men supported its use for family planning and perceived peer support for using it. In addition, sex workers who were skilled in negotiating safer sex found the female condom to be a good alternative when male condoms were unpopular.¹⁹ The pleasurable physical and psychological effects of female condom use can be crucial in negotiation for safer sex. The lubrication and thinness of the material makes sexual intercourse feel slippery, natural and fun. The fact that the man’s erection does not have to be constant is an added benefit for many. Some people value its slightly larger size. People can prolong intercourse, taking breaks (e.g. for other kinds of sex play or something completely different) and do not need to take the condom out. The heat transfer through the polyurethane is another feature that many report makes sex feel more “natural” or enjoyable. It has also been associated with increased femininity.

In Senegal, SWAA (Society for Women and AIDS in Africa) linked the noise made by the movement of the polyurethane during intercourse to the rattling of bine-bine beads, which women wear around their hips as an erotic accessory. As a result, for some Senegalese men and women the noise of the condom was transformed into a sexual turn-on, rather than a turn-off. SWAA Senegal then linked the marketing of female condoms with bine-bine beads, making the female condom one of a range of erotic accessories in some parts of the country alongside incense and sexy underwear. They also used the notion that the female condom accommodates a wide range of penis sizes as an incentive to use them (Personal communication, Cira Endsley, Female Health Foundation and SWAA International, and Charity Binka, President, SWAA Ghana, July 2003).

In Zimbabwe, there is a new word in the Shona language – ketecyenza – invented to describe the gorgeous tickle that men feel when the inner ring of the female condom rubs on the penis.⁷ In Zambia and Ghana men have reported feeling excited by the tapping of the inner ring on the penis. In the absence of their partners, men reported buying a female condom for masturbation with the inner ring (Personal communication, Cira Endsley and Charity Binka, as above). In India, women reported their first orgasms as they inserted the lubricated female condom inside themselves.²⁰ In a Sri Lankan study, a quarter of sex workers charged clients more to use a female condom by convincing them it was an erotic accessory, although the condoms were provided free of charge.²¹

Two sexual health NGOs in Andhra Pradesh, India – Changes in Kakinada and Needs Serving Society in Chaliakaluripet – also found during research on the acceptability of female condoms among sex workers that if men raised objections, they would say that the condom feels like a “natural vagina”, that the lubrication in the condom is similar to skin-to-skin sex and that the inner ring touches the penis in a pleasurable way. They too were able to request a higher price for their services due to these features. According to Cheswera Prasad of Needs Serving Society, Andhra Pradesh, an organisation working with sex work communities, when a client of a sex worker complained about the noise, the sex worker said: “It only makes noise when men are good.”¹⁴

In Mongolia, the female condom has been promoted by sex workers, by an HIV prevention programme and through branding and marketing with pleasure as a key feature. Marie Stopes International, with the support of UNFPA, launched the female condom there linked to the existing popular male condom Trust and branded it as Lady Trust. The package insert of Lady Trust talks about the possibility of enhanced sexual pleasure with the female condom, the links between male and female sexual pleasure, the different uses of condoms, and anatomy and insertion. The marketing was accompanied by extensive training of outreach workers and service providers, as well as a media campaign on local radio and in two popular newspapers (Personal communication, D Altachinmeg, Marie Stopes Mongolia, Social Marketing Manager, July 2003, and presentation by Sarah Black, Program Support Manager, Marie Stopes International Australia, MSI Asia Regional Meeting, Bangkok, May 2004).

Thus, the female condom has many features that enhance pleasure, which can be used to encourage safer sex.²²

Conclusion

We have shown just a few of the ways in which pleasure can play a key role in the prevention of STIs and HIV. The Pleasure Project intends to continue documenting examples and case studies of incorporating pleasure into safer sex programming, to identify lessons learned and best practices, and to develop ways to ensure that pleasure is at the heart of better and safer sex.

Note

The views expressed by Anne Philpott do not necessarily represent the views of DFID.

Acknowledgements

A version of this paper was presented at Condoms: An International Workshop, London, 21–23 June 2006. Research for The Global Mapping of Pleasure and the case studies was funded in part by CARE International and CARE Cambodia. We appreciate the time and information provided by the agencies and staff, especially Supriya Pillai, formerly of PSI, and Barry Whittle of PSI. To order Pleasure Project publications, e-mail <[email protected]> or visit <www.thepleasureproject.org>.