A few weeks ago I posted a video about masturbation, and people are still calling me about it. Some found it useful, some found it funny, while others felt a minister of health and wellness had no business talking publicly about something so private. But the range of reactions made me think about something bigger: Why are we still so uncomfortable talking about sex?

We talk freely about relationships, marriage, and family, and we certainly have opinions about other people’s relationships, but when it comes to what people do sexually, we become far less comfortable. Perhaps that is understandable. Sex is personal; our views are influenced by our upbringing, our faith, and our values, plus there are some sexual practices that many Jamaicans simply do not agree with. But discomfort does not change behaviour, and from a public health perspective, that is where the conversation becomes important.

If we are serious about reducing HIV and other sexually transmitted infections (STIs), we must understand how people are behaving, not simply how we assume they are behaving. And some of the Jamaican data challenges those assumptions.

Our 2024 Integrated Biological and Behavioural Surveillance study, for example, found that 35 per cent of men who have sex with men also reported having a female sexual partner. In 2017, the figure was 39 per cent. Put simply, roughly one in three.

That may surprise some people because we tend to think about sexuality in clear categories. A man is straight, gay, or bisexual, and from that label we make assumptions about who he has sex with. Reality can be more complicated. Some men who have sex with men also have sex with women. Some identify as gay or bisexual, while others consider themselves straight. Some female partners know about these relationships, and some may not, while other couples have arrangements that are understood between them.

Why does this matter to the Ministry of Health and Wellness? Because when it comes to HIV and other STIs what you call yourself tells us far less than what you do. Having sex with men, or with both men and women, does not in itself give someone HIV. The risk comes with behaviours, such as having multiple or overlapping sexual partners, inconsistent condom use, untreated STIs, not knowing your HIV status, and not using the prevention or treatment available to you — those behaviours can occur whether someone is gay, straight or bisexual.

Our data reinforces this point. Over the past decade multiple sexual partners were the most commonly reported risk factor among people diagnosed with HIV — 43.5 per cent of men and 29.6 per cent of women. STIs were another major reported risk factor for both groups. So, this should not become a conversation about one group of Jamaicans endangering another. It should cause all of us to think more carefully about our own behaviour, and it should also make us think about the conversations taking place in our doctors’ offices.

When a doctor takes your sexual history, for example, he/she should ask about the sex of your sexual partners, rather than assume. A man having a wife or girlfriend does not necessarily mean every person he has sex with is a woman, just as assumptions should not be made about a woman’s sexual partners. The doctor is not asking because he or she needs to decide whether you are gay, straight or bisexual. The information helps your health-care provider understand your sexual practices, assess your risk, and determine what testing, screening or prevention may be appropriate.

Of course, asking the question is the easy part. Answering it honestly may be much harder.

We must acknowledge the society in which these conversations are taking place. Faith, family, and traditional values matter deeply to many Jamaicans, and there are strong views about sex and same-sex relationships. Some people may fear being judged if they speak openly. Others may worry about confidentiality, their relationships, their families, or even their personal safety. Our laws also continue to criminalise certain sexual acts between men, adding another layer to what is already a difficult and deeply personal conversation.

Health workers have a confidentiality responsibility

But if we want people to be honest with their health-care providers, then our health system must give them the confidence to be honest. What a patient tells a health-care provider is confidential medical information, and health workers have a responsibility to protect that confidentiality, treat patients with dignity, and provide professional care. Trust must work both ways.

The importance of that trust becomes clearer when we look again at the data. Since HIV surveillance began in Jamaica, 35.2 per cent of males in the data did not disclose their sexual practices. We cannot say why they did not disclose, but it leaves an important gap in what we know about the sexual behaviour of men diagnosed with HIV.

There are other findings that should make us pay attention. Over the past decade, just over half of males who reported sexual activity with both men and women were between 20 and 29 years old. More concerning is that, on average, 30.4 per cent of males reporting sex with both men and women had advanced HIV or AIDS when they were first diagnosed.

The data does not tell us why they were diagnosed at that stage, so we should not guess. Instead, it should prompt us to ask whether people are testing early enough, whether some are reluctant to seek care, whether health-care providers are asking the right questions, and whether enough people know about the prevention options available to them.

Those questions are particularly important because HIV today is very different from what it was 30 years ago. Jamaica has made real progress. HIV prevalence among female sex workers has fallen from about 12 per cent in the 1990s to between two and three per cent in more recent studies. We have eliminated mother-to-child transmission of HIV and syphilis, and AIDS-related deaths fell by 38 per cent between 2010 and 2024.

We also have more tools to protect ourselves. Condoms and regular testing remain important, but there is also pre-exposure prophylaxis (PrEP), which can significantly reduce the risk of acquiring HIV. It is available free through our primary care system for people at increased risk, including people with inconsistent condom use, multiple sexual partners or recurrent STIs, as well as men who have sex with men, transgender persons, and sex workers.

There is also post-exposure prophylaxis (PEP) for someone who may have recently been exposed to HIV through unprotected sex, a condom breaking, or sexual assault. It must start as quickly as possible and no later than 72 hours after possible exposure.

No one should be stigmatised because of HIV

For people already living with HIV, treatment has also changed everything. A person who takes treatment and achieves and maintains an undetectable viral load does not sexually transmit HIV. This is known as U=U — Undetectable equals Untransmittable — and it is an important fact because no one should be stigmatised simply because he/she is living with HIV.

What does this mean for the average Jamaican? It means we cannot rely on assumptions to protect our health. A woman should not assume that being in a relationship automatically means she is not at risk, just as a man should not make that assumption. Protecting yourself is not an accusation against your partner; it is simply taking responsibility for your health.

Know your status. Get tested for HIV and other STIs. Use condoms. If you have new or multiple sexual partners, speak with your health-care provider about how often you should test. If you may be at increased risk, ask about PrEP. If you think you have recently been exposed to HIV, ask about PEP immediately. And if you are living with HIV, start treatment and stay on it.

Most importantly, when your doctor asks about your sexual history, tell the truth. And doctors and nurses must make it easier for patients to do that by asking the right questions respectfully, protecting confidentiality and providing care without judgement.

Some people thought I should not have talked publicly about masturbation a few weeks ago. Some will probably think I should not be having this conversation either. I understand the discomfort, but silence has never been a public health strategy.

We can have different beliefs and values about sex, and we do not have to agree on everything people do in their private lives. But we should be able to agree that embarrassment, assumptions, and fear should never prevent someone from knowing their status, protecting themselves and their partners, or getting the health care they need.

When it comes to your health, what you do matters more than what you call yourself.

Dr Christopher Tufton is Jamaica’s minister of health and wellness. Send comments to the Jamaica Observer or cctufton@gmail.com.

Health and Wellness Minister Dr Christopher Tufton (Photo: Anthony Lewis)