Ask the Experts
Experts at the HIV
Center are available to answer questions from the
general public about issues relating to HIV/AIDS. The
Ask the Experts section is provided in conjunction with
the website of the Columbia University Department of
Psychiatry. To read about this service and
guidelines for submission of questions, please
click here.
I
am faithful to my husband, but I think that he is
cheating on me and I am worried about getting HIV or
another STD from him. I would like to start using
condoms with him, but don’t know how since I am on the
birth control pill and we have never used condoms
before.
One strategy you
could try is to introduce the idea of condoms as an
alternative to birth control pills. Many women don’t
like to take the hormones in birth control pills for
health or other reasons. And it would be possible to say
that your health care provider recommended that you stop
using birth control pills and start using condoms.
A good option for
you could be the female condom, which has a lot of
“selling points.” The man doesn’t have to put it on, and
the woman can insert it ahead of time so that the sex
act doesn’t have to be interrupted. It is made of
polyurethane, which conducts body heat and conforms to
the contours of the vagina. In fact, several studies
have shown that many men believe that intercourse with
the female condom feels very natural. And the female
condom doesn’t have to be removed immediately after
ejaculation, as the male condom does.
If this doesn’t
work, there are other strategies you could try, such as
reducing the number of times you have intercourse, or
increasing other types of of sexual activity that are
less risky than vaginal or anal intercourse. But this
could be very challenging, and might not work in many
relationships.
It seems that
there is a larger issue in your relationship: you are
having problems communicating with your husband about
infidelity, safer sex, and possibly other important
issues. These are subjects that it would be helpful to
discuss with a professional counselor.
It seems to me that teenagers living in cities have
plenty of access to solid information about HIV/AIDS and
other issues of sexuality, but what about those living
in suburban and rural areas? What particular concerns do
they have, and how can they be reached?
It would be great
if all youths had access to accurate, comprehensive
information about all aspects of sexuality, including
HIV, other STDs, contraception, and sexual orientation.
I wouldn’t be so
sure that teenagers in cities necessarily have access to
all the information and resources that they need. The
quality, and even availability, of sex education varies
widely. And many urban youths have a lot of other life
stressors that also go unaddressed, such as poverty,
racism, and other forms of discrimination.
Still, you may be
right that many urban youths have more opportunities to
access the services they need, such as youth drop-in
centers, community-based organizations, and school
clinics. Distances are so much smaller in cities that
many teenagers can use public transportation to reach a
wide range of resources outside of their own
neighborhoods, where they are may have greater privacy.
Youths in suburban or rural areas, especially if they
are too young to drive or can’t afford a car, may face a
great deal of social isolation. It can also be difficult
for them to have the anonymity they may need to, for
instance, acquire contraception or try to get support if
they are questioning their sexual identity. And while
some suburbs are affluent, it’s important to remember
that poverty, and the stresses that come with it, also
affect many suburban and, especially, rural areas.
Of course, the
Internet has done a great deal to bring access to new
resources and support to everyone, regardless of their
geographic location. But in suburban and rural areas
where there may be fewer services accessible to youths,
it becomes more important for all of the services they
encounter to provide quality sex education and social
services to youth. Public schools, community agencies,
health facilities, youth clubs and activities – all of
these must recognize that just as sexuality is a part of
everyone’s life so education and training in responsible
sexuality should be part of their work as well.
I have a busy
medical practice that includes quite a number of people
who have HIV or who are at risk of HIV. Yet none of them
ever bring up the issue of sexual risk behavior and what
they can do to stay safe. How can I raise the issue with
them?
Your position as a
health care provider offers you a unique opportunity to
talk about protected sexual behavior. Because this is
such a sensitive subject, you cannot expect your
patients to bring it up on their own. Instead, it is
important for you to give them an opportunity to raise
any concerns they may have, and then to take the time to
have a discussion about risk behaviors.
One way to
approach the issue is to say “Some of my patients wonder
whether HIV may be a risk for them. Do you ever think
about that?” By bringing up other people, you make it
less about them individually than about a general issue
faced by everyone. This same approach can also be used
to discuss other sensitive subjects, such as
contraception and sexually transmitted diseases. It is
especially important to bring up issues related to
sexuality with younger people. Many school systems are
doing an inadequate job of teaching youths about
sexuality, for example, by having “abstinence-only”
curricula that are increasingly being shown to be
ineffective. Instead, it is crucial to provide younger
people with accurate, scientific information and to
reflect openness to their concerns.
Discussing
sexuality with a young person will not be “putting ideas
in their heads.” Sex is “in their heads” already –
they’re hearing about it ever day from their friends and
peers as well as from a media-saturated society in which
sexuality is everywhere. Based upon your expertise and
comfort with discussing sexuality, you should be able to
assess an individual’s risk and then also make
appropriate referrals. Beforehand, you should
familiarize yourself with a range of information sources
and community-based organizations, and to share this
information with your patients. More questions on this
topic
I am HIV-negative and starting to date someone who
is HIV-positive. I would like to pursue a relationship
with him, but only if I can be 100% safe 100% of the
time. Is this possible? If not, should I break things
off?
Whenever an
HIV-negative person is in a sexual relationship with
someone who is HIV-infected, it is not possible to be
100% sure that HIV will never be transmitted. However, a
lot is known about how this virus is transmitted and
consistent and correct use of protective barriers can
reduce the risk of transmission to a very minimal level.
There are many resources available on the web and
elsewhere that provide detailed information about
safer-sex practices. I would strongly encourage you to
take the time to educate yourself about the facts of HIV
transmission and prevention.
As for becoming
involved with this particular person, there are many
reasons as to why one person may not want to pursue a
relationship with another person. There are a lot of
"risks" (physical and emotional) when we make ourselves
vulnerable by truly opening ourselves to another person
and daring to "fall in love." I do not believe that HIV
status, in and of itself, needs to be a reason to not
pursue a relationship. While being in a mixed-status
relationship has its challenges, it is certainly viable.
There are many people having happy, healthy, and
satisfying long-term relationships even when they are of
opposite HIV status.
To put some of
this in another perspective, there is never 100% chance
we will not get hit by a stray bullet or a "hit-and-run"
driver, die in a plane crash, get sick from food
poisoning, be injured by falling debris when walking
down the street, be abandoned by a lover -- the list can
go on and on. But we do not stop ourselves from leaving
the house and engaging in life and relationships. With
that said, you or anyone else certainly has the right to
select a partner based on whatever characteristic may be
important to the person -- whether that be HIV status or
any other physical, health, or personality attribute.
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