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Relapses in having unsafe sex / Prevention Case Management
Sep 14, 1999

I am a gay man. Know all of the dangers of unprotected sex (I am an insertive top), in fact I used to work with People with Aids and saw firsthand of what can happen. Every now and then I just "slip" into someone's ass without a condom. The next day, I wake up feeling guilty and swear that I will not ever do it again. It lasts only a few weeks, and then I slip again. Is there any hope for me? What can I do? Any response will be appreaciated. thanks.

Response from Mr. Sowadsky

Thank you for your question. The situation you are describing is all too common. Previously, when it came to HIV and STD prevention, we used to just tell a person to practice safer sex, give them a few condoms, then the person would leave and we would often never see them again. But based on the recent increase in barebacking among Gay men (and the subsequent recent increases in STDs among Gay men), we now know that this type of prevention strategy is simply not good enough, and does not work over a prolonged period of time. Practicing safer sex involves changing a persons sexual behavior, not just in the short term, but in the long term as well. People often relapse into high risk sexual behaviors, unless prevention programs and interventions are ongoing and continual.

A newer approach to HIV and STD prevention is what is sometimes referred to as "prevention case management". Prevention case management involves working with a person on an ongoing basis through multiple safer sex counseling sessions over a prolonged period of time (often for months or more). The idea is to have an ongoing intervention program, so if a person feels like they will soon "slip up" and starting having unsafe sex again, we can quickly intervene to prevent such an occurrence. Prevention case management is a much more intensive prevention effort than what has been done previously, and is specifically designed to prevent relapses in high risk behaviors. Some of these programs work on an individual (one-on-one) basis, and other programs work in a group setting (such as support groups).

One of the drawbacks of this type of individualized intervention, is that it is much more labor intensive than previous prevention efforts, and it takes more time to do. Because it takes a more individualized approach, it can only be used with a small group of people at any one time. Taking all this into account, this type of intervention requires AIDS service organizations and health departments to hire more staff. Because it is much more labor intensive, prevention case management is also more expensive (which is a major problem since money targeted towards prevention programs is very limited). Since prevention case management is a relatively new prevention strategy, only a few places are currently taking this approach at HIV and STD prevention. However, thus far, in places that are using prevention case management, it seems to be highly successful.

If you find that you are "slipping up" from time to time, and having unsafe sex, you have several options:

1) Contact your local AIDS service organization to see if they have a prevention case management program.

2) Some cities have support groups specifically to help HIV negative people continue to practice safer sex. You may also find some online support groups specifically for people who are HIV negative.

3) Contact your local AIDS hotline from time to time if you need a little reminder, reassurance, and reinforcement, about practicing safer sex.

4) Even if you already have HIV or another STD, prevention case management programs can still be very helpful to help you practice safer sex (prevention programs for people who already have HIV and other STDs are known as secondary prevention programs).

Practicing safer sex with every partner, every time you have sex, can be a very hard thing to do. Maintaining safer sex practices over a prolonged period of time is even harder to do. The best way to get a person to start practicing safer sex, (and to maintain safer sex practices), is through intensive, individualized, and ongoing prevention programs.

In summary, simply giving people condoms and telling them to practice safer sex is just not good enough, and in many instances, simply does not work. A much more intensive and individualized approach at HIV and STD prevention is necessary in order to truly reduce a persons risk of infection for these diseases over a prolonged period of time.

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).



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