Dr. Sex: It's All About Communication
This article is an extension of a letter I wrote to the editorial section of a local paper and it addresses the difficulty around communication and disclosure of status. My intention is not to place blame or shame on anyone, but to help individuals understand how their actions affect others, and take responsibility for themselves.
The first issue concerns couples (emphasis is on couples and not tricks or one-night stands) in which one person is HIV-positive and the other is negative. The partner who is positive is fully aware of his/her status and does not disclose this to the partner or lies and states they are negative. Now let me add another layer to this; the couple has been together for some time. With that there is a sense of trust in which condom usage may decrease or not be used at all -- which is understandable. Now add that the person who is HIV-positive is exchanging bodily fluids with their partner. What formula do we have here? A perfect formula for an infection.
I have been told a number of reasons for this behavior including fear of rejection or losing the person they love. While these reasons are understandable, be aware that if you love someone then be honest with them. Placing them at risk without their knowledge is life threatening and even criminal. Being HIV-positive and sharing that information can be difficult. However, there are plenty of organizations across the U.S. that can help someone learn ways to share their HIV status with a loved one.
The best example I have of this is when I tested a woman of color for HIV in her 50s. She stated she just found out her boyfriend of five years was HIV-positive and never told her. I asked if they used protection and she stated, "Why would we use protection when we were in a relationship and living together?" Made sense to me. I then informed her that if she wanted to press charges she could. She stated she could not do that and I stated I understood. She then said, "No you don't. He died three days ago from AIDS and that is how I found out." Guess what -- she came back positive.
My point with all of this is communication. Telling a loved one your status is hard -- I understand. What is even harder is trying to explain to that person why you did not tell them or lied to them. In the case of the woman I counseled, her communication ended and was buried. She was left alone with no answers and no support from her "loved" one.
The second issue has to do with tricks/one-night stands. I again have worked with individuals who did everything right. They asked the person who was going to be the insertive partner/top to use a condom. The person obliged and put a condom on. The insertive partner/top at some point took the condom off and ejaculated inside the receptive partner/bottom. If someone does not like using condoms -- then the individual should be honest from the beginning and share that information. Don't mislead someone.
My example for this case was that after my original letter to the editor was published, I received a thank you card from a gay man in his early 20s. He stated that he took home a trick and saw the person put on a condom. He stated after they were done he noticed the person no longer had the condom on. He asked the person what happened and he replied that he did not like condoms and took it off. Guess what -- he came back positive. He stated that when he tried to talk to his friends about this and warn them, they did not believe him. For him my letter was now proof that this happens. This person did what was right -- he asked for a condom. (For those of you who are saying it could have been someone else that the infection happened from -- it was not.)
My suggestions for addressing these issues are fairly simple: when entering a relationship test for HIV/STDs together, discuss the results in the presence of an HIV counselor. Have a discussion about condoms, whether the relationship is going to be exclusive or open (I often heard, "How could I be positive? I am in a monogamous relationship.") or how to maintain open communication about sexually difficult issues. During sex, check occasionally to make sure the condom is still in place, has not broken or was removed. My belief is that everyone is responsible to take care of himself/herself. Waiting for someone to tell you their status (or be truthful about it) may not happen. I advise people that if you do not know the person -- get it in your mind that he/she is HIV-positive regardless of what they say, look like or do and act accordingly. Until you can test together -- take care of yourself first. It really all comes down to a matter of basic human dignity, trust and respect.
Keith Waltrip is Director of Programs at TPAN. He can be reached at TPANProgrm@aol.com.
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