I currently run programs for women with HIV at Exponents in New York City, and many participants come to our programs with a history of sexual abuse and domestic violence. There is a strong association between childhood sexual abuse and HIV-related sexual risk behavior, and we work hard to help participants feel safe enough to disclose this information. This may be the first time many individuals reveal their sexual abuse history, and therefore we have to be prepared to make appropriate referrals for medical and/or social support.
In addition, many women who attend our programs have a history of domestic violence or are currently in abusive relationships. In these relationships, it is the man who decides whether to use safer sex methods. If a woman suggests it, she runs the risk of physical abuse. We deal with delicate negotiation strategies daily. Individuals can't always "just say no" or ask for a condom, so we need to work with individuals over time. Their attitudes and behaviors took years to form, and women in abusive relationships cannot simply walk away. To help them make behavioral changes we need to work on what they tell us they need, not what we think they need.
One of the first things we teach is that sex is what we do; sexuality is who we are. HIV-positive women are entitled to free expression of both, just like anyone else. There are many people who believe that HIV-positive individuals should not have sex anymore. But this is not real. If we don't acknowledge that we are sexual beings like all others we increase the likelihood of falling into unsafe sex practices. We need to be able to speak out in a safe atmosphere, where we can brainstorm and share ideas about how we can enjoy safer sex.
Everything about HIV affects your sex drive. How can you feel sexy when you feel so nauseated that you are on the brink of tossing your cookies? Or if you come to bed looking like the Hunchback of Notre Dame? Let's face it -- there is nothing sexy about that, especially when we are so image-conscious to begin with.
If you are in a serodiscordant relationship, fear of transmission always manages to work its way in, even though you are doing everything possible short of jumping into a latex sack to protect your partner.
Then we have the dreaded world-shattering prospect of DISCLOSURE. I can't tell you how many women just stop having sex because they are afraid to disclose. So we discuss how we can assess whether we are ready to disclose, how to disclose if we have chosen to, and how to assess the benefits and consequences of disclosure. Much of the time we dread an outcome that may turn out to be positive. And many women feel that if they meet someone who doesn't want to get to know them better because they're positive then, oh well, that's unfortunate for that person, but they're going to move on.
Most of the time, though, I do not find that type of reaction. It generally has to do with how we communicate this information. If I feel good about myself and positive while delivering the information, most of the time that's how it will be accepted. I will not apologize to anyone for being HIV positive. It is important that I forgive myself for my past destructive behaviors and that I be responsible for my current and future actions. I may be an HIV-positive woman, mother, sister, coworker, educator, but above all I am a human being and I intend to enjoy my life to the fullest each and every day. I don't have time for negativity. It is such a huge waste of energy. So, as I go through life with that attitude, and the support of some very dear friends, I feel good about myself and am therefore able to help provide a safe atmosphere for others to explore their sexuality.
Tell me, what's sexier than that?
Dana Diamond is longtime survivor of HIV and Assistant Director of Prevention at Exponents, Inc., in New York City.