Bet You and Your Doctor Don't Talk About Sex: A Conversation Starter for HIV-Positive Men and Women
Are we right? We thought so. Even though sex is an integral part of life, communication about the details with your doctor can be very difficult -- for both you and your doctor. In fact, studies show that a lot of doctors are embarrassed to talk about sex or may avoid the topic out of concern about offending you, their patient. Following are some tips and advice to help change this. You can be part of the plan to make good communication about sex between patients and doctors the norm rather than a rarity.
The Importance of Having "The Talk"It's not a secret that unprotected sex can harm people's health. But until now, the emphasis has been on partners of people who are HIV+, not HIV+ people themselves. We believe the focus should be on you as well as on your sex partners. There have been alarming headlines recently (February 2005) about a new strain of HIV that resists almost all anti-HIV drugs and quickly progresses to AIDS. We do not know the full implications of this case report, yet the announcement may serve as an impetus for you or your doctor to bring up the subject of risky sexual practices in order to help protect your health and well-being.
Yes, unprotected sexual intercourse can increase the risk of you spreading HIV to your partners, but these risky behaviors can also put you at risk for acquiring and/or passing on resistant HIV strains. Unprotected sex also increases the risk of getting a sexually transmitted disease (STD). STDs are very common among sexually active adults. An STD can seriously harm the immune system of a person living with HIV. And, they can cause bothersome, often painful symptoms. They can also disrupt relationships by forcing people to temporarily give up sex during the treatment period.
Safer sex practices, such as using a condom for every act of intercourse and abstaining from semen-exchanging activities, remain the best way of preventing HIV from passing to your partners, reducing STD infections, and avoiding resistant HIV strains. Of course, the decision for safer sex is yours, but we encourage you to explore options with your doctor to protect your health and that of your sex partners.
Getting Past the BarriersRegardless of how competent and helpful your doctor may be, talking about sex, especially specific risky sexual behaviors, can be difficult. Your doctor may resist talking about the topic because he may worry about ruining the mutual trust the two of you have built. Your doctor may also worry about adding to the stigma that HIV-positive patients sometimes feel. If your doctor is of different sexual orientation than you, he may worry about not understanding your sexual life. Plus, there are many other priorities to be completed during your medical appointment. Reviewing your lab results and discussing your treatment options may leave little time for an adequate and helpful discussion about your sex life. As the HIV epidemic and treatments have evolved, doctors still struggle to make medical visits as productive and helpful as possible for their patients without leaving anything out. Give him the benefit of the doubt and start the conversation yourself.
Tips to Get the Conversation GoingAs a patient, you can take a personal and active role in solving your health problems. Since doctors can be one of the best sources of support and information, we offer some strategies to support you in this process.
For Further InformationWe also wish to offer worksheets that could help you to make the most of your doctor's appointment. These worksheets are tailored to your readiness for change. If you are ready to start practicing safer sex with your current and/or new partners, you can download the Worksheet for Practicing Safer Sex. If you are considering practicing safer sex but need more information, you can download the Worksheet for Thinking About Safer Sex.
A good relationship relies on good communication. In the past, it has been the responsibility of doctors to educate their patients. We think that these days, your doctor can learn a thing or two from you. Good luck!
Barbara Gerbert, Ph.D., Dale Danley, M.P.H., Dung Huynh, B.A., Daniel Ciccarone, M.D., M.P.H., Paul Gilbert, M.S.P.H. and David Bangsberg, M.D. are with the University of California San Francisco. Kathleen Clanon, M.D. is with the Alameda County Medical Center. Anas Hana, M.D. and Michael Allerton, M.S. are with The Permanente Medical Group, Kaiser Permanente.
Funding support from the National Institute on Drug Abuse (R01 DA 15016).
This article was provided by University of California-San Francisco Center for Health Improvement and Prevention Studies.