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HIV: Therapeutic Strategies for Guilt, Uncertainty, and Taking Control
HIV: Therapeutic Strategies for Guilt, Uncertainty, and Taking Control

Section 4
Track #4 - 'You're dead already, bitch.' - How to
View Sex, Abstinence, & HIV

CEU Question 4 | CEU Answer Booklet | Table of Contents | HIV/AIDS CEU Courses
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

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On the last track we discussed disclosure strategies.  Three aspects of disclosure regarding a client’s HIV positive status that we have discussed are who to tell, feelings about disclosure, and dual disclosure.

On this track we will discuss dating and sex.  While implementing therapeutic approaches to helping clients cope with HIV in a group setting, the topic of dating and sex came up.  Research on the topic of dating and sex regarding HIV positive clients reveals a number of different perspectives.  Some research indicates that abstinence is the only safe sex, which is indisputable.  However, ultimately, HIV does not deter clients from the pursuit of romance indefinitely. 

In one of my group sessions, the focus of discussion turned to dating and sex.  Topics included disclosure tactics, sex, and the dangers of sex.  As you listen to this track and parts of the discussion, consider your HIV positive client.  Could he or she benefit from hearing this track?  Could you perhaps play this track in your next group session so that your clients can expand on these ideas?

Share on Facebook #1  Disclosure Tactics
One of the first topics regarding dating and sex that came up in my group session was disclosure tactics.  Ross, age 32, stated, “I mention my HIV status first thing.  It’s better to find out quickly who will stand and who will fall away. I mean, I don’t need everybody; just a few ‘somebodies’.” Is your client, like Ross, comfortable with his or her HIV positive status?

Aaron was not so comfortable regarding disclosing his HIV. Aaron stated, “I always have safe sex, so it’s not like I’m putting anyone in danger. That’s why I wait until after sex to tell them.” Clearly, Aaron’s tactic for disclosure presents a number of problems. 

Haley, age 36, discussed her personal experience with latent disclosure tactics similar to Aaron’s.  Haley stated, “When I was in my twenties, I was doing the same thing.  I’d have sex with a guy and then tell him later, like that would help somehow.  It never did.  Instead, one guy I slept with got really upset.  He told me he never wanted to see me again and called me horrible names. 

"Then, about a week later, he started calling me with threats. I got really scared.  He told me he was going to get tested and that if he was positive, he’d kill me. Then, a couple days later, a message was scratched into the hood of my car.  It said, ‘You’re dead already, bitch.’  Later I found out that he had tested negative, but until then I felt like I had ruined his life as well as my own.” 

Could your clients, like Aaron, benefit from understanding the nonproductive effects of latent disclosure tactics?

The group went on to discuss more productive disclosure tactics.  Kyle, age 24, stated, “I always tell on the first date. I like to do it face to face. That way, if the guy rejects me, he has to do it like an adult.”

Candy stated, “I wait until I feel I can trust the person.  That way I feel more comfortable about how they’ll deal with HIV. I might drop a hint first by saying I know someone with AIDS. Then I can watch how the person reacts. Based on their reaction, I tell them, or forget about the relationship altogether.”

Ross, who had earlier claimed that he didn’t need everybody; just a few ‘somebodies’, stated, “I make no secret of my status. It’s part of who I am, so I couldn’t imagine going on a date and not telling someone. At the end of the day, you still have to look at yourself in the mirror.” Would you agree that upfront disclosure may be a productive method for your client?

Share on Facebook #2  Sex
Following our discussion regarding disclosure tactics, some group members had questions about how to handle situations in which dating leads to sex.  First, I wanted to discuss safe sex and safer sex. I stated, “When you are considering sex involving a life threatening STD, the only safe sex is no sex.” Clearly, the clients in the group understood abstinence as safe sex. 

However, the group confronted me with the fact that, even for HIV positive clients, abstinence may be impractical.  Kyle asked, “If I’m in a relationship with an HIV negative person and we both want sexual gratification, what can we do?  I mean, I get tired of masturbation!” 

Candy responded to Kyle.  “Sometimes, my boyfriend and I will have intercourse, but usually we just masturbate together.”  As Candy found, mutual masturbation allows both partners to enjoy sexual gratification together without running the same risk of infection associated with intercourse. Clearly, masturbation is the method of sexual gratification with the lowest risk of viral transmission. Would you agree?

Ross, who was sure of himself regarding disclosing his HIV status, brought up oral sex.  Ross stated, “What about getting or giving head?  That’s how my partner and I usually do it.” The group discussed possible risks and benefits of limiting sexual interaction to oral sex.  I re-emphasized that the only safe sex is no sex. 

However, consensual sex with a knowledgeable partner was frequent among the HIV positive clients in the group. In addition, none of the group members had passed the virus on to their partners at the time of the meeting. I later did some research regarding oral sex and HIV. The Center for Disease Control had done a study regarding oral sex between men. The CDC found that 8 percent of recently infected men who have sex with other men were “infected through oral sex.” 

Also, nearly half of the men who did test HIV positive reported having oral problems, such as occasional bleeding gums. I related this study to Ross, who later stated, “I told my partner about that CDC study. We agreed to always wear condoms during oral sex from now on. And we check each other for any open sores in the mouth or on our penises.” 

Share on Facebook #3  Dangers of Sex
In addition to disclosure tactics and sex, the third topic of group discussion was the dangers of sex.  Clearly, the clients in the group were aware of the danger of infecting their partners.  However, some of the clients in the group were unaware of the risks at which they were putting themselves.  Ross informed the group. 

Ross stated, “I had a friend who was positive.  He was sleeping around and caught a different strain of HIV than the one he already had.  When the doctors found out, they told him it was actually a worse strain that was harder to treat.  My friend’s T-cells went down quickly after that.” 

Other members of the group related similar stories involving other sexually transmitted diseases such as herpes and the human papillomavirus, or HPV.  Aaron stated, “I got genital herpes about a year and a half ago.  My doctor told me that it can actually speed up the progression of HIV.” 

Haley, who had at one time been using latent disclosure tactics, stated, “That alone sounds like a pretty good reason to stay away from sex.” Do you have clients like those in the group?  Could a discussion regarding the dangers of sex benefit your HIV positive client?

On this track we have examined the discussion of one of my groups regarding dating and sex.  Topics included disclosure tactics, sex, and the dangers of sex. 

On the next track we will discuss immune enhancement via emotional healing.  The techniques provided on this track focus on healing emotions and encouraging growth as an additional way HIV positive clients can improve their immune systems.

QUESTION 4
What is the method of sexual gratification with the lowest risk of viral transmission? To select and enter your answer go to CEU Answer Booklet.

 
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