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HIV: Therapeutic Strategies for Guilt, Uncertainty, Taking Control
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?
#1 Disclosure Tactics
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."
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!"
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."
#3 Dangers of Sex
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."
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.
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