6
PERSPECTIVES: UNINFECTED GAY & BISEXUAL MEN
Numbness. Consider whether the HIV epidemic has so deeply affected a client’s life that he or she is unable to feel anything at all upon receiving a negative test result. Respond with a more measured session that gives clients extra time to consider feelings about testing negative. Help clients recognize their reactions are understandable. Assess the extent to which a client is comfortable acknowledging his or her feelings. At this point, some clients may attempt to dismiss their concerns. They may say, for instance, that their challenges are insignificant compared to someone who is infected. Validate that the needs and concerns of someone who is uninfected are important. Primary Prevention: Remaining Uninfected Recognize that the time just after receiving a negative test result can be one of the riskiest for HIV infection. Learn the extent to which a client values the prospect of remaining uninfected, both now and in the past. When a client displays ambivalence, learn more about this. For instance, a client References 1. Unpublished data. Based on personal conversation with Robin Ortiz-Young, UCSF AIDS Health Project, May 31, 1996. 2. Unpublished data. Based on personal conversation with Doug Hein, Boston Public Health AIDS Services. May 17, 1996. 3. Truax SR. Unpublished data. State of California, Department of Health Services, Office of AIDS. October 1996. 4. McFarland W, Fischer-Ponce L, Katz MH. Repeat negative human immunodeficiency virus (HIV) testing in San Francisco: Magnitude and characteristics. American Journal of Epidemiology. 1995; 142(7): 719- 723. 5. Hein D, Beverley G, Longo V, et al. A short-term support and education group for HIV-negative gay and bisexual men. Boston Public Health AIDS Services and Fenway Community Health Center. May 1996: 5. 6. Ibid, p. 6.
Negotiation with Partners Help clients develop skills to negotiate the safety they need in terms of the risks they are willing to accept. Assess a client’s negotiation skills and learn how a client communicates with partners. To what extent do clients believe they are able to talk with sex partners about sex beforehand? Do they believe they can let partners know what they will and will not do, and what they like and do not like? Are there ways they can communicate during sex to let partners know what feels comfortable or unsafe? People who are uninfected may
grow weary of negotiating with partners, and, without accurate information, make assumptions about the serostatus of partners as a way to avoid negotiating. Assess the extent to which clients base the behaviors in which they engage on assumptions of a partner’s serostatus, and explore the dangers of doing so. Negotiating sex in or out of preexisting relationships involves balancing positive feelings toward sex with concern of contracting HIV. Learn what is important to a client in sexual encounters. Understanding the importance of specific parts of the sexual experience is crucial to negotiation. If a client skips this step, he may find continual dissatisfaction with safer sex, and may abandon altogether safer sex guidelines. Discuss trust. What does trust mean to a client? What trust does a person place in a partner who says he or she is uninfected? Trust may mean believing that a partner engages only in safer sex outside a relationship or it may mean believing that partners with HIV infection will respect the client’s boundaries of acceptable and unaccept-
7. Odets W. In the Shadow of the Epidemic: Being HIV-Negative in the Age of AIDS. 1995; Durham: Duke University Press, p. 16.
16. Gold RS. Rethinking HIV Prevention Strategies for Gay Men. FOCUS: A Guide to AIDS Research and Counseling. 1995; 10(3): 1-4.
8. Unpublished data. Based on personal conversation with Michael Discepola, UCSF AIDS Health Project, March 26, 1996, May 24, 1996.
17. Gold RS, Skinner MJ, Ross MW. Unprotected anal intercourse in HIV-infected and non-HIV-infected gay men. The Journal of Sex Research. 1994; 31(1): 59-77.
9. Discepola.
18. Ibid.
10. Moon T. A case for HIV-negative social services: Part 1. San Francisco Sentinel. January 11, 1993. p. 18-23.
19. Ibid.
may say he or she does not want to become infected, but state there is no reason for “sticking around” when others are ill or dead. When discussing safer sex behaviors, acknowledge the loss of not being able to engage in sex “naturally,” without protection, and a client’s feelings about this. Also, be aware that some clients may engage in relatively low-risk behaviors, but overestimate their risks based on their experience of being surrounded by so many people who are infected.
11. Hein, p. 5. 12. Odets. 13. Unpublished data. Based on personal conversation with Ed Wolf, UCSF AIDS Health Project, April 4, 1996. 14. Remien RH, Carballo-Dieguez A, Wagner G. Intimacy and sexual risk behaviour in serodiscordant male couples. AIDS Care. 1995; 7(4): 429-438. 15. Johnston, WI. HIV-Negative: How the Uninfected are Affected by AIDS. New York: Plenum Press, 1995. p. 147.
20. Ibid. 21. Hansell PS, Budin WC, Russo P. Seronegative children in HIV-affected families. FOCUS: A Guide to AIDS Research and Counseling. 1994; 8(6): 1-4. 22. Mayes SD, Elsesser V, Schaefer JH, et al. Sexual practices and AIDS knowledge among women partners of HIV-infected hemophiliacs. Public Health Reports. 1992; 107(5): 504-514. 23. Odets, p. 207. 24. Unpublished data. Based on personal conversation with Alvin Novick, Yale University, June 5, 1996.