Presentation on theme: "International AIDS Conference Wednesday, July"— Presentation transcript:
1International AIDS Conference Wednesday, July 25 2012 Disclosure & Dating:From early courting to intimacy for teens and young adultsInternational AIDS ConferenceWednesday, July
2Disclosure & Dating Workshop Presented by AIDS Alliance’s Youth Advisory Committee AIDS Alliance for Children, Youth, &Families is a national nonprofit membership organization established in 1994 to give voice to and advocate for women, children, youth, and families living with and affected by HIV and AIDS
3Your Presenters Jahlove Serrano – New York, NY Dee Borrego – Boston, MACristina Jade Peña – San Francisco, CATrell Jackson – Atlanta, GAYuri Velasquez – Miami, FL*For Youth, By YouthEveryone introduces self
4Session Outline Explore four stages of a romantic relationship Define challenges and barriers for HIV disclosure and multidisclosure in a romantic relationshipProvide disclosure-specific communication approaches and tipsThis workshop is on Disclosure and Dating; and offers suggested tips to guide you thru this process if you are interested or ready to disclose.This workshop will help you as you go through the process and what you & your partner may experience emotionallyA quick overview of the topics we will cover during this section of the institute: See slide
5Four Stages of a Relationship Stage 1: Getting to Know YouStage 2: DatingStage 3: IntimacyStage 4: Long-Term Love*The stage or phase of your relationship can help you decide when it’s the right time to discuss serious issues and when it’s the right time for you to discloseWhat do Stages meanOver time a relationship will go through different stages and it is important to always think about the relationship and how you are guiding it*The emotions you encounter may also be very different depending on which stage you are inDisclaimer of StagesThese 4 stages will be used as a model for relationships as they begin and progress, but please not this is not necessary the stages for every or all relationships.Go though the first 3 stages in 24 hoursWhy Use Stages-* Resource: Influenced Intrapersonal Communication Theorist Mark Knapp's Model of Relationship Development (5 Stages of "Coming Together"). I based my organization of the 5 stages (used in the Serodiscordant Relationship) off Knapp's initial concept, however it greatly differs and only pulls from the general organization
6Stage 1- Getting to Know You Definition: Getting to know each other by spending time together, exploring mutual interests, crushing, curious, going out, flirting, holding hands, cuddling, maybe kissing.Keep In Mind: Important phase to begin building & developing trust and respect for each other.Q. Do want to have sex as hook or is a person with potential for a relationship?Will explore concept of trust and respect* Takes time to buildImportant for building a strong relationship-Important to maintain trust and respect throughout the relationship (and throughout different phases)Define: People put high price/priority of trust versus respect, but both are equally important. Trust is about the whole cheating thing.Most have trust in a releationship rather than respectTrust & Respect relate to disclosure and knowing setting the foundation for when you decide to disclose.--“Hello, I love you, Won’t you tell me your name?”---The Doors
7Empowering Your Self to Take Responsibility HIV positive partner must ask self:How is the relationship progressing?Do I need to disclose soon?Am I close to putting my partner at risk?Is our relationship ready for sex?This is an empowerment stage for you to take the responsibility; lack of disclosure and don’t know how to say.This is how to educate about HIV/AIDS.Where is this relationship going?Is it worth if to disclose?Do I want to disclose?We are hoping that those who are shy or timid, will find voice and be more vocal while in a releationship.Level of risk depends/influenced by: Differences between condom usage, type of sexual behavior, if in care or not in care.NOTE: Although both partners are responsible for their mutual and collective well-being, the HIV positive partner must monitor the development and level of risk in the relationship**Example: You might be ready to get physically playful (increase intimacy and risk level), but not ready to disclose HIV statusHow fast the relationship is progressing (emotionally and especially physically) can influence when you need to disclose or consider disclosure seriouslyImportant to recognize who is guiding the speed of the relationship?You?, Your Partner ? Both?* NOTE: Usually one partner will be moreforceful, influential, dominate (emotionallyand/or physically)Note: Usually one partner will be more forceful, influential, dominateFactors that can lead one partner to be more forceful, influential, dominate:▪ Prevalent with partner who identifies as “dominate role”(Note: Typically, in heterosexual relationships: Male- More dominate physically/ Female more dominateemotionally)▪ Prevalent with partner who is older in age▪ Prevalent with partner who is more experienced (Remember: You could be veryexperienced(physically/emotionally) and have only been with one partner)▪ Prevalent with partner who has had more partners-It’s important to recognize if relationship is “severely” unbalanced;ex: physically demanding, moving too quickly,▪ Partner may show early signs of being abusive▪ Partner may show early signs of being violent********************I didn’t disclosue in the beginning and now I do.“I felt so much better about it---get it out of the way”If I tell them and they are not down with it---it’s a lot on my-In any relationship but especially in a serodiscordant relationship, in which the sero-negative partner has not yet been told about the HIV status of the other; the burden of responsibility rests on the HIV +WHAT: is the responsibility?-This includes:keeping the sero-negative partner safe and reducing risky behavior,2.keeping self safe (unknown if partner has an STD/STI that could be threatening to health)3. keeping emotions and privacy protected (in case of relationship break-up),4. monitoring the development (AKA Speed) of the relationship-Responsibility shared once sero-negative partner knows HIV status and becomes (fully) active in the decisions and direction of the relationship
8Responsibility Laws and Rights: Varies by state, region, country Failure to disclose HIV status to partner prior to sexual activity can make you vulnerable to criminal prosecution and/or lawsuit by your sexual partnerBecome familiar with the specific disclosure laws & resources in your region and countryPart of Empowerment is knowing about HIV but also the laws that can protect you too,Knowing the laws & resources can affect how you decide to disclose.* Important to know there are legal ramifications for failing to disclose HIV status prior to engaging in “risky” behavior. (Can be deemed: Attempted murder, aggravated assault with a deadly weapon, attempted manslaughter and manslaughter)A number of states have passed specific statutes that make it a crime for a person to expose another to HIV through sexual activity (regardless of condom use, level of risk and/or if transmission has occurred)**Advise to go to Center for HIV Law and Policy-Take the safe road: tell partner before you put them at risk because1. reduces the chances that they will want to exit the relationship---you have shown respect for their safety and emotions by telling them before any risk has occurred2. Eliminates prospect for prosecution and lawsuit “reckless endangerment.”
9Why to hold off on Disclosing Haven’t established enough trust & respectAt this time, disclosure is unnecessaryOwn safetyEmotionally not ready to discloseNot ready mind, body & soul for relationshipPositive RelationshipOther positive person has to be at same level with HIV status, body, healthThat is not equal More like a parentLast: Understanding where you are at andBeing honest with yourself, maybe you are not ready for a relationshipWhy Disclose:-Physically moving quickly and entering more risky behavior-Emotionally closer and feel an important aspect of life to share with partner-Pressure from outside forces; family, friends, care providers recommend you to tell your partner, need to clarifyrumors, if partner poses questions-Feeling pressure, guilt, anxiety: Just want to get disclosing over withPotential Replacement Question 1: Why would you want to start talking about more “serious” issues like safe-sex, getting tested, and disclosure of status?-Pressure from outside forces; family, friends, care providers recommend you to tell your partner, need to clarify rumors, if partner poses questionsPotential Replacement Question 2: What are the reasons to hold off on having these discussions?*As long as not engaging in risky behavior you have time- Haven’t established enough trust and respect between both partners. Must be a two-way road-Not certain how long-term /serious relationship is or will be?- Still in early phase of relationship (Ex: Week 1, Week 2 or Week 3) *Still crushing, lusting, curious
11Stage 2- DatingDefinition: Consistency in time spent and intimacy together, progressing emotionally and physically, becoming closer, identifying as a couple, falling for each other, feeling in loveTimeframe: Typically, Stage when more “serious” conversation takes place (disclosure, STDs, safety, comfort level, future of relationship)-Typically: when more “serious” conversations begin to happen between partners“Dating Stage” often viewed as preferred time to disclosure HIV status and history to partnerEstablished Trust and Respect in the relationship could help ease negative reactions from partner, helping partner view you as a person with the disease rather then the disease*Nobody can tell you when the perfect time is to disclose, you are in the driver seat.-Underscore that the time of disclosure is different for each person and each relationship. There is no right or wrong way to do it-HIV Disclosure could lead to “Double-Disclosure”▪ If transgender- disclosing HIV status and explaining gender identification▪ Disclosing HIV status and (past/current) drug use▪ Disclosing HIV status and sexual history* Note: Disclose may be a two-way road:Sero-negative Partner my disclose they haveAs the HIV+ individual, you may also be unaware of what your partner may or may not be infected with. If HIV+, the last thing you want is another STD; ex; Herpes, Gonorrhea.---“I, I love you like a love song, baby!” – Selena Gomez
12Reasons to Disclose Physically moving closer and/or ready for sex Emotionally moving closerPressure from outside forcesPartner poses questionsJust want to get disclosing over withWhy Disclose:-Physically moving quickly and entering more risky behavior-Emotionally closer and feel an important aspect of life to share with partner-Pressure from outside forces; family, friends, care providers recommend you to tell your partner, need to clarifyrumors, if partner poses questions-Feeling pressure, guilt, anxiety: Just want to get disclosing over with
13Dual Disclosure and Identity There may be other things you need to disclose about yourself especially if . . .You’re transgenderYou’re bisexualYou’re polyamorousYou have mental health issuesYou have physical health issuesThere’s more to disclosure than just saying, “I’m HIV+”-HIV Disclosure could lead to “Double-Disclosure”▪ If transgender- disclosing HIV status and explaining gender identificationClarify that “Dual Disclosure” is in reality “Multiple Disclosures” for many YPLWHASolely in terms of self-identity, there are many potential things which might need to be revealed to a partner during the dating stage – remind that this stage can range from a few hours to months – especially for trans*, bisexual and poly* folk; also for people with any mental/physical health challengesClarify umbrella term use of “trans*” as meaning as anyone who self-identifies somewhere along the transgender spectrum, inclusive of genderqueer, gender variant, Two-Spirited (&c similar Native terms), and intersex individuals]Trans* people may want/need to tell partner about their body and its history. This is often as uncomfortable and stressful as disclosing HIV status. It can often open up the trans* person for violence, as is witnessed by the countless world-wide murders annually of transgender people commemorated annually on 20 November with the Transgender Day of Remembrance.Trans* person will most likely have to share their current genital status, ie. what exact type of plumbing their partner can expect to find. Not all trans* people will need/want/have to share this information – esp common within “stealth” trans* community. [Define “stealth” if unclear to audience].Trans* person will also be questioned about any hormone replacement therapy or surgical treatments they’ve had or intend to have at some point in the future. Quite frequently trans* people are asked very personal questions about their own medical care/treatment with no regard to their right to privacy of this information. Many cisgender [define cis* if unclear to audience] people feel entitled out of curiosity to ask these questions in any way they see fit.Trans* people also are frequently questioned about their current legal name/gender and what these things were at the time of their birth. It is often posed as a question, “What’s your real name?” which completes ignores the trans* person’s current identity and preferences, reinforcing the gender binary system and the notion that gender is sex and it is fixed at birth.Many trans* people are also encumbered by questions around their competency to make sound medical decisions for themselves, both by their partners and the medical providers themselves. There can also be discussion around the decision-making process (and ability) of the individual around every aspect of their transition (from name choice to surgical choices)For transgender/gender variant/intersex individuals, you may want and/or need to disclose your gender identity and gender history, including:Genital statusHormonal treatmentsSurgical interventionsCurrent legal name/gender and birth name/gender
14Disclosure & HistoryOther aspects of your personal life to consider disclosing that may or may not relate to your HIV statusPast or Present Drug UseViolence, Abuse and/or RapeHIV+ vs. AIDS diagnosisHIV status of other family membersOther aspects of your personal life to consider disclosing that may or may not relate to your HIV status: Read from Slides* Note: Disclose may be a two-way road:Sero-negative Partner my disclose they haveAs the HIV+ individual, you may also be unaware of what your partner may or may not be infected with. If HIV+, the last thing you want is another STD; ex; Herpes, Gonorrhea.
15This is from my year as an exchange student in Norway I was 19 in this picture, taken in spring 2003The students are from around the world.Clockwise from left: Pe’ from Thailand, Seda from Turkey, myself, Juliane then Judith - both from Germany, Judit from Hungary in the center, and Catherine from Arizona doing the splits
16Pre-Disclosure: Things to Consider Is enough trust and respect established ?Prepare for rejectionPractice disclosure dialogueSeek help from Social Service Providers,Caregivers, Physicians, HIV+ mentorsPrepare to Get Emotional - it’s ok!Is there enough trust and respect established-How well do you know partner and they know you?-How long have you been dating? How serious is the relationship?-Is your partner sensing something is wrong/different about your relationship?2. Prepare for rejection-Once you disclose, sero-negative partner makes the decision to stay or leave the relationship-Must be prepared to “lose” your partner, once you disclose-You can’t force a person to be with you and you also can’t avoid telling your partner about your HIV status as relationship processes physically and/or emotionally3. Practice Dialogue-What are you planning to say?-What would you like your partner to know about you?-What would you like your partner to know about HIV/AIDS? (What are going to teach them)-When do you plan to disclose? (Time, Location, etc)-Who do you have to turn to for support after the conversation, if the conversation goes bad?4. Seek Help from Social Service Provides, Caregivers, Physicians, HIV+ mentors-Support Groups are often safe and best places to discuss these issues5. Prepare to get emotional –it may happen and it’s ok-Sometimes prepare words and what say, but overlook the emotions you may have while disclosing. Emotions can take a person by surprise
17Practice Disclosure Dialogue What are you planning to say?What would you like your partner to know about you?What would you like your partner to know about HIV/AIDS?What setting do you plan to disclose in?Who do you have to turn to for support after the conversation, if the conversation goes bad?**CONSIDER as interactive activityWhite card, aud. Picks one question to think about and answer on paper.(What do you want to teach them)(Time, Location, etc)
18“Safer” Conditions for Disclosure ● Alone with partner in private, safe or neutral environment ● Face-to-face ● With a trusted friend or family member ● After you have had a good day together● Before any risky behavior has occurred● After trust and respect is established by both partners● If your partner is asking you questions or probing● If discussing your future togetherClarify that these are what can be considered “safer” conditions, but there’s no universally safe way to discloseTime allowing, aural brainstorm activity:-List of safe and ideal conditions for disclosureUltimately, no matter where/how/when you choose to disclose, it is your decision.Follow thru the rhythm of where, how, and when examples from the slide
19“Less Safe” Conditions for Disclosure ● In public and/or around a large group of people or friends ● Via text, , phone ● Leaving limited time to fully disclose or answer questions ● When HIV+ partner is feeling guilty, depressed, insecure● Right before or during sex/risky behavior ● If you have already put them at risk or had a close call ● After a fight ● When you’re about to break upReiterate that although its your decision where/how/when you disclose, there are some conditions which are inopportune.Time allowing, aural brainstorm activity:-List of less safe and ideal conditions for disclosureFollow the rhythm of where, how, and whenASK Audience:1. Is there such thing as a neutral condition to disclose?2. What about a Clinic, Doctor’s Office, HIV/AIDS Service Center?
20Potential Emotions/Reactions Range of emotions/reactions to disclosureEmotions/reactions can change over timeFrom hours to days to weeks to months to yearsNegativeIndifferentOptimistic● Upon learning HIV status; Sero-Negative Partner can experience and show a range of emotions/reactions- “Negative”- “Indifferent”- “Optimistic”Possible optimistic emotional reactions:-Sympathetic and Compassionate-Curious to better understand you and the disease-Moved by your honesty-Impressed by your strength, pose, life-Surprised that you are infected (ex: you look so good, never would expect it)Possible “negative” emotional reactions;-Angry (that you told them, that you are infected, that you dated them)-Scared (for own safety and health)-Questioning HIV facts, figures, stats-Betrayed that you didn’t confine the truth sooner-Confused that you are infected-Demonize you for being infected-Thinks you deserve it-Shocked that you are infected-Blames you for putting them at any risk-Gets verbally and/or physically abusive-Walks outIndifferent:-Uncertain how to respond-Limited questions or little/no desire to know more about your situation/HIV-Doesn’t want to continue talking about itEmotion and Reactions can change over time (overthe course of hours, days, weeks)* Partner’s reaction will help you determine if should or can move forwardBUT Remember it’s better to tell a partner before you put them at risk because that reduces the chances that they will want to exit the relationship— you have shown respect for their safety and emotions by telling them before any risk has occurred and this can reduce “negative” emotions
21Post-Disclosure: Things to Consider For Yourself:For Your PartnerPrepare to answer questionsClarify: How open you want partner to be with your HIV statusProtect yourself: Tell partner your legal rightsGive partner timeGive partner HIV resourcesGive partner support in decision they make1. Give partner time to think about everything*If you don’t know, say you don’t and plan to look up the answer or ask your doctor2. Prepare to be open and answer questions about HIV honestly-whether it is breaking up and staying friends3. Give partner support in the decision they make-breaking up and not being friends* Don’t be the victim; demonstrate that HIV is apart of your life and its something you want your partner to be understanding and comfortable with-remaining a couple4. Give partner resources and HIV information, or where to turn toLet partner know you would appreciate that they respect your privacy and not disclose your personal information, such as HIV status to other* Confidentiality and Privacy laws protect HIV+ individuals from having their status and personal information shared without consent5. Inform partner of own level of privacy or openness in the community regarding HIV status---Can’t expect partner (or soon to be ex) to take on the burden of this knowledge and not talk about it with someone6. Support partner in speaking to another person, preferable a professional service HIV provider-Our nature is to seek advice and guidance from others
22Red Light Green Light Read & listen to each scenario Would you disclose based off this scenario?Decide; hold up selected color paperRed Paper – No, will absolutely NOT discloseYellow Paper – Requires cautionGreen Paper – Yes, willing to discloseSET-UPSigns on the “Willing to Disclose My HIV Status” side of the room:“STOP/RISKY” (Red)“CAUTION” (Yellow)“GO/SAFE” (Green)Signs on the “NOT Willing to Disclose My HIV Status” side of the room:ACTIVITY SUMMARYRead scenarios from a list (max 2-3)SAMPLE: Hugging#1: Unprotected Oral Sex#2: French Kissing or Tongue KissingOPTIONAL: Protected Anal or Vaginal SexInstruct the participants to move to the side of the room and under the sign that best describes what they would doAsk selected volunteers why they are standing where they areModerator provides feedbackLarge group process before conclusionInclude brainstorming a list of ideal and not-so-ideal conditions to disclose
23Scenario 1: Friends –turned-Lovers Meet Jamal and CourtneyFriends since middle schoolNow in collegeJamal wants to date CourtneyCourtney is HIV+*Should Courtney disclose her HIV status now?Jamal and Courtney have been friends from middle school and now are juniors in college. Jamal decides to express his interest in Courtney on a romantic level and asks her if she wants to change their friendship to a relationship. Although they are good friends, Courtney chose not to disclose her HIV status to Jamal and is now faced with making a decision about dating him all together and disclosing her HIV status
24Scenario 2: Last Test Meet Angela and Shawn Just started dating During drive home, Angela asks Shawn: “When was the last time you got tested for HIV or an STI, and what were your test results?”Shawn is HIV +*Should Shawn disclose his HIV status now?Angela and Shawn are dating for a few months and in that in between time where they will decide to enter into a relationship or part ways. While on a drive home Shawn asks Angela “When was the last time you got tested for HIV/STI, and what were your results?”
25Scenario 3: Got Condoms? Meet Jason and Timothy Just started seeing each otherShare a bottle of wine while watching a movie.Kissing evolvesJason asks: “Do you have condoms?”Timothy is HIV+*Should Timothy disclose his HIV status now?Jason and Timothy just meet a few weeks ago. They decide to hang out, have beers and watch a movie until that initial kiss. Then kissing evolves into Jason asking about condoms, and Timothy has to make a quick decision about having sex and disclosing his HIV positive status.
26Scenario 4 “I Love You” Meet Tonya and Kris Tonya and Kris have been dating for over 2 monthsKris tells Tonya “I love you!”Tonya feels the same way toward KrisTonya is HIV +*Should Tonya disclose status now?Tonya and Kris have been dating a short time, maybe a month. Unexpectedly Kris tells Tonya that he is in love with her. Tonya is now forced to decide if Kris declaration of love should prompt her to disclose her HIV positive status to Kris. Tonya is newly diagnosed and Kris is the first person she has dated since being diagnosed a year ago.
27Stage 3- IntimacyDefinition: Engaging in any/all risky sexual behavior, emotional attachment increasingTimeline: May occur soon after or instead of a dating stage. At this point the partners have built enough trust to explore a deeper emotional and physical connectionTransition: To IntimacyHowever life isn’t always that simple and sometimes a relationship will progress or move physically quickly into risky behaviorSometimes disclose just doesn’t happen before intimacy and rather realistically discloser will occur right before/during/after a level of physical intimacyNote: Usually physical intensity adds more pressure to disclose HIV status rather then emotional need._________________________________________________________________________________________Partner might not know everything about HIV but willing to learn and better understand how to be a seronegative partnerDecision to continue dating is largely dependent on sero-negative partner’s reaction and expectationsExpect a combination of reactions from partner upon finding out about HIV status (Ex: Positive Emotional Reactions, Negative Emotional Reactions and/or some level of IndifferenceIntimacy Stage– where things go from complicated to emotionally intense---“It’s getting hot in here (so hot)” -Nelly
28Post-Disclosure: How to Decide to Continue the Relationship? Do both partners “want” to make the relationship workDo both partners have similar expectations for the relationship?Are both partners ready to be mature and thoughtful moving forward in the relationshipMutual understanding: Much to learn about selves, one another and how to work together________________________________________________________________________Always be mindful that the negative partner may be at times fearful of possible risks (ex. Condom brake, unexpected pregnancy due to condom brake, etc).Hence, partners should always maintain good communications and constantly educate themselves about HIV.Education is key to discriminate stigmaEngage in routine counseling & testingParticipate in support groupsInteract with other HIV+ and possible couples, who were or are currently in your situationI’ve noticed that couples who are serious about the relationship often go to doctor’s visit together and the negative partner becomes more in-tune with his/her own health.Negative partners become curious and ask to accompany the patient to the doctorThis is a great opportunity to counsel the couple and give the negative partner a chance to interact and ask ALL possible questions from a medical provider
29Having Sex and Being Safe ● How to prepare for safe sex?1. Seek professional support & ask questions2. Learn preventative safe sex practices3. Talk to each other: understand level ofcomfort● Why practice safe sex?- Keep partner HIV Free- Prevent unwanted pregnancy- Reduce risk of acquiring other STIs & STDs.● How to prepare for safe sex?1. Ask questions and talk to HIV Physicians, Health Care Providers, Social-Psycho Support2. Know Preventative Safe Sex Practices3. Have Conversations with each other to gauge comfort level____________________________________________How to prepare for safe sex?1. Ask questions and talk to HIV Physicians, Health Care Providers, Social-Psycho Support *Preferably together2. Know how to engage in preventative safe sex practices-Know how to correctly use male condoms-Know how to correctly use female condoms-Know level of risk for each behaviorMost risky= unprotected anal sex (bottom)Highly risky=unprotected vaginal sexRisky=unprotected oral sex (ingestion of HIV infected fluids)-Avoid oral sex and contact with HIV infected fluids, after a medical procedure in the mouthLeast/Minimal risk=protected anal, vaginal, oral sexLeast/No risk =Masturbating partnerLeast/No risk=kissing mouth-to-mouth********Ask Linda aboutTalk to Physician about writing a “anti-retroviral” prescription, AKA “post-exposure prophylaxis (NPEP/PEP)” to partner as a safety precaution * sometimes deemed “Non-Occupational PEP”-Could help reassure and reduce partner apprehension-Could further induce fear and apprehension******4. Have conversations with each other to gage comfort level*Can’t NOT talk about thisSexWhy practice safe sex-Top Goal: To keep partner HIV FreeAlso to reduce pregnancy or spread of other STDs***Should always practice safe sexTips for Serodiscordant Couple-Be responsible to each other “Check and Balance”-Work as a team to protect one another-Both equally responsible for safety
30Levels of Risky Behavior ● Non Risky- Kissing, holding hands, masturbating● Very Minimal Level Risk- Protected/Safe Anal, Vaginal & Oral Sex● High Level Risk- Unprotected Anal, Vaginal, Oral Sex- Exchange of bodily fluids (ie: vaginal, blood, semen)Definition-engaging in any/all riskybehavior, Emotional attachmentincreasing●**Intimacy where things go from complicated to an intense emotional rollercoasterHigh Level RiskOral Sex*Clarify what is risky:HIV/STD + Girl=Receiving oral sex, so going down on herHIV/STD + Boy=Receiving oral sex, so getting a blow job● Rubbing privates together, ex: penis tip rubbing outsideof vagina, this induces wetness, fluids● Vaginal sex● Anal sexMedium Level Risk● Masturbating Female Partner/Fingering, level ofcomfort and being respectful of other partner● Masturbating Male Partner/ Jacking off, level of(ex: If partner has herpes and you are touchinggenital, you would expect they told you about theirstatus in advance, HIV is the same way)● Dry humping w/out clothes----then on your way tohaving sex that night
31What Can Lead to Unsafe/Risky Sex? ● Under the influence● “Quickie”/ Caught up in the moment● Protection Burnout● Curious● Belief that risk level not high● Pressures from partner● Apathy toward HIV infection● Denial● Belief that HIV is “no big deal”● In long-term relationship**The potential of “Close Call” situations show why HIV status discloser is so important ---if both partners are aware of risk and responsible of outcomes ---then this should help to counter deemed-risky behaviorWhat causes/situations could lead to unsafe sex practices?-Under the influence of alcohol or drugs-Rushed for time/Engaging in a “Quickie”-One-night Stand-Protection Burnout *Safe sex takes work-Caught up in the moment, Not willing to break the passion/moment for protection-Curious to have unprotected-Feel close enough to have unprotected sex, think unprotected sex takes intimacy to new level-Believe risk level not that high-Viral load of HIV+ undetectable, CD-4 count high, very healthy-In long-term relationship-Serodiscordant Partner continues to test negative-One partner pressure other-Seronegative partner not concerned with risk, apathy toward HIV infection-Denial-doesn’t believe can get it, *pregnancy effect=It can’t happen to me-Believe HIV is a manageable disease, no big deal**NOTE: More excuses NOT to practice or overlook having safe sex!
32Close CallsSteps to Take: 1. Stay calm 2. Call HIV physician, clinic, center 3. Go to HIV clinic or hospital 4. Discuss severity of risk with professional and if PEP is neededExposure- any situation where there would be a risk of transmission if one partner was HIV +Follow up with your doctor for the best medical adviceAsk your doctor about using PEP or PrEPKnowing the facts will make you more confident and help to answer the questions your partner might have
33PrEP vs. PEP PrEP (Before Exposure) PEP (After Exposure) Pre-Exposure ProphylaxisARVs taken before exposure to reduce chance of getting HIVAsk doctor$$$Post-Exposure ProphylaxisARVs after exposure to reduce chances of infectionAsk doctor$$$What is PrEP?Using HIV drugs before exposure to reduce the chance of getting HIVuses two HIV drugs (tenofovir and FTC) in one pill (called Truvada) before (and after) exposure to reduce infection.What is PEP?Using HIV drugs after exposure to reduce the chance of infectionUsually involves taking a combination of 3 drugs for 28 days
34Photo shoot for Greater than AIDS campaign Karaoke night in DC with CristinaLobbying at the Hill on Advocacy day (VOICES conference)Miami’s AIDSWALK- with coworkers
35It’s important to work together to continue “HIV risk-reduction” Stage 4- Long Term LoveDefinition: Committed in a relationship for 2+ years, continuing to grow physical and emotional intimacy; considering a life together (ex: moving in together, marriage, starting a family)It’s important to work together to continue “HIV risk-reduction”-How to Continue Reducing Risk?*Note: As the relationship progresses, increase risk of HIV transmission with each encounterAlso, as the relationship progresses overtime, riskier behavior can ensueWhy: -Protection burnout- Serodiscordant Partner continues to test negative- Serodiscordant Partner no longer concerned with risk, apathytoward HIV infection- Viral load of HIV+ undetectable, CD4 count high, appearshealthy- Feels close enough to have unprotected sex, think unprotectedsex takes intimacy to new level1. Continue Practicing Safe Sex (make it easy on yourself, keep a big box of condoms in your bedroom)2. Continue Regular HIV and STD Testing3. Communicate regularly with Health Care Providers-Ask questions-Ask about new treatment options-Ask about new studies to reduce risk in serodiscordant partners-Ask about vaccine research4. Communicate regularly with each other about feeling regarding infection, safety, emotions, frustrations-Talk it out, rather then act it out.-Show you love your partner in other ways then through unprotected sex---“I got you babe, I got you babe”- Sonny & Cher
36Emotions Both Partners Can Experience Overtime For HIV+ Partner:For Partner:Happy in relationship and lovedConcern with becoming infectedNot enough concerned over own health & riskFear for your HIV+ healthFear inner circle/outside world’s impressionHappy in relationship and lovedConcern with infecting partnerConcern with rejected by partnerFear partner will disclose without your consentFear partner’s inner circle will not accept you● Overtime, partners can experience varying emotions and concerns for one another and themselvesEx: Happy to be loved and in a relationship, while also experiencing anxiety, fear, sadness● Partners often experience contradicting emotions and concerns at the same timepartners● Outside Pressures, such as family, friends and work can influence emotions and concerns felt by bothEmotions felt by Seropositive Partner:1. Happy to be in relationship and lovedEmotions can include:2. Concern with infecting partnerimmediate-Stress,- Sadness- Fear- Anxiety- Depression- Frustration-Guilt for expressing physical intimacy, or engaging in risky behavior- Don’t want to be a bad person, be a “killer” by infecting them- Don’t want to ruin partner’s life-Hyper-Sensitive to any signs, *If seronegative partner sneezes, you freak-out-Reluctant to engage in intimacy- Showing emotional or physical distance in relationship (Kamikaze-Effect on Relationship)- Pressure to create/maintain good intimacy, with protection- Pressure to show/prove your love through physical intimacy3. Concerned with being rejected by partner- Fear using safe sex practices is going to push away our partner- Fear the stress of HIV is going to push away your partner- Fear of making accepting partner “angry” *Can lead to abusive relationship, unbalanced-power-Rush partner into becoming part of HIV/AIDS world4. Fear partner will disclose without your consent- Fear partner will/is spreading rumors- Fear, anxiety, stress, etc. that partner will talk-**Usually, reputation not on the line, because they are NOT infected5. Fear partner’s inner circle (family, friends, coworkers) will not accept youEmotions felt by Sero-Negative Partner2. Concern with becoming infected- Frustration, Stress-Anxiety-Isolated *HIV+ has plenty of support, but seronegative partners tend to be more limited-Uncertainty, Confusion *what is safe and what isn’t-All responsibility placed on HIV+ partner3. Not enough concern/ accountability over own health and risk of infection-HIV + partner forced to carry all neg. emotions for both them and their partnerEx: Not willing to meet HIV Care Providers, not willing to talk about HIV, not willing to ask questions-Not willing to be involved with partner’s “HIV World”-Concern, Stress, Anxiety, Sadness4. Fear for HIV+ partner’s healthy and safety-If HIV+ partner gets sick, freaks out-Unintentionally takes on more of a “caregiver role”- Ashamed to be putting self at risk- Ashamed to be dating HIV + person5. Fear of inner/outside world’s impression- Too fearful with how others will react-Uncertain about how other will react-Unwilling to tell family-Too trusting with how others will react-Prepare for negative reactions/indifferent reactions from seronegative partner’s family● FamilyOutside Pressures-Ways to overcome this and reduce negative reactions:-The younger the age of the couple/seronegative individual, the more concern, dislike and even angry will be expressed by family members2. Offer seronegative partner’s family informational material, call-concerns/issues1. Hold conference between both partner’s families to discuss3. Get tested and show family your results to help elevate fearshotline● Friendsbenefits, services4. Invite seronegative partner’s family to” HIV World,” fundraisers,-Can also express dislike, concern with friend engaged in-Usually more forgiving then family membersserodiscordant relationship
38Making HIV & STI Testing Routine Discuss why testing is importantShare how you both feel about HIV/STI testingDecide on regularity of testingConsider going togetherMany people will be surprised to find out how supportive their partner can be and how this conversation can bring them closer.Ask your partner how he/she feels about getting testedStress the importance of knowing your HIV statusSuggest going togetherRemember : In a healthy relationship you can talk about anything including HIV, STDs and getting testedTalking Tips“I want to talk to you about things that we can do to have safer sex”"You know, I really love you. We have been together for a while, but we never got tested for HIV. I hate the thought that I could be putting you at risk, because I could not stand to hurt you. Why don't we go get tested together for our peace of mind?"
39Safe Sex: Fun, Frisky, Do-able Safe sex shows you care about the health ofyourself and partner(s)Know how to correctly use male/female condomsKeep condoms nearbySupport each other in maintaining safe sex practices* Safe Sex takes work, communication & understanding *Choosing to have safer sex shows that you care about the pleasure and health of yourself and your sexual partner(s)There are a lot of couples whose HIV status is differentYou can have a full and active sex life without your partner ever getting HIVCondoms if used correctly can protect your partner against HIV and other STDSAsk questions and talk to HIV/STD physicians, health-care providers, social-psycho support* Preferably together● Know how to engage in preventative safe-sexpractices- Know how to correctly use a male condom- Know how to correctly use a female condom- Know level of risk for each behaviorHigh risk- Unprotected oral, vaginal and anal sexMinimal risk- protected oral, vaginal and anal sexLeast risk- Kissing mouth-to-mouth, masturbating● Remember: Relationships take work, communication andunderstandingDefinition – Committed in a relationship for 2+ years, continuing to grow emotional and physical intimacy- Continue Practicing Safe Sex* Keep a big box of condoms (male orfemale) by your bed- Continue regular HIV/STD testing- Communicate regularly with health care providers and physicians-Communicate regularly about feelings infection, safety, emotions, frustrations* Show you love your partner in other ways then through unprotected sex
40Other Aspects of Relationship ● HIV is just one component of a relationship● However, HIV can affect other aspects in a relationship- Finances - Needs- Career Ambitions - Residency- Emotional Stability - Family● Remember HIV will be a factor in the relationship, but should never be “everything” in the relationshipOther aspects HIV can affect in a relationship-Financial independence/stability-Ability to work/ develop career-Activity level of HIV+ partner ex: Can keep up in activity level with seronegative partner?-Depression in HIV+ partner and/or seronegative partner- Amount of time spent receiving care, being admitted into clinics,hospitals, therapy-Can be taxing- Ability to relocate and/or travel, if required to stay near Health CareServices and/or in location to benefits-Starting a family
41Happy, Healthy and Successful Relationships Require: Love!CommitmentStrong CommunicationPatienceBelief in RelationshipTrustResponsibilityHonestyUnderstandingFunRespectResponsibilityHonestyUnderstandingFunRespectClosing RemarksHappy, healthy and Successful Serodiscordant Relationships Take:Commitment and Responsibility- From both partners to make it work-Commitment to being safe and seeking answers2. Strong Communication- between partnersWith health care providers, physicians and support team3. Honesty-about desires, emotions, insecurities4. Patience and Understanding-Takes time to build trust and respect-A level of Maturity5. Belief in your relationship6. Have Fun:-Dream, Laugh and Loveand . . .
42Any Final Questions?We are not experts on the legal issues surrounding HIV disclosure and you should consult local expertsWe have compiled a resource guide of experts and it is also available on our website at org
43Questions About Legal Issues? ● We are not experts in the legal issues surrounding disclosure and we suggest you may want to contact an expert as you go through this process.We have developed a list of some resources for more information and to help you identify experts regarding issues in your area.This resource guide is also on our website at
44Helpful Tools Resource guide created to assist youth in finding support around disclosing in their day-to-day livesSourceService(s) ProvidedDescriptionWebsite or addressContact InfoThe Center for HIV Law and Policy HIV law and policy/ legal supportNational legal and policy resource and strategy center for people living with HIVCatherine HanssensExecutive DirectorHIV Law ProjectLegal support/ HIV Law and policyLegal agency providing services to low-income people living w/HIV/AIDS in New York CityTracy L. Welsh, Esq.National AIDS HotlineCounseling, testing, legal supportHIV/AIDS counseling and testing resources for discrimination and other legal issues1-800-CDC-INFOGay Men’s Health CrisisCounseling, support, hotlineHotline for those newly diagnosed trying to access HIV/AIDS resources1-800-AIDS-NYCInternational:
45Helpful Tools Created by AIDS Alliance Youth Advisory Council- 2012 SourceService(s) ProvidedDescriptionWebsite or addressContact InfoHIV Law ProjectLegal support/ HIV Law and policyLegal agency providing services to low-income people living w/HIV/AIDS in New York CityTracy L. Welsh, Esq.Executive DirectorUS Dept. of Health & Human Services, Office for Civil RightsLegal support/ civil rightsPrincipal agency to bring forth discrimination complaints based on HIV statusAIDS.orgHIV/AIDS resourcesNumerous resources around HIV/AIDS in the USThe BodyWebsite that offers innumerable HIV/AIDS resourcesCreated by AIDS Alliance Youth Advisory Council- 2012
46Helpful Tools Created by AIDS Alliance Youth Advisory Council- 2012 SourceService(s) ProvidedDescriptionWebsite or addressContact InfoState Health Facts HIV related Health informationProvides up-to-date, easy-to-use health data including HIVCriminal HIV Transmission Blog Opinions and resources related to HIV crimesCollection of published news stories, opinion and resources about so-called HIV crimesThe Canadian HIV/AIDS Legal NetworkHIV law and policy/ legal supportLegal network that promotes the human rights of people living with and vulnerable to HIV/AIDSAmericans with Disabilities Act Information & Assistance HotlineEducation and legal supportAssistance navigating HIV lawsinternational:Center for Disease Control Business & Labor Resource CenterWorkplace support and educationComprehensive workplace HIV/AIDS programsinternational:Created by AIDS Alliance Youth Advisory Council- 2012
47Helpful Tools Created by AIDS Alliance Youth Advisory Council- 2012 SourceService(s) ProvidedDescriptionWebsite or addressContact InfoAIDSLEXHIV Law and Human Rights EducationThis free e-Library has resources on HIV-related legal issues and human rights issues.International Labor Organization(HIV/AIDS Division)International policy developmentPractical guidelines and policy development for international communitiesHIV Travel HIV and travel-related informationinformation on current HIV travel restrictions, including short-term stays and visasCreated by AIDS Alliance Youth Advisory Council- 2012