International AIDS Conference Wednesday, July

International AIDS Conference Wednesday, July 25 2012
Disclosure & Dating: From early courting to intimacy for teens and young adults International AIDS Conference Wednesday, July

Disclosure & 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

Your Presenters Jahlove Serrano – New York, NY
Dee Borrego – Boston, MA Cristina Jade Peña – San Francisco, CA Trell Jackson – Atlanta, GA Yuri Velasquez – Miami, FL *For Youth, By Youth Everyone introduces self

Session Outline Explore four stages of a romantic relationship
Define challenges and barriers for HIV disclosure and multidisclosure in a romantic relationship Provide disclosure-specific communication approaches and tips This 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 emotionally A quick overview of the topics we will cover during this section of the institute: See slide

Four Stages of a Relationship
Stage 1: Getting to Know You Stage 2: Dating Stage 3: Intimacy Stage 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 disclose What do Stages mean Over 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 in Disclaimer of Stages These 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 hours Why 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

Stage 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 build Important 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 respect Trust & 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

Empowering 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 status How fast the relationship is progressing (emotionally and especially physically) can influence when you need to disclose or consider disclosure seriously Important to recognize who is guiding the speed of the relationship? You?, Your Partner ? Both? * NOTE: Usually one partner will be more forceful, influential, dominate (emotionally and/or physically) Note: Usually one partner will be more forceful, influential, dominate Factors 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 dominate emotionally) ▪ Prevalent with partner who is older in age ▪ Prevalent with partner who is more experienced (Remember: You could be very experienced (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

Responsibility 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 partner Become familiar with the specific disclosure laws & resources in your region and country Part 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 because 1. 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 2. Eliminates prospect for prosecution and lawsuit “reckless endangerment.”

Why to hold off on Disclosing
Haven’t established enough trust & respect At this time, disclosure is unnecessary Own safety Emotionally not ready to disclose Not ready mind, body & soul for relationship Positive Relationship Other positive person has to be at same level with HIV status, body, health That is not equal More like a parent Last: Understanding where you are at and Being honest with yourself, maybe you are not ready for a relationship Why 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 clarify rumors, if partner poses questions -Feeling pressure, guilt, anxiety: Just want to get disclosing over with Potential 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 questions Potential 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

Stage 2- Dating Definition: Consistency in time spent and intimacy together, progressing emotionally and physically, becoming closer, identifying as a couple, falling for each other, feeling in love Timeframe: 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 partner Established 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 have As 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

Reasons to Disclose Physically moving closer and/or ready for sex
Emotionally moving closer Pressure from outside forces Partner poses questions Just want to get disclosing over with Why 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 clarify rumors, if partner poses questions -Feeling pressure, guilt, anxiety: Just want to get disclosing over with

Dual Disclosure and Identity
There may be other things you need to disclose about yourself especially if . . . You’re transgender You’re bisexual You’re polyamorous You have mental health issues You have physical health issues There’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 identification Clarify that “Dual Disclosure” is in reality “Multiple Disclosures” for many YPLWHA Solely 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 challenges Clarify 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 status Hormonal treatments Surgical interventions Current legal name/gender and birth name/gender

Disclosure & History Other aspects of your personal life to consider disclosing that may or may not relate to your HIV status Past or Present Drug Use Violence, Abuse and/or Rape HIV+ vs. AIDS diagnosis HIV status of other family members Other 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 have As 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.

This is from my year as an exchange student in Norway
I was 19 in this picture, taken in spring 2003 The 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

Pre-Disclosure: Things to Consider
Is enough trust and respect established ? Prepare for rejection Practice disclosure dialogue Seek help from Social Service Providers, Caregivers, Physicians, HIV+ mentors Prepare 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 emotionally 3. 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 issues 5. 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

Practice 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 activity White card, aud. Picks one question to think about and answer on paper. (What do you want to teach them) (Time, Location, etc)

“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 together Clarify that these are what can be considered “safer” conditions, but there’s no universally safe way to disclose Time allowing, aural brainstorm activity: -List of safe and ideal conditions for disclosure Ultimately, 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

“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 up Reiterate 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 disclosure Follow the rhythm of where, how, and when ASK Audience: 1. Is there such thing as a neutral condition to disclose? 2. What about a Clinic, Doctor’s Office, HIV/AIDS Service Center?

Potential Emotions/Reactions
Range of emotions/reactions to disclosure Emotions/reactions can change over time From hours to days to weeks to months to years Negative Indifferent Optimistic ● 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 out Indifferent: -Uncertain how to respond -Limited questions or little/no desire to know more about your situation/HIV -Doesn’t want to continue talking about it Emotion and Reactions can change over time (over the course of hours, days, weeks) * Partner’s reaction will help you determine if should or can move forward BUT 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

Post-Disclosure: Things to Consider
For Yourself: For Your Partner Prepare to answer questions Clarify: How open you want partner to be with your HIV status Protect yourself: Tell partner your legal rights Give partner time Give partner HIV resources Give partner support in decision they make 1. 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 doctor 2. Prepare to be open and answer questions about HIV honestly -whether it is breaking up and staying friends 3. 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 couple 4. Give partner resources and HIV information, or where to turn to Let 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 consent 5. 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 someone 6. Support partner in speaking to another person, preferable a professional service HIV provider -Our nature is to seek advice and guidance from others

Red Light Green Light Read & listen to each scenario
Would you disclose based off this scenario? Decide; hold up selected color paper Red Paper – No, will absolutely NOT disclose Yellow Paper – Requires caution Green Paper – Yes, willing to disclose SET-UP Signs 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 SUMMARY Read scenarios from a list (max 2-3) SAMPLE: Hugging #1: Unprotected Oral Sex #2: French Kissing or Tongue Kissing OPTIONAL: Protected Anal or Vaginal Sex Instruct the participants to move to the side of the room and under the sign that best describes what they would do Ask selected volunteers why they are standing where they are Moderator provides feedback Large group process before conclusion Include brainstorming a list of ideal and not-so-ideal conditions to disclose

Scenario 1: Friends –turned-Lovers
Meet Jamal and Courtney Friends since middle school Now in college Jamal wants to date Courtney Courtney 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

Scenario 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?”

Scenario 3: Got Condoms? Meet Jason and Timothy
Just started seeing each other Share a bottle of wine while watching a movie. Kissing evolves Jason 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.

Scenario 4 “I Love You” Meet Tonya and Kris
Tonya and Kris have been dating for over 2 months Kris tells Tonya “I love you!” Tonya feels the same way toward Kris Tonya 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.

Stage 3- Intimacy Definition: Engaging in any/all risky sexual behavior, emotional attachment increasing Timeline: 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 connection Transition: To Intimacy However life isn’t always that simple and sometimes a relationship will progress or move physically quickly into risky behavior Sometimes disclose just doesn’t happen before intimacy and rather realistically discloser will occur right before/during/after a level of physical intimacy Note: 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 partner Decision to continue dating is largely dependent on sero-negative partner’s reaction and expectations Expect a combination of reactions from partner upon finding out about HIV status (Ex: Positive Emotional Reactions, Negative Emotional Reactions and/or some level of Indifference Intimacy Stage– where things go from complicated to emotionally intense ---“It’s getting hot in here (so hot)” -Nelly

Post-Disclosure: How to Decide to Continue the Relationship?
Do both partners “want” to make the relationship work Do both partners have similar expectations for the relationship? Are both partners ready to be mature and thoughtful moving forward in the relationship Mutual 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 stigma Engage in routine counseling & testing Participate in support groups Interact with other HIV+ and possible couples, who were or are currently in your situation I’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 doctor This 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

Having Sex and Being Safe
● How to prepare for safe sex? 1. Seek professional support & ask questions 2. Learn preventative safe sex practices 3. Talk to each other: understand level of comfort ● 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 Support 2. Know Preventative Safe Sex Practices 3. 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 together 2. 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 behavior Most risky= unprotected anal sex (bottom) Highly risky=unprotected vaginal sex Risky=unprotected oral sex (ingestion of HIV infected fluids) -Avoid oral sex and contact with HIV infected fluids, after a medical procedure in the mouth Least/Minimal risk=protected anal, vaginal, oral sex Least/No risk =Masturbating partner Least/No risk=kissing mouth-to-mouth ********Ask Linda about Talk 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 this Sex Why practice safe sex -Top Goal: To keep partner HIV Free Also to reduce pregnancy or spread of other STDs ***Should always practice safe sex Tips for Serodiscordant Couple -Be responsible to each other “Check and Balance” -Work as a team to protect one another -Both equally responsible for safety

Levels 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 risky behavior, Emotional attachment increasing ●**Intimacy where things go from complicated to an intense emotional rollercoaster High Level Risk Oral Sex *Clarify what is risky: HIV/STD + Girl=Receiving oral sex, so going down on her HIV/STD + Boy=Receiving oral sex, so getting a blow job ● Rubbing privates together, ex: penis tip rubbing outside of vagina, this induces wetness, fluids ● Vaginal sex ● Anal sex Medium Level Risk ● Masturbating Female Partner/Fingering, level of comfort and being respectful of other partner ● Masturbating Male Partner/ Jacking off, level of (ex: If partner has herpes and you are touching genital, you would expect they told you about their status in advance, HIV is the same way) ● Dry humping w/out clothes----then on your way to having sex that night

What 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 behavior What 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!

Close Calls Steps 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 needed Exposure- any situation where there would be a risk of transmission if one partner was HIV + Follow up with your doctor for the best medical advice Ask your doctor about using PEP or PrEP Knowing the facts will make you more confident and help to answer the questions your partner might have

PrEP vs. PEP PrEP (Before Exposure) PEP (After Exposure)
Pre-Exposure Prophylaxis ARVs taken before exposure to reduce chance of getting HIV Ask doctor $$$ Post-Exposure Prophylaxis ARVs after exposure to reduce chances of infection Ask doctor $$$ What is PrEP? Using HIV drugs before exposure to reduce the chance of getting HIV uses 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 infection Usually involves taking a combination of 3 drugs for 28 days

Photo shoot for Greater than AIDS campaign
Karaoke night in DC with Cristina Lobbying at the Hill on Advocacy day (VOICES conference) Miami’s AIDSWALK- with coworkers

It’s important to work together to continue “HIV risk-reduction”
Stage 4- Long Term Love Definition: 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 encounter Also, as the relationship progresses overtime, riskier behavior can ensue Why: -Protection burnout - Serodiscordant Partner continues to test negative - Serodiscordant Partner no longer concerned with risk, apathy toward HIV infection - Viral load of HIV+ undetectable, CD4 count high, appears healthy - Feels close enough to have unprotected sex, think unprotected sex takes intimacy to new level 1. Continue Practicing Safe Sex (make it easy on yourself, keep a big box of condoms in your bedroom) 2. Continue Regular HIV and STD Testing 3. 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 research 4. 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

Emotions Both Partners Can Experience Overtime
For HIV+ Partner: For Partner: Happy in relationship and loved Concern with becoming infected Not enough concerned over own health & risk Fear for your HIV+ health Fear inner circle/outside world’s impression Happy in relationship and loved Concern with infecting partner Concern with rejected by partner Fear partner will disclose without your consent Fear partner’s inner circle will not accept you ● Overtime, partners can experience varying emotions and concerns for one another and themselves Ex: Happy to be loved and in a relationship, while also experiencing anxiety, fear, sadness ● Partners often experience contradicting emotions and concerns at the same time partners ● Outside Pressures, such as family, friends and work can influence emotions and concerns felt by both Emotions felt by Seropositive Partner: 1. Happy to be in relationship and loved Emotions can include: 2. Concern with infecting partner immediate -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 intimacy 3. 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 world 4. 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 infected 5. Fear partner’s inner circle (family, friends, coworkers) will not accept you Emotions felt by Sero-Negative Partner 2. 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+ partner 3. Not enough concern/ accountability over own health and risk of infection -HIV + partner forced to carry all neg. emotions for both them and their partner Ex: 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, Sadness 4. 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 + person 5. 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 ● Family Outside 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 members 2. Offer seronegative partner’s family informational material, call- concerns/issues 1. Hold conference between both partner’s families to discuss 3. Get tested and show family your results to help elevate fears hotline ● Friends benefits, services 4. Invite seronegative partner’s family to” HIV World,” fundraisers, -Can also express dislike, concern with friend engaged in -Usually more forgiving then family members serodiscordant relationship

Making HIV & STI Testing Routine
Discuss why testing is important Share how you both feel about HIV/STI testing Decide on regularity of testing Consider going together Many 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 tested Stress the importance of knowing your HIV status Suggest going together Remember : In a healthy relationship you can talk about anything including HIV, STDs and getting tested Talking 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?"

Safe Sex: Fun, Frisky, Do-able
Safe sex shows you care about the health of yourself and partner(s) Know how to correctly use male/female condoms Keep condoms nearby Support 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 different You can have a full and active sex life without your partner ever getting HIV Condoms if used correctly can protect your partner against HIV and other STDS Ask questions and talk to HIV/STD physicians, health- care providers, social-psycho support * Preferably together ● Know how to engage in preventative safe-sex practices - Know how to correctly use a male condom - Know how to correctly use a female condom - Know level of risk for each behavior High risk- Unprotected oral, vaginal and anal sex Minimal risk- protected oral, vaginal and anal sex Least risk- Kissing mouth-to-mouth, masturbating ● Remember: Relationships take work, communication and understanding Definition – 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 or female) 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

Other 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 relationship Other 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 Care Services and/or in location to benefits -Starting a family

Happy, Healthy and Successful Relationships Require:
Love! Commitment Strong Communication Patience Belief in Relationship Trust Responsibility Honesty Understanding Fun Respect Responsibility Honesty Understanding Fun Respect Closing Remarks Happy, healthy and Successful Serodiscordant Relationships Take: Commitment and Responsibility - From both partners to make it work -Commitment to being safe and seeking answers 2. Strong Communication - between partners With health care providers, physicians and support team 3. Honesty -about desires, emotions, insecurities 4. Patience and Understanding -Takes time to build trust and respect -A level of Maturity 5. Belief in your relationship 6. Have Fun: -Dream, Laugh and Love and . . .

Any Final Questions? We are not experts on the legal issues surrounding HIV disclosure and you should consult local experts We have compiled a resource guide of experts and it is also available on our website at org

Questions 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

Helpful Tools Resource guide created to assist youth in finding support around disclosing in their day-to-day lives Source Service(s) Provided Description Website or address Contact Info The Center for HIV Law and Policy HIV law and policy/ legal support National legal and policy resource and strategy center for people living with HIV Catherine Hanssens Executive Director HIV Law Project Legal support/ HIV Law and policy Legal agency providing services to low-income people living w/HIV/AIDS in New York City Tracy L. Welsh, Esq. National AIDS Hotline Counseling, testing, legal support HIV/AIDS counseling and testing resources for discrimination and other legal issues 1-800-CDC-INFO Gay Men’s Health Crisis Counseling, support, hotline Hotline for those newly diagnosed trying to access HIV/AIDS resources 1-800-AIDS-NYC International:

Helpful Tools Created by AIDS Alliance Youth Advisory Council- 2012
Source Service(s) Provided Description Website or address Contact Info HIV Law Project Legal support/ HIV Law and policy Legal agency providing services to low-income people living w/HIV/AIDS in New York City Tracy L. Welsh, Esq. Executive Director US Dept. of Health & Human Services, Office for Civil Rights Legal support/ civil rights Principal agency to bring forth discrimination complaints based on HIV status AIDS.org HIV/AIDS resources Numerous resources around HIV/AIDS in the US The Body Website that offers innumerable HIV/AIDS resources Created by AIDS Alliance Youth Advisory Council- 2012

Source Service(s) Provided Description Website or address Contact Info State Health Facts HIV related Health information Provides up-to-date, easy-to-use health data including HIV Criminal HIV Transmission Blog Opinions and resources related to HIV crimes Collection of published news stories, opinion and resources about so-called HIV crimes The Canadian HIV/AIDS Legal Network HIV law and policy/ legal support Legal network that promotes the human rights of people living with and vulnerable to HIV/AIDS Americans with Disabilities Act Information & Assistance Hotline Education and legal support Assistance navigating HIV laws international: Center for Disease Control Business & Labor Resource Center Workplace support and education Comprehensive workplace HIV/AIDS programs international: Created by AIDS Alliance Youth Advisory Council- 2012

Source Service(s) Provided Description Website or address Contact Info AIDSLEX HIV Law and Human Rights Education This free e-Library has resources on HIV-related legal issues and human rights issues. International Labor Organization (HIV/AIDS Division) International policy development Practical guidelines and policy development for international communities HIV Travel HIV and travel-related information information on current HIV travel restrictions, including short-term stays and visas Created by AIDS Alliance Youth Advisory Council- 2012

More info www.aids-alliance.org

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