Sex Spoken Here: Secrets of a Sexuality Educator

Teens, Sex, and Communication

As a sexuality educator, I know too well that abstinence only sex education doesn't work. Study after study prove it. More recently, it has been shown that youth who take a "virginity pledge" are merely substituting other high risk sexual activities in lieu of vaginal penetration. 

Let me be clear that I believe abstinence has a place in sex education--when it is part of a comprehensive sex education program. Being part of a larger conversation about sex and sexuality makes a lot of sense to me. It is the abstinence "only" part that drives me a little nutso.

I'm not a professional wordsmith, but I have enough knowledge to know that the word "withholding" is synonymous with "abstinence", which makes almost no sense to me. Seriously, think about it for a minute.

Communication is truly one of the most important tools anyone uses in their life. However, most people are never taught how to effectively communicate with...really..anyone. Peers, bosses, kids, family, and the list goes on and on. 

Using an abstinence only model (with virginity pledges) is really only getting youth to agree to something they don't consent to (as well as depriving youth from learning how to communicate around the topics of sex and sexuality.) Consent is difficult to reach if you are purposely leaving important information out. Maybe I'm a bit dense, but what is the harm with giving youth accurate information about sex education?

Learning to make good decisions is part of getting older, isn't it? Giving youth comprehensive information on sex education allows them to know what the risks are for pregnancy or HIV/STI transmission and how they can prevent it. I, for one, would be incredibly happy to never hear about a new season of "16 and pregnant" or "Teen Moms".  

I've worked with a lot of youth in my undergraduate (interning at a juvenile prison & interning with a juvenile probation office) and professional life. My post college work with youth has been as a case manager at a half-way house (in other words, youth who were released directly from prison), as a probation office (and an active participant in a "teen court" program), and working with both HIV positive and HIV negative youth in the San Francisco Bay Area.

In short, I have had a lot of experience with youth--everyone from LGBTQIQ youth who are marginally housed and homeless to students who attend some of the finest (ie expensive & progressive) private college preparatory schools. When it comes to college age youth, I've provided sex education to people attending community colleges as well as premiere universities like Stanford. 

Even though I am a non-breeder, I truly love being around teens and young adults. I hear so many parents complain about how they can't relate to their children and that they have no idea what they might or might not be doing sexually. The thing is, with me, I have the exact opposite effect with youth. Basically they tell me in intimate details who, where, and when they have hooked up with sexually. Some have even drawn me flow-charts...I'm not even kidding about this.

Maybe it's because I don't have my own kids that I am able to relate so well (and in such a meaningful way) to youth. Maybe it's because I am super awesome sex educator, or maybe it's because I am perpetually curious and am genuinely interested in speaking with them. Also, I may look younger than I am, but many of the high school youth I had daily contact with were young enough to be my children. So why is it that, in general, youth are so open to talking about sex and sexuality with me?

Here are a few of my thoughts on why youth are so willing to talk openly about sex with me. 

I relate to them on their level. Ok, so maybe this makes me a bit un-sophisticated and immature, but I can talk to most youth about almost anything. It usually starts out with me asking something like:

    "Whats going on at school?"

    "Are you interested in anyone in particular?"

    "What's the newest update with you, give me the 411",

    "Hey, are you thinking about college yet?",

    "What do you do for fun?"

    or even

    "So, have you been getting any penetration lately?"

Being that I am a super curious person, all I have to do is open the door with a few open-ended questions and the proverbial flood gates open up. I also come from a place that I recognize youth are sexual beings, which is something really difficult for a parent to conceive of.

I've figured out that there is an art to asking the correct questions. For example, If they say they have, indeed, had penetration, I will ask what kind, did they enjoy it, how do they feel about it now, is it with someone serious, do they need condoms and lube, etc. 

It's been my experience that youth are way smarter and intuitive than they are given credit for. The youth I have known are really open to confiding intimate details about their life because they see me as a trusted adult and/or ally. 

I don't want to give the impression that I'm advocating parents to go out and become their children's best friend. I mean, look at how well that has turned out for Lindsay Lohan and her mom. There needs to be some sort of rules or parameters, and those should be set by the parent.

I guess what I'm getting at is that I don't want people to think youth gravitate towards me because they see me as their pal and, therefore, a push over because 1) If you know anything about me and my past work experience (see above), you know I am anything but a push over, and 2) I have never had a problem calling a youth out on their shit. My process looks something like this--we have a private conversation, we discuss whatever the issue is and I then communicate what type of behavior is expected from them moving forward, and then I drop it and move on. I've lost count the number of times youth were obviously squeamish to be around me after our little private conversation. They are usually blown away that I am still around for them after they have messed up. I think it is these type of instances where I have left the biggest mark on emerging youth. There have been many times when I (along with other youth service providers) have been the first healthy relationship a youth has had with an adult, and it is something I take very seriously. Being an active person in a teens life can have dramatic results, even if that time is limited to only a few months. 

I know that this might seem like a radical way of interacting with youth. Open and honest communication...how novel!  

I get that not everyone is going to have the capacity to do this. In that case, the best I can hope for is that those youth have some adult in their life who they feel comfortable discussing this stuff with.

Or, you can always send them my way. 

**Scarleteen, Sexetc.org, & Go Ask Alice are all wonderful sexuality resources!

What the Hell is Harm Reduction?

Harm reduction is probably one of my most favorite things about being a sex educator. Simply put, harm reduction means meeting people where they are at. 

Most people are familiar with the harm reduction concept because it is used in reference to alcohol and drug use. For example, needle exchange programs are, in essence, the perfect harm reduction model and here is why--people who work with needle exchange acknowledge that people are IV drug users (notice, there is no judgement here), and provide them with clean needles in order to decrease the transmission of HIV and Hepatitis C. Some needle exchange programs even distribute literature on how a person can shoot up in a way that is going to do the least harm. 

As someone who worked in the HIV positive community, I usually identify myself as someone who uses a harm reduction method when talking about sex education.

Ok, but what does that mean?

In a nutshell, it basically means that I acknowledge that most people engage in some type of sexual activity. Once I find out what type of sex they are having, I can talk about ways of minimizing personal risk or risk to others if that is something they are interested in.

In my case, the majority of the youth I worked with were either HIV positive or had an AIDS diagnosis, and sexual activity was the main mode of HIV transmission. The trend I noticed that at first surprised me was just how little HIV positive youth new about safer sex, much less about the HIV virus. This was one of those cases where people required basic sex education as well as specific sex education in relation to them being HIV positive (this is called "prevention with positives"). 

When working with HIV positive youth, harm reduction can be as simple as showing someone how to properly use a condom. It can also be incredibly complex and it can mean that you literally break down the level of risk involved in any sexual activity they participate in.

Many of the HIV positive people I worked with had their own harm reduction model--only they were not aware of it being a prevention strategy.

Hooking up online is really popular, and unless you met through a HIV poz website, you will most likely not know the HIV status of your newest partner. What I heard time and time again is because the HIV poz person didn't know their partners HIV status, they were more willing to "bottom" bareback. This works as a harm reduction method because 1) they already have HIV and 2) there is less risk of HIV transmission if you are "topping" bareback.

A lot of people take issue with this scenario because there is no HIV disclosure. However, believe it or not, this is harm reduction in action.

Engaging in barrier free receptive anal penetration is the most risky of all sexual activities when it comes to HIV infection. Offering up your ass constitutes harm reduction because it puts your partner at much less risk for HIV infection. 

There are A LOT of people who find harm reduction troubling. They may hold certain religious, medical, political, or personal beliefs that are incongruent with harm reduction. The best I could do was hope like hell that these people were not providing any type of HIV treatment, care, or advocacy for my clients. I would have never referred an HIV positive person to someone who doesn't subscribe to the harm reduction model. I'm also someone who tends to be super protective, so it was common for me to accompany my clients to their medical appointments. Because my dad is a practicing physician and my mom was a former nurse, I never had the weird or uncomfortable feelings many have towards medical treatment providers. In fact, I learned that growing up with parents in the medical field was a huge asset when it came to medical advocacy for others. 

I've mentioned this before, but it is my experience that disclosing that you are HIV positive is not always commonplace amongst some communities. Many people assume that if your partner doesn't say anything, then they are HIV negative. Also, many people never ASK about the STI/HIV/AIDS status of their partner.

For the record, I strongly believe that YOU need to be an active participant in your sexual health. This means getting tested regularly for all STIs. It also means talking with your partner (even if it is a one time hook up) about their sexual health history. Alternatively, you can use a barrier and stick to sexual activities that are less risky if you don't know your partners HIV/STI/AIDS status.

Let's face it, it is really difficult to make an empowered and informed decision about sexual risk if you don't know what parameters you are working with. Not talking about it doesn't mean that everyone involved is HIV/STI/AIDS negative.  

Most people who are not in the sexuality community find bringing up the topics of sex and sexuality to be really, really uncomfortable. I get it. It's not like anyone really teaches us this skill. However, I believe that the majority of your partners will be thankful for you broaching the subject. Incidentally, it is also one of those things that gets easier the more often you do it. 

Harm reduction, it's a really good thing!

Shame on You HIV/AIDS Researchers!

**I've made a few modifications to the post since what is inside my brain doesn't always translate to my writing. Hopefully, the post is a little more clear.**

HIV/AIDS is a cause that is near and dear to my heart! My mom worked as an early HIV/AIDS advocate in Chicago (specifically the Howard Brown Clinic) in the late 1980's and I began working in the field in 2002. If you aren't familiar with the Howard Brown Clinic, here is some background on it during the time my mom was a volunteer nurse

By 1987, AIDS had taken hold of the gay community’s emotional and intellectual collective thinking. Howard Brown did more than respond in kind, it pioneered the strategy against the war on AIDS by fighting with facts, providing more medical and psychosocial services, and continuing to reach out to all that needed assistance.

I saw something this past week that is just not sitting well with me. In the past year or so, HIV/AIDS researchers have made an important distinction when it comes to how people become infected. Those living with HIV/AIDS are now unfortunately being categorized into 2 groups--"behaviorally infected" and "perinatally infected". I seriously almost lost my shit when I saw it in a recent article for "POZ" magazine. 

***I should also point out that I'm not thrilled with the term "infected" either. I'd probably go bat shit crazy if I ever worked in the medical field*** 

Here is how the School of Public Health, University at Albany described a webcast that I unfortunately missed. The topic was "Transitional Care for HIV and AIDS from Adolescence to Adulthood" 

Adolescents and young adults are an increasing proportion of the HIV-infected population. In 2008, 17.6% of new HIV cases in New York State were in the 13- to 24-year-old age group. In addition, more perinatally infected patients have entered this age group. The HIV-infected adolescent population comprises a mixed group of 1) perinatally infected adolescents who are now surviving into adulthood, and 2) behaviorally infected adolescents, most of whom were infected sexually

My huge issue is that pretty much the rest of the world demonizes and stigmatizes people who are HIV positive or have an AIDS diagnosis. Even in a progressive city like San Francisco, there can be some pretty big challenges for people living with HIV/AIDS. I saw it every day when I worked in the HIV positive community. So why on earth would HIV/AIDS researchers perpetuate this type of judgement? Unfortunately, I have no good answer for you.

Intellectually, I get that this is important to medical researchers who are called Epidemiologists. I like Epidemiologists because they are able to sift through pages and pages of data that would make me want to stab my eyes out with a fork. In fact, my BFF is one of them. However, unless you work in the medical community, public health, or the CDC, there is really no reason for you to know about them (so don't feel stupid if you've never heard of one).

Epidemiologists are people who work in a branch of the medical field who deal specifically with the incidence and prevalence of disease in large populations and with detection of the source and cause of epidemics related to infectious disease. Simply put, people who work in "Epi" (medical slang) study the causes, distribution, and control of disease in populations. 

In this particulat case, I am upset because medical research terms (perinatal vs behavior) are spilling over in the HIV positive support community.

What do I mean by that?

Now when you read an article about someone who is HIV positive and living their life, it is common for the publication to specifically mention how the person came to be HIV positive.

For example, you will see something like this--"Mary Doe, 37 years old, behaviorally infected" or "Sam Doe, 23 years old, perinatally infected". 

Even though I get the Epi reasoning behind the newer infection classification, I think it is a slippery slope. So now on top of the general public judging you for being HIV positive, you have the HIV community judging you for how you became HIV positive, at least it really seems that way to me. That is some crazy shit!

As someone who worked in the San Francisco HIV positive community for 5 1/2 years, I don't like it, and I definitely don't approve. It makes it seem like the community is now pitted against each other based on how they became HIV positive. I'm sure some people would argue that perinatal infection is much more acceptable than someone who was behaviorally infected. You know, because getting HIV through childbirth is less dirty than getting infected through unprotected sex. That, my friends was sarcasm.  
                                                                 

The main ways of becoming HIV positive perinatally is through a vaginal delivery or c-section. However, becoming HIV positive due to ones behavior can mean many things (and it usually has a judgement around it). Behavior can refer to having unprotected anal sex, unprotected vaginal sex, unprotected oral sex, and IV drug use. The main take away from this, I think, is very sex negative. 

I still can't help wondering why the HIV/AIDS community would accept this change. I just don't see the point. Is it possible they think people who are perinatally infected are more worthy to access care services like drug trials, emotional support, and medical care? Maybe they think that people who are behaviorally infected could benefit more from other services. And why do we not use the "behaviorally" term when it comes to other medical issues like Heart & Liver Disease, Cancer or Migraines? After all, research does show that certain lifestyle modifications can reduce or increase your risk of getting Heart & Liver Disease, Cancer or Migraines. 

I guess my bottom line is that HIV is HIV is HIV. Yes, it is important for the medical community to be aware of when a person became positive (also called seroconvertion) and through what means. I get that a baseline assessment needs to be made and blood testing needs to get completed so a HIV positive person can better understand how it is presenting in their body. However, I guess I just fail to see the everyday practical need for outing or classifying how someone became HIV positive. 

There, I've said my piece. Now I have to leave because writing this particular blog post has given me a "behaviorally infected" migraine. 

 

Food for Thought--Advice From Catherine About Entering the Field of Sexuality

As someone who didn't really figure out what my personal path was until later in life, I can say with absolute certainty that I love my job. I'm good at it! I get rewarded for being myself! I'm also thrilled that my enthusiasm seems to be infectious in that I get multiple emails a week asking me how people can do what I do. 

I've written quite a few blog posts about how I became a sex educator, how one can become a sex educator, tips for becoming a sex educator, and some of the not so great parts of being a sex educator. Even though I identify myself and my career mostly as a sex educator, search engines recognize me mostly as a sex coach. 

I have some practical advice for people who are looking to work in the growing field of sexuality. 

One of the best things you can do is to take an inventory of how you feel about sex and sexuality. This is hugely important, and I can't stress this enough. Talking about sexuality is not the same thing as being sex positive. Let me repeat; talking about sexuality is not the same as being sex positive.

One of the things I pride myself on and consistently get positive feedback on is how I can talk about the spectrum of sexuality and not tense up when it comes to certain topics. Here are a few examples:

• What about people who engage in unprotected sex while being HIV positive and an active drug user? Great, let's talk about it. 
• I'm curious about anal and vaginal fisting? Sure thing!
• Tell me more about about fetishes that are seemingly so mysterious that they are kinda underground? Hey, I may not have the exact answers to everything, but I bet I can find someone who does.
• What does it mean to be abstinent? Let's talk about it. 
• What does someone mean when they say they are asexual? Great question!

When you are a sex educator and people ask questions, they look to you for answers as much as they look at you when you answer them. They want to know if you are able to accurately hear and answer what they are asking as much as they are looking to see how comfortable you are with the subject matter.

My deal is this: not knowing an answer is totally ok. After all, there are few educators who have all the answers. I have no problem letting someone know that 1) they are asking a great question, 2) I don't have the exact answer for them, and 3) I bet I can find a person who can get their question answered. I know that my personal knowledge about sex and sexuality covers a ton of information, but that I am not an expert in all topics. 

If you are looking to have a career in the field of human sexuality then one of the best things you can do is to figure out what personal triggers you have when it comes to sex and sexuality. This isn't always an easy task, and sometimes you have to admit to being sensitive to certain topics you wish you were more open minded about. 

It may seem a little contrary, but I have found that group training is one of the easiest ways to figure out what triggers or limitations a particular person has. I've gone through sexuality training in San Francisco where people claim to be sex positive yet firmly state that they hate the idea of porn (and would not sit through any porn viewing), where people repeatedly used the wrong pronoun when referring to someone who has already stated their gender identity, who believe that everyone who is HIV positive should be criminally prosecuted for having unprotected sex, people who strongly judge and openly mock certain fetishes, and much more. 

Sex will always be a hot button issue for certain people. However, I have to admit that I've met a few people who are working in the sexual health profession who should probably strongly consider a job in a different field. 

My other suggestions for working in the sexuality field are to figure out if you want to work for a company or organization or work for yourself. Working for someone else has a lot of benefits that include things like a steady paycheck, health insurance, and being part of a team. Working for yourself also has a lot of benefits like setting your own hours, setting your own rate, and having ultimate creative control over what you do. 

However, if you want to work for yourself (like I do), then you need to consider things like where are you going to meet and work with clients since it is not recommended that you use your home as a meeting place, are you focused enough to actually get work done on your own, what type of business are you going to have (a sole proprietorship or LLC), what business licenses and business insurance you need, who is your ideal target market, how are you going to brand yourself, and how are you going to get clients. 

If you ultimately want to be a sex coach, you probably need to spend some time working or studying in the field of sexuality. Some people who do sex coaching call themselves "relationship", "love", or "intimate relationship" coaches. Lots of people advised me to change my title from sex to relationship coach. The title of sex coach can be problematic for some people because it is too in your face and overt. My feeling is that I am the first to admit that not all of my personal relationships are easy, great, or rewarding, so I would have a hard time calling myself a relationship coach. 

I have found that working in the field of human sexuality has been incredibly satisfying and rewarding for me. Hopefully this blog post will help make your journey into the field a little easier. 

Catherine Answers Your Anal Sex Questions

As someone who has publicly outed myself as being completely and utterly anally focused, I love that I recently got this question. Even though I'm an anally focused individual, I am someone who personally enjoys the idea of anal much more than the reality of it.

This question about anal sex and anal douching was asked by a college student at one of my recent sexuality workshops. 

Dear Catherine, 

What is your take on enemas in relation to anal sex? Dangerous? Good thing? Unnecessary? Help! ps, where can I buy an enema kit?

Wow, what a great set of questions!

First things first, I do not condone, recommend, or endorse the use of vaginal enemas. The eyes and vagina are the only 2 self-cleaning organs on the human body. Vaginal douches are evil. Evil, I tells ya. 

When it comes to anal douching, this is a fantastic question. Some people are attracted to the idea of engaging in anal sex (either giving or receiving), but get stuck on the fact that waste comes out of there. When I worked in the young LGBTQIQ community, we used to have a saying when it comes to anal sex: "no one likes a messy bottom". Ok, no one is a bit extreme, but the vast majority of people engaging in anal sex want it to be a pleasurable and erotic adventure that is poop-free. 

What porn doesn't show you is the personal preparation involved before a scene is shot. When it comes to anal sex, most people have some kind of personal regimen they like to
follow. Anal douches are a great option because, unlike shower-shots, the require no installation and filter. Anal douches look like a plump weeble woble, and may come with a variety of different nozzles. 

If you are interested in trying out an anal douche, go for it. Just remember that you want to use warm water and plenty of lube on the tip of the nozzle prior to insertion. Rectal tissue is incredibly sensitive, so using water that is too hot or too cold can be a shock to your system. Once you have the douche ready, you can administer it. Sometimes people douche while they are in the shower since it makes for easy clean up. Sometimes people will lay on a bathmat next to the toilet and bring their knees up to their chest, and sometimes people will use it while they are still sitting on the toilet. Even if you have recently had a bowel movement, don't be totally surprised if you happen to see a lot of visible waste. You will probably want to stay close to the toilet for a short period after douching. One of the main purposes of the rectum is to absorb water so that waste can pass (bowel movement). Some of the douche water may become absorbed back into your body.

I'm a fan of anal douching as long as you follow the recommendations. There are some people (like me!) who only feel comfortable engaging in receptive anal sex if, and only if, they have completed their anal douche regimen. 

You can purchase anal douches at a variety of online retailers or, in most cases, at your local pharmacy. 

Anal sex is a little like swimming. You don't want to dive in right after you've eaten. 

Anal douching = yes (if following above recommendations)

Vaginal douching = no, no, no

I've Updated My Media/Press Kit!

I became a sexuality educator because I saw a HUGE need for people to get reputable and easily accessible information on the taboo topics of sex and sexuality. My goal is to normalize and demystify these hot button topics by being educational, entertaining, and informative. I've heard that my workshops are described as being edu-tainment. 

Let's face it, a lot of what is out there is just plain wrong, fear-based, sexist, and completely non culturally/gender preference/sexuality identity friendly. And as someone who identifies as multi-ethnic (but many people see me only as Japanese American), I've noticed that there are too few ethnically diverse sexuality educators! 

I offer workshops on everything from body image and flirting to genital shame and oral sex, as it's my belief that they all fall on the enormously wide spectrum of sex and sexuality.

I'm currently booking workshops at universities and colleges for the spring of 2012. I have complete media/press kits that I would be happy to send to you. I'm not gonna lie to you, they are pretty freaking awesome and comprehensive!

Alternatively, you may also download a pdf media/press kit below.

Download PressKit CC

Warning: Controversy Below

The topic of this blog post might take many people aback, but, really, what else do you expect from me. I'm going to be talking about how I feel about HIV positive people engaging in sexual behavior with others and not disclosing their status. If this makes you uncomfortable, I suggest you check out my other blog posts.

The past 2 years have been a roller-coaster! I'm not going to get into a ton of detail, but here it is in a nutshell: therapist got sick and stopped practicing, mom passed away the week before I officially launched my business, the cat I'd had since I graduated college died very suddenly, and I found out my therapist passed away by googling her name to get her contact information. 

Finding out your therapist of many years has passed way by reading her obituary is a kick in the balls. We had keep in contact every 3 months, and I lost her number when I switched to a new cell phone. My therapist was awesome, and losing her so close to my mom was a really hard blow to my psyche. 

I've only recently dipped my toe back in the water of attempting to find a new therapist. I met with one a few weeks ago, and I knew we would not be a match. 

I was talking about my prior employment as the director for a non profit serving HIV positive youth. Being that she advertised herself as being "LGB" friendly, I figured the potential for us working together might be high. It wasn't to be. She got caught up on the fact that, as a service provider, I didn't report my HIV positive "members" (what we call them instead of clients since it's a peer-based agency) for having unprotected sex with people and not always disclosing that they are, in fact, HIV positive. She could not get past the point that my inaction was potentially putting others in danger. 

In case you are wondering what constitutes criminal prosecution when it comes to HIV disclosure and sexual activity in California, here is a handy link. For more information on the criminal transmission of HIV go here. 

The agency I worked for is awesomely special! It is possibly one of the only safe havens for HIV positive youth living in San Francisco. Unlike other service providers (no, I won't tell you which ones I'm referring to), BAY Positives never withheld services as a way of getting clients to conform to their rules. This is hugely important!

When you are someone who is coming of age and get a HIV/AIDS diagnosis, your world can change pretty quickly. Yes, there are services that can assist you, but they are usually very difficult to navigate. Some youth providers repeatedly cross boundaries and, in my opinion, act conversely from their own mission statement. In short, services are provided but often in a very inconsistent and inhumane way.

The agency I worked for operated with minimal ground rules; no fighting in the agency, no smoking in the agency, no stealing from the agency, don't threaten others, don't raid the food pantry, don't try to sleep with staff, and no sex in the agency. This may seem like a ridiculous set of rules for people because they are all pretty much common sense. I like to say that common sense is the least used of all senses. 

BAY Positives was often a last stop or resort for HIV positive youth when other service providers refused to work with them. Not all members were great to work with. Many were very active drug users, many had severe mental health issues, few were on HIV/AIDS medications, some exhibited signs of advanced and untreated Syphilis, and many often complained about the agency. A lot. The fact remains that our agency got the most comprehensive sexual activity information on HIV positive youth than any other youth agency in the city. 

Does everyone who is HIV positive inform their current, past, or future sexual partners? Absolutely not. To believe this is reality is ridiculous. Most people lack the proper communication skills when it comes to sex and sexuality in the first place. Finding out you are HIV positive doesn't magically give you great communication skills, give you confidence, or place you in a domestic violence free relationship.

Members would come to the agency and admit to having unprotected sex and not disclosing they are HIV positive. Sometimes members would come by the agency soon after their sexual activity to get information on PEP. Post-Exposure Prophylaxis (PEP) is a 28-day cycle of antiretroviral drug treatment believed to be 80% effective in preventing an HIV-negative person from becoming positive after exposure to HIV. In order for PEP to be effective, it is important that you begin the treatment within 72 hours of being exposed to HIV. Sometimes members disclosed they are currently having unprotected sex but now want to learn 1) how to tell someone and, 2) when in the relationship do you divulge your HIV status. And sometimes members would talk about having unprotected, undisclosed sex with little to no affect.

Here's the deal. Amongst the population I served, it was highly likely that members were having unprotected, undisclosed & anonymous sex. Many had unprotected sex with people they met online and only have a screen name or an email address. Some did sex work and people paying for the sex will often pay more if a barrier is not used. However, it was far more likely that a member was having unprotected, undisclosed sex with someone they end up falling for and have no idea on how to bring up the being- HIV-positive-and-we've-already-had-unprotected-sex part.

Having worked in a non profit serving HIV positive youth, I'm really sensitive to the entire topic of status disclosure. I don't feel like I have the right to out someone as being HIV positive. Further, sometimes it takes literally years to build a trusting relationship with HIV positive youth (hell, youth in general). One quick and very verbal judgement about their sexual behavior will not only ruin your personal relationship with them but possibly make them never come back to the agency again for life saving services. Not judging their sexual behavior just seemed like a no-brainer to me. In fact, it was such an important aspect of our agency that we purposefully asked the question "what do you do when a member comes to you and tells you they have been having unprotected sex without disclosing their HIV status?" Seriously, it was the single easiest way to screen potential new employees.  

What makes my stance controversial is this: I believe that it is up to YOU to take control of your sexual health. That means that it's up to YOU to question your potential sexual partners about their HIV/STI status.

I strongly believe that most HIV positive people would disclose their status if they were flat out asked in the context of potential sexual activity. Communication is a 2 way street. For me, that involves asking about a persons sexual history as well as disclosing YOURS prior to sexual activity if there is something to tell.

Do I think that HIV positive people having unprotected, undisclosed sex is right? No, it is definitely not ideal. However, judging someone (remember these are early adults) isn't the right answer either. For me, I found that offering a safe space to talk about their sexual behavior was probably the most basic and important component in helping to effect positive behavior change.