Many people looking into HIV Treatment for the first time are concerned about drug-resistant strains of HIV.  It’s no wonder, with all the news out there about a “super bug”.  It is true that HIV mutates and evolves very quickly, and inside a person’s body, it can be resistant to specific drugs that person is taking.  But this is just one piece of the HIV drug resistance story – and maybe not the most useful piece for people who are newly diagnosed and wondering how they will respond to meds.

The thing about HIV’s rapid mutation is that it’s also seemingly random and completely lacking any quality control.  In a person who is not taking antiretroviral treatments (ARVs), HIV produces billions of new copies of itself each day and every single one can be a little bit different from all the others.  According to a recent article published in Relay Magazine, “the quality control process is so poor that every single possible change in the HIV can be produced within one or two days of infection”.  But one variant doesn’t stand out among the others unless it has the advantage.

Imagine you have a bit of a mouse problem in your house, and the mice come in a whole range of colours.  You buy a cat to chase the mice but the cat just can’t stomach blue mice.  The blue mice end up surviving and thriving while all other colours are killed.  The previously colourful mouse colony is now just blue.  In the case of HIV, somebody who is not taking antiretroviral treatment will have a very colourful HIV infection.  Enter the cats!  Nowadays, in the rich world at least, when somebody starts taking ARVs, they’ll be taking a combination of drugs (called highly active antiretroviral therapy or HAART) that attack the HIV at different stages in its replication.

There are now more than 20 different ARVs available in six different classes that attack HIV in different ways and are combined to maximize effectiveness.  Your doctor will help you decide when it’s time to switch up one medication for another.  People who have been living with HIV and taking treatment for many years will have fewer options, but new drugs (and even new ways of attacking HIV) are being researched and developed all the time.  Unfortunately, unlike our mouse and cat example, bringing in other drugs (a blue-mouse-eating cat?) cannot eliminate the HIV altogether.  We do not have a cure for HIV; some HIV always remains in the body.  Or, there’s always a mouse hole the cat can’t find.  The goal of the ARVs is to keep the HIV from replicating, because more virus means a greater attack on your immune system, and because replicating means mutating, and mutating means resistance.  It does feel like a bit of an uphill battle, but studies show that many people are successfully avoiding resistance.

The most important way to delay and prevent resistance is to follow your medication schedule precisely and consistently.  Taking your meds on time, at the same time, and as directed, allows them to work at their maximum effectiveness, attacking the HIV in its replication and restricting its ability to mutate.  While it continues to be hotly debated, it is advisable to continue practicing safer sex with other HIV positive partners so that you don’t risk reinfecting each other with resistant strains of HIV (or “sharing” resistance, so to speak).  Staying away from street drugs is also important, as they make it very hard to follow a drug regimen precisely, as well as increasing the likelihood of sharing needles and having unprotected sex which can also lead to reinfection and increase resistance.

Like so many issues relating to HIV/AIDS, resistance is not black and white.  We can’t even say for sure whether resistance is inevitable.  But we have developed some amazing ways to avoid and work around it.

-Miriam

When I started in this work 16 years ago, there were few treatments and little hope. But people are resourceful thinkers, and alternatives to medicine were hot. Meditation groups, yoga, and the power of positive thinking were just a few things that were embraced. Having a life threatening illness that often meant a rapid death with little help from Western medicine challenged people to get their minds around these different approaches. For some it meant getting clean from drugs or alcohol, for others it meant looking at unhealthy relationships and deciding to leave them. Through these changes, there were people who came to the notion that “HIV was the best thing that ever happened to me.”  But there were also those who didn’t reap the perceived benefits of learning they had HIV.

Louise Hay’s thinking  was popular in those days. Louise Hay was writing about the connection between mind and body, implying that you could heal yourself from a disease like cancer. Not everyone read her books, but the ideas of her books floated in the air and took weight in conversations. People felt the possibility was there. 

“I hate Louise Hay,” spat a support worker one day as we debriefed.
“Why?”
“Because her philosophy of you can heal your life just adds to the guilt that PWAs have if they can’t.”

And he was spot on.  There were those who plunged further into drugs and alcohol, and lost any hope they’d ever have a healthy relationship because HIV would keep them trapped (abusive partners often helped reinforce this notion). And there were those who tried like mad  to heal their lives and got sick and died anyway.

I see echoes of that in this day and age of HIV being hailed as a “chronic manageable condition” for those who are on treatments (and not everyone is, but that’s another story). I’m not dissing treatment by any means, but it hasn’t made things manageable for everyone. I was grateful to see a recent blog by the smart and funny Dr. Bob to this effect. Dr Bob, himself HIV-pos and by his own admission very privileged, highlights some of the hefty challenges that HIV still brings, both physical and emotional.

How people speak of their illness can be influenced by language. I thought of this as I read Judy Segal’s piece in the Vancouver Sun about being a cancer survivor who wasn’t so sunny about her diagnosis. She wrote, “If, as a person with cancer, you violate the code of optimism, or if cancer somehow failed to improve you, you’d better be quiet. So I thought I’d better speak up.” She expresses a need to be honest about not feeling positive at times, and feeling pressured that she wasn’t keeping up the optimistic narrative that those diagnosed with cancer are supposed to have. It so made me think about those living with HIV.

“I reject a survivalism that seems to blame the breast-cancer dead for not trying hard enough,” wrote Segal.  An echo to my support worker friend’s lament that made me nod as I read and sipped my coffee. 

I’m with the optimists that say you can change your attitude about things and that in itself can change your overall health. Optimism is important. But it is one of many avenues a person might travel in a day when dealing with life changing diagnoses like HIV or cancer. A presumption that a person should always make the best of it is like putting a bearing rein on horses that holds their heads in place and can inhibit them from putting their heads down into hard work. It’s not the best support we can offer. The best support is to listen to what’s happening in the moment. 

-  Janet

A recent headline about humanpapillomavirus (HPV) made me glad, because it underlines the importance of talking about all kinds of safer sex. Researchers are finding HPV DNA in various tumours where the cancer is found in mucosal tissue, such as the nasal cavities or the throat. The connection between oral sex and HPV that leads to these cancers can be used as another argument in favour of the HPV vaccine, which has been controversial. I support parents’ rights to make decisions about what vaccines their kids receive, but am also for illuminating the prevalence of HPV.   

HPV is one of the most common and easily spread sexually transmitted infections. Even using barriers like condoms and dental dams might not prevent it, as skin-to-skin contact is all that’s needed for transmission. A recent study from McGill University found over half of sexually active young adult couples were infected with HPV. Forty-four percent had the types that can lead to cancer. For people who are becoming sexually active at a younger age and racking up more sexual partners, these trends are likely to continue. Enter the HPV vaccine.

The HPV vaccine currently available (another has just been approved by Health Canada) was developed to protect against four strains of HPV, two of which can lead to cervical cancer and two of which can lead to genital warts. At present, it’s being offered to girls and young women aged 9-26, ideally before they become sexually active. Once women have become sexually active and been exposed to HPV, the benefits won’t be as dramatic as they are for unexposed women. (Manufacturers are trying to market the angle  that women won’t have been exposed to all four strains the vaccine protects against, so vaccination in the 27-40 age range could be helpful and cost-effective. They haven’t convinced the powers that be just yet). Studies are ongoing- Oak Tree Clinic is one of the sites exploring how the vaccine affects HIV+ girls and women.

There has been discussion about vaccinating boys too. They aren’t currently offered the vaccine, but you can see where they could benefit. Less HPV circulating in the population means less likelihood of exposure, infection and need for eventual treatment, etc. Research on that is also in the works.

Some parents have held off vaccinating their girls, citing that vaccination might seem to be a “go to it” directive for sex at a young age. As a parent and sex educator, I disagree. I think one can instead look at it as an opportunity to talk to our kids about different tools to keep them healthy when they decide to have sex. Depending on what we want to teach our kids about when those sexual relationships might begin is an indivdual choice, but approach is important. Studies have found that religion- based abstinence programs often fail, but abstinence programs that provide kids with negotiation and problem solving skills have greater success at delaying sex.

Whether parents choose to vaccinate or not, the debate about the HPV vaccine is a great opportunity to talk about the variations of sexual behaviour and about personal safety. It’s a chance to talk about safe practices and the responsibilities and risks that can accompany the pleasures of sex. There are age appropriate ways to do so. (If you’re not sure where to start,  see Meg Hickling’s fantastic selection of books.) using the HPV vaccine to talk about healthy sexuality and self-esteem sex with girls (and their brothers) isn’t a directive to have sex- it’s a responsible thing to do. 

- Janet

One of our favourite online information sources is The Body – The Complete HIV/AIDS Resource.  They have an excellent high-traffic Ask the Experts forum where twelve HIV specialists (many of them doctors) answer the public’s questions.  A recent thread got me thinking about the notion of risk.  Dr. Robert Frascino (Dr. Bob) calls it the QTND – question that never dies – what’s the risk of getting or passing on HIV by giving or receiving oral sex?  “Sometimes I wish there were a universal factsheet” writes Confused London Boy, “[…] saying when and in what situation a condom should be used”.  “Where is the line?”

Dr. Bob responds to CLB the same way we always respond, reiterating that the risk of HIV transmission via oral sex is very low, but not completely non-existent.  He also clearly outlines a few of the other risk factors, which can increase the risk of transmission: the presence of other STIs, oral trauma or gingivitis, the viral load of the HIV positive partner and whether they are on treatment, etc.  There is no line; “in reality what exists is more of a zone”.  Some people choose to take a “no avoidable risk” approach and always use a condom or dental dam for oral sex with an HIV positive partner.  Some don’t.

One angry answer-seeker had written to Dr. Bob on Christmas day, claiming that he contracted HIV from oral sex and demanding that Dr. Bob retract his assertion that oral sex is a low risk activity “and take a more strident stance that Oral Sex [sic] is a significant risk”.  (It turns out this man actually hasn’t taken an HIV test “yet”, but he’s pretty sure the scratchy throat he’s feeling is caused by HIV …)  Dr. Bob basically says, no, because that would be lying, and defends himself for consistently presenting the risk as it stands statistically (very low), providing as much information as possible about risk factors, considerations, etc.  But he considers it a decision for each individual to make with their sex partners.

There have been a handful of studies on this issue, summarized in 2007 by researchers from Imperial College in London. (Dr. Bob describes these studies here.)  The results all indicate very low risk (with six out of ten studies reporting no HIV transmission via oral sex), but the researchers agree that it is extremely difficult to tell whether somebody really did get HIV from oral sex, because most people don’t engage in oral sex only.  Among the handful of people who make the on-line claim that they contracted HIV from oral sex, it is completely possible that some of them really did.  These people might be one in a million, making up that tiny little statistical probability that makes us say “very low risk”.  For them though, becoming infected with HIV is not “one in a million” … it’s 100%.  You either have HIV or you don’t and if you do it’s a big thing to live and deal with.  But this is exactly the dilemma that intrigues me about statistical probabilities and the notion of risk.  Statistical probability is a scientific measurement of risk, but it is definitely not an adequate indicator of personal impact.

We take risks every day, some smaller, some greater—driving a car, crossing the street, skiing, eating in a restaurant.  The trick is to be informed, avoid unnecessary risks and take precautions when it makes sense.  This navigating of risks is something that each person must do for herself.  As professionals, we can inform you of the facts—the statistical risk and other factors—and we can even strongly caution you against high risk activities, such as sharing needles and having unprotected vaginal or anal sex with somebody you cannot guarantee is STI-free.  But ultimately, you decide what your risk threshold is.  Of course, it’s also important to consider whether something is putting other people at risk …

To make your own decision about oral sex, definitely take a look at The Body’s oral sex chapter and search for “oral sex” on our You Should Know website, dedicated to the sexual health of women after 40.  And remember that there are other, more common STIs that are transmitted by oral sex, including Chlamydia, Gonorrhea, both types of Herpes and Syphilis.  The risk of getting or passing on one of these diseases is greatly reduced by using a condom or dental dam when giving or receiving oral sex.

-Miriam

This blog represents the ideas of individual writers, and does not necessarily reflect any formal stance taken by Positive Women’s Network.

If you’re visiting our blog and website for the first time, welcome!  Perhaps you ran into us distributing condoms and information cards on the street, or maybe you picked one up from a display basket at a local business.  I’ve spent the last couple months learning everything there is to know about condoms.  Here are some of the gems, Trivia-style:

1) Besides the obvious, how do soldiers, engineers, filmmakers and paramedics use condoms?

2) Before Charles Goodyear invented vulcanized rubber in 1839, what were condoms made of?

3) An ancient version of a female condom appears in the legend of Minos, dating back to 150 AD.  When did the first known real-world condoms appear?

4) What is the earliest known example of “condom testing” and who performed it?

5) What does Gabriele Falloppio (the doctor who fallopian tubes were named after) have in common with King Louis XV and Giacomo Casanova?

6) In 1880, if somebody asked for “a little something for the weekend”, what did they want?

1) Besides the obvious, how do soldiers, engineers, filmmakers and paramedics use condoms?

Since condoms became standard issue to prevent the spread of sexually transmitted infections (STIs) in the military, soldiers have found additional ways to use them.  They can be used to hold water in emergency situations and began being used in World War II to cover and protect rifle barrels from water and particles that could harm them.  Engineers use condoms to keep soil samples dry and to protect sensors embedded in probes for soil resistance testing.  They are also apparently used by the film industry to protect microphones for underwater recording when a waterproof mic is unavailable or just not in the budget.  Perhaps the most awe-inspiring non-sex use of condoms is by paramedics in need of a one-way valve for chest decompressions in the field.  A needle is inserted though the condom and then into the chest and the condom allows air to exit but not enter the chest.

Whether they are soldiers, engineers, paramedics, or none of the above, women can also use a modified male latex condom when receiving oral sex, to prevent the transmission of STIs that can infect the mouth and throat, such as gonorrhea, chlamydia, syphilis and both types of herpes.  To learn how to make a dental dam for female oral sex, click here.

And you thought condoms were just for vaginal and anal sex!

2) Before Charles Goodyear invented vulcanized rubber in 1839, what were condoms made of?

Some of the earliest condoms covered only the head (called the glans) of the penis and were used as birth control by the upper classes.  In China, these glans condoms were made of oiled silk paper or lamb intestines.  In Japan, they were made of tortoise shell or animal horn (ouch!).  Later, chemical-soaked linen and animal intestines or bladders became materials of choice for full-penis-covering condoms in Europe.  Dutch-produced leather condoms made an appearance in Japan in the late 15th century.  The first rubber condoms again covered only the glans and a doctor had to measure each man to ensure the correct size.  That made them quite inaccessible and they often fell off during use, so manufacturers moved to the full-length option.  They were made by wrapping strips of raw rubber around penis-shaped molds, then curing the rubber with chemical.  In 1912, a faster and more efficient technique was developed, called cement dipping, which involved dipping glass moulds into raw liquid rubber.  Latex was invented in 1920 and latex condoms appeared soon after.

To find out what today’s condoms are made of, click here.

3) An ancient version of a female condom appears in the legend of Minos, dating back to 150 AD.  When did the first known real-world condoms appear?

According to the Greek legend, Minos’ wife Pasiphae cursed him with semen containing serpents and scorpions (funny, I don’t remember learning that one in grade school …).  In order to protect his lover from bites and stings, she inserted a goat’s bladder, like we might use a female condom today.  The legend appeared in 150 AD and some historians suggest this is indicative of condom use in ancient societies.  It has also been claimed that condoms are represented in 12,000-15,000 year old cave paintings at la Grotte des Combarelles in France.  The first usage of condoms that we can be sure about corresponds with the first well-documented outbreak of syphilis which began in 1494 and spread rapidly throughout Europe and Asia.

Curious about those female condoms?  For more information, click here.

 4) What is the earliest known example of “condom testing” and who performed it?

Early condoms varied widely in size and quality.  In fact, when a biochemist tested 2000 condoms in 1935, he found that 60% of them leaked.  Already in the 18th century, condoms of questionable quality could be purchased throughout Europe in pubs, barbershops, from the chemist, and at the theatre.  The first known condom quality tests were informal ones performed by the famous lover Giacomo Casanova and involved blowing each condom up with air to test it for holes.  While it is definitely not recommended that you blow up a condom before using it, it would also be unnecessary.  Condoms are now rigorously tested for quality and as long as you use them correctly and consistently, they are highly effective at preventing the transmission of HIV and many other STIs.

For more information on how to use condoms with confidence, click here.

 5) What does Gabriele Falloppio (the doctor who fallopian tubes were named after) have in common with King Louis XV and Giacomo Casanova?

These three gents were all users or advocates of condoms.  Gabriele Falloppio was an Italian doctor who wrote De Morbo Gallico, a 1564 treatise on syphilis which recommends the use of a chemical-soaked and ribbon-tied linen glans condom, which covered only the head of the penis.  Louis XV, the king of France from 1715 to 1774, is known to have used condoms to prevent his mistresses from becoming pregnant.  He reportedly sent a British diplomat to inquire and obtain them from across the Channel.  The Venetian seducer Giacomo Casanova (1725-1798) famously used condoms and tested them for quality.

For more information about the present day use of condoms, click here.

 6) In 1880, if somebody asked for “a little something for the weekend”, what did they want?

People are always happy to have a nickname to refer to something taboo.  With condoms, this was particularly important during times when they were illegal.  In the United States, the Comstock laws were passed in 1873, banning the manufacture and sale of condoms.  In Ireland, they were effectively outlawed right up until the 1970s.  In other parts of Europe, contraceptives were illegal but condoms could be used for disease prevention.  Whether they were legal or not, condoms continued to be used throughout North America and Europe and there were lots of different euphemisms to refer to them by.  “A little something for the weekend” was one of them.  Also “male shield” and “rubber good”.  If you were in England, you might have called them “French letters” to protect from the “French disease” (syphilis), while the French would ask for an “English riding coat” to protect from “the English disease” (also syphilis).  You get the picture!

Whatever you decide to call them, use condoms with confidence and enjoy!

-Miriam

This blog represents the ideas of individual writers, and does not necessarily reflect any formal stance taken by Positive Women’s Network.

Researcher Katie Mairs presented findings on Wednesday at the Ontario HIV Treatment Network conference in Toronto. I wasn’t in Toronto, but later that day heard her co-researcher Sandra Bullock on CBC’s On the Coast talk about their findings. It seems that snowbirds going down south to escape Canadian winters may come into contact with more than a heckuva lot of sunshine. Almost three hundred seniors were surveyed, and 80% said they were sexually active and dating (8% of them while married) down South. Yet they weren’t using condoms on a regular basis at all. The research found that those who don’t think they’re at risk for pregnancy don’t think a condom is necessary. True enough if you’re thinking solely of reproduction. But for STI prevention, a condom is a fantastic tool.

This research is asking questions of a population that can be sorely underrepresented in sexual activity/ sexual health findings. Being post-menopausal doesn’t make women less likely to get STIs (in fact, it can increase the risk), and HIV prevention information is important in this age group. According to Mairs, HIV prevalence among US residents over 50 is highest in Florida. With a “holiday” attitude that is easy come easy go, sexual choices could put people at risk. It reinforced the importance of the work we’re doing with our You Should Know campaign, which is aimed at women over 40.  It’s great that this research might open more avenues for discussion, make way for education, support doctors and patients to talk. STI prevention is important, no matter what the age of sexual adventurers.

Janet

This blog represents the ideas of individual writers, and does not necessarily reflect any formal stance taken by Positive Women’s Network.

I’m secretly excited about the prospect of H1N1 becoming known as Hini (pronounced “heenee”).  I’ve heard it a couple times now and hope that it catches on.  I normally take flu season in stride, but like most people, I’m following the situation a bit more closely this year.  It’s a relief to find small ways to laugh and joke about it, like the Hini title and last spring’s Zombie Flu spoof.  Once you’ve had a chance to chuckle, check out these slightly more serious guidelines for people living with HIV/AIDS, released by the BC Centre for Excellence in HIV/AIDS.  They clearly outline how to identify, prevent and treat H1N1.

Here at Positive Women’s Network, there have been several discussions around the water cooler about what exactly H1N1 looks like and how to tell if you have it.  The symptoms can be just like regular seasonal flu symptoms, but there are a few particulars to look out for.  Usually, the abrupt onset (in other words, sudden start) of a fever and cough with one or more of the following additional symptoms: sore throat, joint pain, muscle pain, feeling ill enough to spend time in bed.  You might start feeling these symptoms anywhere from one to seven days after you are exposed to the virus.

If you think you might have H1N1 and you have a BC CareCard, call HealthLink (811) to talk to a nurse any time of day or night.  The nurse will help you decide whether you need to visit a doctor.  If your symptoms are considered mild, the best bet is probably to stay home, rest, drink fluids, avoid contact with others and keep your tissues and trashcan close by.  If your flu is deemed to be moderate or severe, or if your CD4 count is less than 200, you’ll probably be told to see a doctor.  In this case, it’s really important that you call the doctor’s office before you go in, so that they can tell you what you need to do to avoid exposing the staff and other patients at the clinic.  The doctor may decide to prescribe the antiretroviral Tamiflu (also called oseltamivir).  The cost is covered by PharmaCare in BC, so you probably don’t have to pay for it.  There are no known negative interactions with HIV antiretrovirals (ARVs), so it’s important that you continue taking your meds too.

Assuming you don’t have H1N1, there are some important things to do to avoid getting it (and also to avoid passing it along if you learn that you have it).  These are the same old basic precautions for every flu season: wash your hands frequently, especially after coughing or sneezing and before eating; cover your nose and mouth with a clean tissue when you cough or sneeze and throw out the tissue immediately; cough and sneeze into the elbow of your sleeve (check out this fun video)  when you’re caught off guard; avoid people who are sick; and stay home if you get sick.  It is recommended that people living with HIV/AIDS get three vaccinations related to the flu: the H1N1 vaccine, the seasonal flu vaccine, and the pneumococcal vaccine (if you have not had it within the last five years).  Of course, you can talk to your doctor or call HealthLink (811) about the specifics.

As usual, we are asking anybody who’s sick (including staff) to stay home instead of coming to PWN.  Hopefully most of us will avoid H1N1 and the rest of us will get over it quickly and come out the other end strong and healthy.  All the best.

-Miriam

This blog represents the ideas of individual writers, and does not necessarily reflect any formal stance taken by Positive Women’s Network.

Last week’s retreat was another huge success and many women came away connected and recharged, according to the evaluations. Retreats are unlike any other thing we offer. They are a whole weekend of symbolic unpacking by a variety of women with a range of life experiences (one attendee commented on the diversity of women and how well everyone got along). Women unpack their sadness of being diagnosed and feeling they can never look at life with hope again. Women can unpack their worries about going on treatment and how it might affect their bodies. Women unpack their long-term experiences with HIV, how they have made changes and stayed healthy. Women unpack their vulnerabilities and their successes, and share them.

All this unpacking makes change. People feel lighter, less burdened. They feel connected to others. They feel when they go back to their regular life that it is permanently changed. The space where we hold the retreats can handle it. The common room where much is shared is airy, the corridor leading to the bedrooms is wide, open. There is a lot of room for experiences. This is a place where women can talk, walk away, absorb, and revisit the same topic later with new thoughts that have arisen. This is how change happens and new possibilities grow. 

Retreats aren’t easy. Going away with a group of people who share a diagnosis that for many women is private and challenging can make for an emotional weekend. Disclosure is obvious, but not necessarily easy. Support staff are available, and there are always women who have been on a retreat before and know how intense it can be. A number of people commented on how much hope they got from talking with long term survivors. Retreats are a reminder of connection and healing at a deep level: one person reaching another. They define the “network” in PWN.

On Sunday, participants pack their belongings. But they also leave some stuff behind, and take new gifts with them. One woman said she’d be taking home “the laughter.” And that’s something great to pack.

- Janet

The next retreat will be in the spring.

This blog represents the ideas of individual writers, and does not necessarily reflect any formal stance taken by Positive Women’s Network. 

One of the many nerdy things that interest me is database design.  I learned to make the most basic contact database in university and have been improvising my way through various PWN database challenges ever since.  One exciting example from pretty early on is the question of the tick box.  Databases are good at storing tick box information.  For example, if woman X is interested in both cake decorating and field hockey, woman X will show up in database lists of both icing-spreaders and stick-wielders, as well as in lists of women who both spread and wield.  For some reason, we have a much harder time with ticking multiple boxes in real life; we tend to want everyone to fit into neat little boxes and either/or categories.  This seems to be where many people fall through the cracks in HIV prevention and care.

It’s widely presented that “lesbians can’t get HIV” and sure enough, there have been no recorded cases of woman-to-woman sexual transmission in the US.  But it turns out that there are lots of women who identify as lesbians and are also living with HIV/AIDS.  According to a hot-off-the-press (June 2009) report by the Women’s Institute of the Gay Men’s Health Crisis (GMHC) in New York, 14% of GMHC’s positive “female clients” in 2008 identified as lesbian or bisexual.  Could it be because many women who tick the “have sex with women” box might also tick other boxes, given the chance?

Just like heterosexual women (and men for that matter), women who have sex with women (WSW), whether they consider themselves lesbian or not, engage in behaviours that transmit HIV.  The vast majority of WSW who contract HIV do so by having unprotected sex with a man or by sharing needles to inject drugs.  There are also high-risk activities in lesbian sex (anything that allows body fluids from one partner to enter the bloodstream of another).  But it turns out many WSW (84% in one study) believe that they are at “zero risk” for HIV and other sexually transmitted infections (STIs).  It seems that just as many doctors ignore sex between women altogether and don’t ask questions that would lead to proper prevention and care for at-risk women.  The woman and doctor, and any number of other healthcare providers, are ticking the “lesbian” box and moving right along, assuming there is no risk.

For somebody who wants to see the world in black and white, perhaps it is easier to fit people into little boxes.  It makes it easier to pass moral judgments, and some people just aren’t comfortable in their own skin unless they can do so.  But HIV doesn’t really care if you’re a man or woman, black or white, gay or straight, or none of the above.  It only cares about what you do, and all kinds of people regularly put themselves at risk for STIs and HIV (in fact, the vast majority of people will have unprotected vaginal or anal sex during their life).  I agree with the GMHC’s statement that “a woman’s risk of contracting HIV is directly related to her experiences and behaviors, which cannot solely be determined by the use of labels commonly used to identify and individual’s sexuality and sexual identity”.  So stop trying to fit us into little boxes!

-Miriam

A few weeks back I posted about the results of a teen sex survey in Toronto (in a nutshell, the kids want more information than they currently get). One of the things that struck me in the analyses of the study was that 4% of the respondents said they weren’t sure they’d had sex, yet they reported vaginal, oral and anal sex experiences. Which leads me to ask, what are we talking about when we discuss sex? To me, sex can be many things to many people (Hallelujah!), and safe sex involves lots of possibilities. But the study makes me think this isn’t the case in general.

Take oral sex as an example. Some people may not think of oral sex as “real” (that is, it can’t produce a pregnancy). A study looking at STD rates in virginity pledgers  (who pledge to remain sexually abstinent until marriage) vs. non-pledgers found there was not a significant difference in sexually transmitted infection (STI) rates, despite the pledges. Pledgers were six times as likely to engage in oral sex than their non-pledging peers, and anal sex rates among boys who took the pledge were four times that of non-pledgers. While oral and anal sex can’t produce a pregnancy, there are other potential complications like STIs.

The risks for STI infection from oral sex are reinforced by the recent release of an information sheet on the topic from the American Centre for disease Control. And having an existing STI can put a person at higher risk for HIV infection. What this makes clear to me is that when we’re talking sex (with anyone), we have to make sure we’re talking the same language. Sex is not just the “gold standard” of penis into vagina. 

The authors of the Toronto study acknowledge that language could be a problem when asking people about their sexual activity. Vaginal heterosexual intercourse may be what people see as ”sex,” but this isn’t the only sex people are having. Asking about specific behaviours / acts is the better route. Sounds in keeping with the safer sex message that challenges perceptions about risky groups of people and instead says we should be thinking about acts that could be risky: “it’s not who you do, it’s what you do.” So if we’re talking about sex, let’s make sure we’re naming all the the bits of the body and how they bond.

- Janet