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An HIV Counsellor Explains Why Safe Sex Is Not Just About Condoms

As an HIV counsellor working at a large urban hospital in the US, I am privy to more sex lives in one day than most people are privy to in their lifetime. Each day, I provide rapid HIV testing, linkage to care, and counselling to dozens of patients in the emergency room of my hospital. I hand out condoms, talk openly about sexy and non-sexy topics (for example – how the vagina is a self-cleaning organ), and listen carefully as people describe some of the most intimate details of their sex lives to me. It’s an amazing job, to say the least.

My job, first and foremost, as an HIV counsellor is to educate patients on safe sex, and aid in decreasing the transmission of HIV and other sexually transmitted illnesses (STIs). Baltimore, Maryland, has one of the highest rates of HIV in the country, and in recent years, programs such as the one in my hospital (which provides free rapid HIV testing to all ER patients) have been put in place with the goal of reducing the transmission rates of HIV and other STIs in Baltimore. Thus, I find myself constantly talking about condoms – because condoms are the best method of protection against STIs like HIV, as well as pregnancy. My typical dialogue on safe sex with a patient is so rehearsed by now that sometimes I don’t even deviate from my script, repeating it word for word, day in and day out.

But of course, sex isn’t just about condoms. Just ask anyone who has had sex – condoms are probably the last thing that come to mind when sparks fly and you’re getting down with someone (or ‘someones’). Sex is passionate, primal, powerful. Sex is an act of desire, lust, and sometimes, love. It’s finding a deep, essential connection with yourself, and maybe with someone else. As educators and health care providers, we often forget about that real, raw beauty of sex – we forget about the fluids, we forget about vulnerabilities, we forget about the intensities of mind-blowing orgasms. We often forget that sex is as much emotional as it is physical. We hammer into our own heads and into heads of our clients and patients the importance of using condoms, of getting tested, of never, ever exchanging fluids.

When we talk about safe sex, we often forget to talk about, or even think about, past experiences, trauma, and barriers that could be preventing someone from having ‘safe’ sex. What exactly is safe sex, even? Does safe sex mean that there is no risk of pregnancy? Of getting physically or emotionally hurt? Or of not having any risk of acquiring or transmitting an STI? We often don’t even think about the definition of sex – not everyone has penis-and-vagina sex. Not everyone can use condoms. Not everyone wants to. And all of that is perfectly okay.

The truth is that sex means very different things to different people, and in the same vein, so does safe sex. And even safe sex carries some risks, doesn’t it? Using condoms, being on birth control, getting tested often – all of these still come with a little bit of risk, because at the end of the day, none of these guarantee that everything will be perfect and pristine. Our job, as educators and health care providers, is to make sure that we equip our clients and patients with the tools to have sex in whichever way they please – whether it matches our definition of safe sex, or not.

Not every conversation I have with a patient revolves around the same old ‘please-be-safe-use-condoms-get-tested’ drone. My best days are when I have awesome, meaningful conversations with my patients, not just about their sex lives but about their relationships, about their pasts and their hopes for the future. There are times that they confide in me secrets that they are too afraid to tell their families, their best friends, and even their partners. There are times when I get enthusiastic hugs and high-fives when I hand out condoms and negative test results. But, of course, it’s really easy to get jaded – it happens more often than I’d care to talk about. It’s sometimes difficult not to, when the same patients come back time and time again with repeated gonorrhea and chlamydia infections, when partners flat out refuse to get tested, and patients openly tell me that they don’t care about their own health. It’s especially the hardest when every two months or so, like clockwork, I have to give a patient the difficult news that they tested HIV-positive.

Bleak as it may seem, all is not lost. Safe sex and pleasure can actually coincide and co-exist, and sex can be safe and amazing at the same time. Now more than ever, we are talking openly about sex, about pleasure and about staying safe. There are now more toys and tools available for us to make sex safer, better, adventurous and fun. The most important people to put those two things together – safe sex and pleasure – are us: the educators, the therapists and the healthcare providers that are privy to our clients’ sex lives on a daily basis. We must learn to be active listeners, to be open-minded and to equip our clients with the tools to advocate for both their safety and their pleasure. We must remember that our thoughts, views, and judgments should not cloud the information or tools we provide to our clients. We must remember to acknowledge and validate the experiences of our clients, and remember that our own experiences are not the same as theirs. If we don’t do these things, who will?

I’m going to end with Carmen Vasquez’s wonderfully real and eloquent bit on sex and sexuality from the Woodhull Sexual Freedom Summit in 2013 – a paragraph that continues to haunt me and resonate within me since I first heard it:

“I asked: Do I get to bring my sex with me? Do I get to tell you how sick and tired I am of the condoms and the dental dams and the saran wraps and all the other things that keep my skin, my cock, my cunt, my cum, my juice separate from the person I want?  Do I get to tell you that I’m out of control here? Do I get to tell you that I want my lover and somebody else’s lover and a stranger in a bathhouse? Do I get to tell you that I want pain and power in my sex? Do I get to tell you that my sex is very vanilla and I really like it like that? Do I get to tell you that I’m queer and never have sex except for what I desire? Do I get to tell you that I’m a female-to-male transsexual and a gay man? Do I get to tell you that I’m a male-to-female transsexual and a lesbian? Do I get to tell you that I’m a transsexual who is a heterosexual? Do I get to tell you I am a bisexual slut? Do I get to be in your community? Do I really?”

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

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Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

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Find out more about the campaign here.

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A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

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A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform, demanding that the Government of Assam install
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