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

Posted by Tania Chatterjee in Sex, Sexual Health, Staff Picks
November 30, 2016

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?”