STDs and HIV

Case Study

Julie is 20 years old, she has engaged in repeated episodes of unsafe sex with several partners, and she is seeking her first HIV test. She has had five bouts of various STDs in the past two years. She says her STDs have been a nuisance, but she believes they are unavoidable.

Begin by learing more about Julie's STD history. Make sure she understands the seriousness of STDs -- not only the ones she has contracted, but also others she might contract, including HIV. Stress that STDs can recur, and future bouts of them can become more severe. Especially for women, STDs can be silent for long periods and result in widespread infection. Learn if Julie is interested in becoming pregnant, either now or in the future. Explain to her that STD infections can lead to infertility, which can occur without symptoms of disease and without her knowledge.

While acknowledging that HIV and other STDs have similarities, make sure Julie understands their differences. Primarily, explain that while STDs can be eliminated or successfully treated, HIV cannot be eliminated, nor can its progression be permanently halted by treatment or medical management.

While Julie may have so far avoided infection with more "severe" STDs, there is no reason to expect that she will remain free of these in the future if she continues to engage in unsafe sex. Helpl her see that the behaviors she has engaged in are the same ones that can infect a person with HIV, and that by having STDs she is more susceptible to HIV infection during sexual activity.

Explore with Julie what she means when she says that STDs are "unavoidable" and help her understand how she can avoid STDs and HIV. Stress that STDs are not a necessary byproduct of sexual expression. Learn more about Julie's sexual behaviors and history and the nature of her sexual relationships. Ask her whether she has on some occassions engaged in safer sex, and, if so, learn more about these occasions.

Ask her if she wishes to avoid unsafe sex. If she does not, even when presented with the dangers of STDs, emphasize again the dangers of HIV. Explain that if she does not change behavior now, her next STD may be HIV. In addition, present her with referrals for more thorough counselling.

If Julie does desire to avoid unsafe sex, but feels she is unable to do so, discuss negotiating skills, and review the occasions on which she has been able to successfully negotiate safer sex. If she cannot recall occasions in which she has engaged in safer sex, ask if she can recall other experiences in life in which she has asserted herself or insisted upon getting something she wanted. Try to apply the example of these occasions to the process of negotiating for safer sex.

Present her with appropriate referrals, geven her age, gender and concerns. Acknowledge that while changing behaviors can be difficult, help and support are available to make and sustain behavior changes.