Sex-Positive, Part I: HIV Testing, Counseling, and Referral

I'm working on getting HIV Counseling, Testing, and Referral (CTR) certified by Louisiana so that I can conduct HIV testing. I've completed the training, and now I have to observe several individuals conduct HIV CTR before I can conduct the testing and receive my certification approval from the Regional Coordinator.

Tonight was my first observation. I watched three counselors provide the test for walk-in clients. In all honesty, I was a bit shocked by what I saw. Not because the counselors didn't follow the correct procedures and protocols -- they did. Not because of the results. Not because of the individuals who were tested or anything they said.

Let me back up.

It used to be, when you went in for an HIV test, the staff member would explain confidentiality and informed consent, take your blood or swab your mouth, and send you back to the waiting room (or, before the quick tests, on your way). After the test came back, a staff member would notify you with the results. Then, if you were lucky enough to test at an HIV service organization and not a doctor's office, the staff member would refer you for services if your results were positive.

Then someone intelligent dreamed up the concept of CTR. In CTR, you are tested. But while you're waiting the 20 minutes for the results to come back, the staff member ("counselor") has a one-shot chance at counseling and educating you on HIV. In other words, while you're nervous and captive and scared, the counselor asks you about why you came in, what your risk factors are, explains HIV transmission, helps you create a risk-reduction plan, explains how to use a condom and other barriers, and gives other information on prevention, where to get STD tested, and referrals for any other social services you may need. Considering the very minimal education most people in Louisiana receive on HIV and STDs, this method is kind of smart.

As a counselor, you're given a small window to talk with someone you've never met about their most intimate sexual habits, their drug use, their sex work, etc. You get a few minutes to get someone to trust you, listen to you, and most importantly, talk to you. You're often confronting all kinds of barriers -- social stigma about sex, homophobia, identity issues, gender, class gaps, race gaps, fear, misinformation, etc.

The most important lesson in CTR is that counseling is client-driven. It's not about the counselor. It's about empowering the client, helping him or her to identify their risks and identify ways to reduce those risks. It's about listening. It's about working in a partnership with the client, and making sure to meet the client on his or her level -- not above, not below. It's about leaving assumptions, values, and beliefs at the door as much as possible.

CTR takes some serious finesse.

So what shocked me the most about this process?

How incredibly negative the counselors were. Ugh.

One counselor would say, "You're negative, so that's good." The flip side of this, of course, is that people with HIV are "bad."

Another was telling me over and over again how he couldn't understand  why some clients will come in every month for testing. He was complaining that they obviously need to recognize and change their behavior instead of not using condoms and getting tested. Except... testing is a form of action toward prevention and knowledge. So while behavioral change is more pro-active, testing should not be condemned.

Another was clearly berating a client for not using a condom once. I could tell the client felt shamed.

One counselor doesn't ask the person's gender identity because he "can tell" if someone is trans. I'm sure I have several friends who could pass, and he would never know.

One counselor stated that "knowing the person you're having sex with" is a method of prevention. Not asking status, not asking about if they've been tested. But "knowing" them, which made really no sense to me.

Not one counselor talked about sex toys, BDSM, rimming, or any form of sex except oral and vaginal (for heterosexuals) and oral and anal (for gay men). Obviously, these sexual behaviors are common. They need to be discussed.

Two of the counselors did a half decent job talking about oral, but both treated the men as always receiving, never giving.

There was no mention or discussion of anal sex with a straight male client.

There was no mention of any barrier methods but condoms.

One counselor went on a tangent about how going out often is "bad." -- as if this somehow prevents HIV? Or helps a client feel anything but chastised...?

None of the counselors asked their clients to explain what they knew about HIV -- all of them assumed their clients knew basically nothing, and gave them only a cheap shot version.

All the language was gender-based around the partners the clients identified in the last 12 months -- which isn't always indicative of an individual's sexual actions.

All of the counselors quoted some form of inaccurate facts -- two counselors told clients that "New Orleans is #1 in new HIV cases in the country" and one counselor said "New Orleans is #1 in new HIV, gonorrhea, and chlamydia cases in the state." Nope.

(In 2009, Baton Rouge was #1 nationally in AIDS cases per 100,000 people. New Orleans was #3. 39% of people with HIV in Louisiana live in New Orleans. An estimated 4,500 people in Louisiana have HIV and are unaware of their status.)

Not one counselor used open-ended questions or allowed the clients to identify their own ideas on how to protect themselves.

There was a ton of value-based language -- that's "good" or that's "really bad." There is a place for this kind of language -- but "risky" is what should be used, not "bad." There's enough stigma around sex. Why put more?

I left the organization thinking a lot about what "sex-positive" means to me, and how clearly, the counselors whom I observed were not sex-positive. I felt like all of the clients left feeling like they'd just been given a verbal whipping on how bad they were at protecting themselves. It was definitely not about empowerment, nor was it about creating a space where clients could speak openly about any form of sexual behavior.


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It's incredibly difficult to get a stranger to open up about their sexuality and sexual practices. Stigma and fear can be insurmountable barriers, and that doesn't begin to crack the list of reasons why someone might not talk.

How can anyone counsel and educate about HIV without being completely, honestly open and nonjudgmental about sexuality and sexual practices?

Every time a counselor quoted a false statistic, I questioned the validity of every other statement he or she said.

Assumptions about gender and sexual practices create barriers and limitations.

Omitting questions about sexual practices that aren't vanilla and omitting questions because of assumptions linking sexual orientation and sexual practice means that conversation is never started -- and no information is shared or learned.

Making value judgments about individuals' actions shuts a client down faster than anything.


I watched these failures in language use, in education, in judgment, and in assumption create walls which prevented the counselors from successfully helping the clients assess and reduce their risk for HIV. I came to a conclusion.


I strongly believe that in HIV Counseling, Testing and Referral -- and in any sex education environment -- sex-positivity is vital. 

Thanks(Giving) for Sex Ed

In the early 1990’s, there was a massive legal battle over sex education in the school district where I grew up. A very conservative group of Christians had convinced the school board (hell, they probably were the school board) to adopt an abstinence-only program. Another group sued, claiming this curriculum forced religious beliefs on students and taught students incorrect information.

What came out of this massive brew-ha-ha was the mess I, a ninth grader, had the pleasure of experiencing. My school was the second best public school in the state, but yet, my teachers could be suspended or fired if they answered students’ questions about sex, bodies, and sexuality. Several of my fellow students went on to study at Ivy League schools, yet we were taught from books with lines blacked out about how condoms prevented only 22% of pregnancies if used correctly. My school offered over ten AP classes, but also taught us that “automobiles” were a leading cause of sex.

In other words, we were a very well-educated bunch, but we hadn’t a clue when it came to sex education.

My parents were even less helpful. My mom didn’t even explain sex; she thought letting me watch R-rated movies and giving me an American Girl book about “your body” was enough. She bought me some pads and told me to ask my friends how to use tampons. She said, “don’t get pregnant.” My dad left when I was 12, teaching me that the most valuable relationship skill I could cultivate is how to emotionally shut off when things get difficult.

I became sexually active young. Thankfully I stumbled through early sex experiences with few permanent scars. I didn’t use a condom the first time I had penis-vagina intercourse with a man. I didn’t know that oral sex could spread STI’s. When I started exploring my attractions for women, I had no idea what I was doing. None. I had no relationship communication skills, which quickly backfired as I learned the hard way with my first girlfriend. I thought jealousy was a requirement for relationships; I thought it was better to talk behind her back about how I felt than to talk to her.

I survived without an STI, without getting pregnant, and I still talk with my ex. Unfortunately, I didn’t make it out of high school without getting raped. I don’t know if sex education could have changed that, but I do think it could have changed my response. I was under the misconception that women are raped by strangers, not by their friends, their dates, their acquaintances. For years, I thought I had simply “hooked up” with a friend when I was blacked out. I wasn’t introduced to the idea of consent until I was 18 – three years after being raped. Three years after that healing process should have started. Three years too late for me to do anything to prevent the rape.

After years of stumbling in the dark, running into brick walls, and making up answers to questions, I started doing some serious research. I educated myself. I found factual, intelligent resources like Scarleteen, and I started passing the information on. My friends would email me, asking where to get STI tested and how to put on a condom, and I went looking for the best answers. I started a hotly contested sex column at my college, implemented a Safe Sex Week, and pushed the Resident Advisors to make condoms available in all the dorms – not simply across campus at the health center. I got HIV/AIDS tested, and I accompanied anyone who needed a friend to hold their hand at the clinic. I started a Safe Zone program on campus for queer and questioning students, and I challenged professors to think about how the exclusion of LGBT people from history, sex education, health curriculum, and other disciplines hurt students by denying them information. I started exploring my own sexuality in healthy ways – exploring consent and kink, experimenting with new sex positions and partners, examining my understanding of monogamy, jealousy, and communication in relationships.

At the root of what drove me to keep pushing boundaries, to keep educating myself and others was a need to not see my friends stumble in the dark. If you don’t know how to protect yourself, you won’t. If you don’t know how to get tested, you won’t. If you don’t know how to navigate consent and set your own boundaries, you won’t. Knowledge is powerful. It takes knowledge to plan to not get pregnant, to plan to prevent STI’s, to plan to get good healthcare. It takes knowledge (and practice!) have great sex and build strong relationships. Scarleteen is knowledge. Scarleteen is the best resource for fighting the bullshit and lies our schools (and sometimes, our parents) taught us.

We need more information, not less. We need to become empowered through knowledge, not denied the ability to make informed choices. We need love and real answers. We need all sex education to be like Scarleteen.

Scarleteen wouldn’t exist without the donations of people who care about helping young people. Please make a donation. Please give the gift of sex education. Give youth the help and information they need.

sexual freedom

It’s National Sexual Freedom Day (wow, there’s a day!), and in honor of this great day, the Woodhull Freedom Foundation is hosting a blog carnival.

So it’s time to pick up a pen (or, really, my keyboard), and get down to the dirt of why I care about sexual freedom.

This week, I watched two different TV shows, both about parenting young children – “Modern Family” and “Parenthood.” Ironically, both contained plot lines where a couple was faced with how to talk to their young child about sex. In “Modern Family,” the five-year-old (or about that age) daughter started asking her parents about sex – specifically, if she came from her mom’s vagina, how babies are made, how eggs are fertilized, what the daddy “does,” etc. In “Parenthood,” a mom found a photo of a naked woman downloaded on her computer and believed her ten-year-old son to be the culprit.

In both shows, the parents had discussions about what to say to their child, and in both shows, there was a uniting theme: shame. One couple agonized about how many years it would take for their daughter to “live down” their explanation of sex – and the father speculated that waiting another 5-6 years before talking to her would be appropriate. The mother winced at any mention of the word “vagina” and “penis,” though she did try to push for honesty, while the father kept trying to change the subject. In the other show, the father told his wife that a mother talking to a son about sex would “scar him” and embarrass him; they both avoided discussing the subject and used bad euphemisms to try to get their points across. Granted, there were some comedic moments, but both couples implied that discussions of sexually are innately scary, embarrassing, shameful, and worth avoiding.

Wow.

I’m fascinated by sex and sexuality because they are an integral part of most everyone’s lives, and yet, in America, we have such a love-hate relationship with sex. We use sex to sell everything, from cars to clothes to shampoo… and yet, many women couldn’t find their own clitoris, and most people can’t have a frank conversation about sex without using some euphemisms or making bad jokes.

Sexual freedom for me is the ability to discuss sex, to have sex, to navigate what sex means in our lives in an open and honest way. I want to live in a society where we accept sex and sexuality as a part of our lives – not dominant, not non-existent, but integral. I want to live in a society where we don’t speak of sex as shameful – where words like “slut” don’t exist, where “masturbation” isn’t whispered, where condoms aren’t behind glass lock boxes. I definitely think this kind of repression hurts. Countries like the Netherlands, where sex is discussed at an age-appropriate level with children and contraception is widely and easily accessed, doesn’t suffer the same teenage pregnancy and STI rates that America does. I think children without a sense of shame about their bodies and their desires lead happier, healthier lives. And I definitely know, from statistics and experience, that queer kids who grow up ashamed of their sexuality and their sexual practices suffer from higher rates of depression and suicide.

Sexual freedom means talking about consent – as a theory, as a practice, and as a personal interaction. It means talking about rape – and working to end rape and sexual assault. It means talking about sex in nuanced terms. It means discussing that sexuality is different for each individual, as is sexual practice, needs, desires, and expression. It means easy and affordable access to STI testing, gyno services, HIV/AIDS testing, contraception, barrier protection (like condoms), and doctors who are educated and communicative about sex, sexuality, and your body and mind. It means learning, teaching, sharing.

Sexual freedom is power. It is the right to consent or not to, to be abstinent or sexually active, to be monogamous or poly, to be queer or straight – and all of those choices and states of being to be respected and validated.

Sexual freedom is the ability to express your wants, needs, desires. To have those desires validated and met, in a healthy and consensual way.

Once a week, I volunteer with a women’s shelter in town. It’s a great place with an amazing staff, a really inspiring method for helping women and their families, and the only trans-friendly shelter in town. I could talk all day about this place. But this week, I met a new woman at the shelter. Let’s call her “Georgina.”  She’s from a small Southern Louisiana town, where the sheriff’s office flies the Confederate flag right next to the Louisiana flag. Yes, Virginia, places like this do exist in 2010. Georgina ended up at the shelter with her baby girl, “Stella,” after being fired from her job, kicked out of her home, and basically, run out of town…all because she is white and had a baby with a black man (out of wedlock), and she has continued to date black men.  Her family, friends, and neighbors put her out on the street because they didn’t agree with her sexuality due to racist motivations.

I want a society that doesn’t allow this to happen. Sexual freedom is bound up, tightly, in equality – racial equality, gender equality, and queer and trans equality. There’s a lot of emphasis in the gay rights movement on “love.” But I think for that movement to become queer – to align with Stonewall, to align with eliminating HIV/AIDS, and to align with the needs and rights of people across this country – this movement must also focus on sex. We aren’t just talking about the rights for people to get married or have children. We’re talking about the rights of people to hook up with whomever they choose, and to do so without judgment and shame. And yet, many try to distance the gay rights movement from talking about sex for fear of losing support from straight allies. Really, isn’t sex where this a lot of this started in the first place? And isn’t sexual freedom just as important as the freedom to love – as if the two can be separated?

In 2005, in Lawrence v. Texas, the U.S. Supreme Court ruled that sex, in the privacy of one’s own bedroom, is not a state or policed issue. But yet, many people still enforce a measure of shame on sex – the act itself, the gender of the couple, the race/ethnicity of the couple, the marital status of the couple, and even the motivation of the couple. It’s people like Georgina and Stella (and hundreds of thousands of kids in abstinence-only classes) who lose when shame and hatred are held as more important than love, freedom, and humanity.

We all could benefit from more sexual freedom (and more sex!). :)