In this excerpt from a conversation with Nicolas, a test counselor at the BFC, describes how he counsels new couples around trust and the desire to have unprotected sex.
C: I mean even with heterosexual clients that come in is, and let's talk about the ideal client, you know, somebody whose smart, articulate, well centered, I mean, they're not dealing with homophobia, I mean it's like, they're presenting very well, and uh, they've had two girlfriends and they've had almost virtual success with condom use you know, they've been totally steeped, never considered any other approach dadada but even for them there's these one and two time slips, you know, kind of thing, where there was this one time we didn't do it, didn't use a condom you know and helping people deal with those kind of bumps in the road, because so often what happens is those bumps in the road, people overcorrect you know, or tend to get particularly if they're really educated about their risk, tend to get real panicky. About it. And as a counselor you know you can't just say oh well it doesn't matter because you know every time it does matter, you know we can put it in somekind of framework of risk but to try to say you know what was it about it and what are some alternative strategies, and I think one of the things that's good for us to be able to work is to get people a strategy that says here's how you can get barrier free sex, you know if you really want barrier free sex, here is a real strategy.
Nicolas: Are you talking like outercourse or are you talking about negotiated safety.
C: Negotiated safety. I think that's so important to be able to put that in, and one of the things that I always do when clients come in and talk about if they're coming in for negotiated safety, uhm, they're both testing and their plan is to not use condoms after they all get tested,and so often this is the early on, cause the clients we see are/tend to be young, alot of them tend to be young you know it's kind
N: There's always a month in a new relationship.
C: Yeah, yeah it's a month into the relationship, this person is the one, you know, and I've been there, I know it, and so it's impervious to any kind of assault, so uh, youknow, you kind of say well what have you talked about with your partner? And you know we talked about it and we really agree and everything and then I say well let me just share a few things with you that I've had as experience, I see people who, I mean, they're just the happiest couples in the world, you know so I engage the fantasy, they're happy, they're loyal, they're you know, it's wonderful. it's bliss city. but one of the things that I've learned from doing this job is that circumstances not intentions may have a lot of determina/play as what really matters, circumstances not intentions, so they had every bit of intention of being monogamous, they absolutely adore their partner, it's just wonderful, so good that you can't imagine it being any better but circumstances conspire against them, they're out, they're drinking, this person's all over him, you know, next thing they know they've had intercourse, and ugh, they feel so guilty, just feel like shit, you can't believe it and they promise never to do it again but here they now had this no win problem, they have to go back and tell their partner hey, I've got to use condoms because you know, I've had this exposure and I said it's hard to have a headache for six months, you know, so HHH if you have this thing and you say well honey I want to use condoms and she's like why? and you say well I just like them better, HHHHHH,
N: HHHHHH
C: You know and she's, you're gonna
N: I just don't like that real skin to skin contact.
C: Yeah. The thought of coming inside of you just makes me sick and [ ], HHHH, it's so unhygenic.
N: It's so messy.
C: It's so messy. So I really want to use condoms, all the while, every time they have sex reinforces their guilt about the secret and they're dieing for fogiveness, so that they can get rid of this guilt and anxiety and the only person that can forgive them on the planet is the person they've you know violated, the relationship's gonna be over if they tell, cause they're bad and all this other stuff, so, they continue to have sex without condoms but all the while now they're feeling incredibly anxious about you know
N: And they're probably not able to get it up anymore
C: So they come in and they're flipped because here they've lied at some level, this is their frame, not mine, they've lied, they've been bad, now they have AIDs they're convinced and their partner probably has it too and they should be just shot in the test session. Right, so they're just racked and they have to live with this for six months you know and in some ways I wish we could have PCR you know just to take this as an opportunity to say OK, how do we help you deal with this guilt and anxiety while operating within a responsible framework, and the only way to die that is if they're in the relationship or talk to a person and the problem is when you're feeling very guilty and shamed that's the most difficult time to talk to them. So what I encourage people to, not that this would ever happen to you, but, just from experience, that it's easier to talk about these, and I say, you can even use me as the heavy, you can say you know I talked to my counselor and he said we needed to discuss what happens if we have sex, you know he said something about you know just circumstances and you
N: We talked about other couples and how they
C: Right. So we talked about other couples and how they handled it and that what he saw worked was if couples talked about it in advance, uh, before, while they're still in the [ ] before they've gone condom free that they could talk about it and say you know what, it's, we're not ready to make this level of committment, let's just stay with that condom thing, it's gonna be some [ ] for a little bit longer and just see how they check out or how do we handle, let's see if we can make a committment to each other to say you get some amnesty if you come clean on the first, you know, provide some incentives for coming clean, and I see that, you know I'm backing out, I see that as a winwin thing because those types of things can become an opportunity for really improving intimacy, and there's no reason why sex outside of your agreement has to be the death penalty, to put everything in this death penalty thing, and to open up some possibilities because what happens with that strategy is there are no options, you have this six month window problem and you have this I made a promise problem and I've broken that and I've done this and now I have AIDS and I may have even given it to my partner, you know, and I see that happen with herpes, that happens with herpes, you know, and I tell them another example sometimes is to say, you know, I see, I've had friends as well as clients who contract herpes in a relationship and absolutely freaked out about it, you know and come to find out the other partner had herpes but thought as long as they weren't having an outbreak or whatever, it was gonna be fine it can't be transmissible and all that and they didn't want to bring it up cause they had a lot of shame about it or they felt like they would no longer sexually attractive, that they thought they were in a no win position, if I tell you I have herpes, it says something about what the scum bag I am or it would mean that you wouldn't want to be with me, so they take the path of least resistance, which is hope and pray, well they're partner comes down with herpes and they're flipped, and the thing that they tell me that upsets them most is not that they have herpes but that they weren't told at the beginning and that most of them say you know, I totally love him and dadadad, it tends to generally be women, women who come in who now have herpes that got it from their male partner and the male takes this kind of like, either well they told me that as long as I didn't have an outbreak it would be ok or the, you know I had some sores one time that I never thought that was anything, become denial like I had no idea I had herpes, you know, eventhough they were symptomatic at some point, so that if you can talk about these things that it takes it out of a nowin situation, and that you generate possibilities through discussion and that anything is possible, one of the things that I've learned in working with people and reading literature on this, around sexuality is, anything is possible, I mean, when you think oh no that would never work, it's like only not work if your brain says it cannot work.
N: Not only that, your partner's probably thinking, is probably gonna think when you do bring it up oh I'm so glad you brought it because I wanted to, you know.
C: And that the time to bring it up is early on when you're least thinking to talk about it because this is forever and it's totally perfect but what I know, you know, circumstances so important, circumstance is so important to put in that circumstances frame, because what clients will say a lot of times is I'll say well, you know, have you talked about what if you have slept or something, oh no, we're in total agreement, that would never happen, that's just not gonna happen and it may not, you know I don't want to say that people aren't trustworthy but I say it's important for you to realize that this isn't about trust, trustworthy people make mistakes, or have problems, because there are so many things going on, or they'll say something like, well I trust him, I would never want to bring this up, you know, I totally trust him, and to say well you know what, it's not really about trust, because he may not know he has HIV, this would be on the issue of so you're coming in to get tested so is your partner being tested? and they say, no my partner's not going to get tested, he got tested two years ago and he was negative and you know, we've talked about the people he's been with since then
N: If anything, I would be a risk to him, that's what I always hear.
C: Right, yeah. Wouldn't be an issue. And uh, generally I don't take the attack at that point, you know I just go oh ok, so then we talk about her, frequently it's a woman, not always and get it all checked up [ ] and then kind of come back to this now, what's, let's kind of go back to what you were saying about your partner. Now, why is it that he doesn't need to get tested? And they'll say well you know he got tested two years, and I say well, has he had any sex since then? Well yeah. Uh, but they weren't problems and I said well how do you know that and they're like well I don't, I just trust him, and I say you know what I bet he is really trustworthy but I want you to know this isn't about trust, why is it that, I said you know think about it, you're really making a big committment and I think this is great, I mean we encourage people to do this if it's right for them, but isn't this the perfect time to check this off the list, I said, one of the things that I see, sitting in this chair, is people get into a relationship/you know same scenario, then they find out something later on, oh well there was this one time that I you know that I fucked this train of prostitutes HHHH but that one didn't really count cause I didn't [ ] her or something comes out that was a whole nother thing and they're freaked because now they think they have AIDS, because any time people do something that they know they shouldn't do they tend to really heap on, heap on the stuff and overcorrect as a way of making up so it's kind of God, if I'm negative I promise I'll never have sex again....this is a wonderful opportunity to do things that you don't even, prophelactically, preventive that later on can become sources of great anxiety and don't need to be because this is the time and there is no time after you cross this threshold to go back and undo this, you know, this is it, now, that is a main crossing, crossing this is automatic penalty, you know, there can be no outcomes, uh as a result of this but just be aware that you have an opportunity here and that's it's an opportunity to talk about your expectations about relationships and to talk about things cause so frequently in this situation, people haven't talked, they haven't talked in some detail, uh, they're dieing to know some of these things and to talk about these things but they don't have the vocabulary to do it and there's this sense that it needs to be as natural as the feeling to have sex is natural, the urge, and it's just not that way because it's a social thing and you really have to learn how to have the dialogue and to talk about it and you need to hear it said and rehearsed and you know have things set up, so that's one of the things that I try to do to help.
N: People will take incredible risks sexually but not interaction, in terms of conversation.
C: Right.
N: Risk asking a question.
C: That's right. And when you just initially asking them to do that is such a threat to their coping because their way of coping is denial, ugh, is saying well or somekind of irrational reasoning like well his partner tested negative so he's negative, therefore if I'm negative we're all negative, and or some other version of that or he's super trustworthy or
N: And it's all third or fourth hand rumors you know.
C: Right, right.
N: Reputations.
C: So, those are examples of all very different kinds of circumstances from people who come in with you know, low to no risk histories, that are about to make this decision and they're not really decided, you know, communication to people who have had the highest risk exposures engage in behaviors very frequently and what they both have in common is that they need social skills, social in terms of, and you know they're all socially competent, but I mean need these social skills around sex and we don't do that and we don't do that in the conseling session because it's not amenable to a fourty minute or twenty minute or even an hour.
N: And plus there's this desire to first of all cover the medical and legal things and lab stuff and the technological fix, which is the answer, it's just like in birth control counseling, you know, the only problem we have to talk about is how to get you put that damn diaphragm in or that condom on and it's technology all the time.
C: Uh hm.
N: And the other issues are totally background.
C: And the way I try to open it up is to always think about options, you know I feel like a session goes well if I've left people with options, I believe that the best chances of survival are directly proportional to the number of options you have. So more options, higher probability for survival.
N: So rather than saying you should do one thing, you say these are some, this is my experience, these are some things other people have tried or I've tried.
C: And what they can get from me that they haven't that they can't get on their own is this exposure to thousands of people talking about their sex life and uh, somebody who has spent so much time talking about sex that I'm very comfortable.
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