Nicolas Sheon, Berkeley Free Clinic, October 1996
What follows are some suggestions on ways counselors and outreach workers can talk with HIV test clients about condoms. The same techniques can be adapted to non-clinical situations, such as with your sex partners. In other words you can learn from counselors about ways to negotiate condoms and how to make them work better for you and your partners. The trick is to adjust the language to fit the context. For example, the questions below are written for counselors in a clinical setting. This means they are walking a fine line by asking perfect strangers very personal questions. If you are talking to a partner about their experiences with condoms, other issues of trust and boundaries come into play. The trick in either situation is to remain as non-judgmental as possible.
Bringing up the topic of condoms with HIV test clients
In order to save time and energy assess the client's needs in terms of condom information first. Begin any discussion of condoms with an open ended probe about their experiences with condoms.
The above questions are open ended because the client can't just say "yes" or "no." The client has to give a narrative or justification of their response. This conveys a lot of information about their experiences, attitudes and beliefs regarding condom use.
Don't ask, for instance, "So, do you use condoms every time you have sex?" This will invariably get a "yes" and end the discussion. Based on what the client said in response to the open-ended question, propose a brand of condom that would work better. If participant's financial situation permits suggest that they try a lot of different condoms until they find the kind that fits them best. Give the client a selection of different condoms and point out the qualities of each type. If sex is a sport, you wouldn't want to get to a match having never practiced with the equipment right. Practice, practice, practice.
Marketing of condoms is a good strategy to get client to try condoms with an open mind. For instance, tell them about a particular condom that would work better given what problems they have indicated. I like to market Japanese condoms because they are much thinner and stretchier than condoms made elswhere. I explain to clients that the Japanese do not use birth control pills (oral contraceptives are actually unconstitutional in Japan) and how the Japanese rely condoms for birth control and STD protection. Japanese also have very high production standards. This makes the client feel like they are in on a secret and perhaps intrigued enough to try some good Japanese rubbers like Maxx, Beyond Seven, or Kimono.
One of the most effective ways to demonstrate the differences in characteristics of different condoms is to open the packages and have the client feel the difference with their fingers. Take a Japanese condom, such as Beyond Seven condom and an American condom such as Lifestyles, take them out of the package and unroll each of them. Hold them by the base ring between your fingers and gently blow a little air into each to unstick the sides. This gives the client a sense of the different shapes and dimensions. To demonstrate the different levels of sensitivity, have the client hold each condom and feel the tips of their finger through the condom.
In some situations it might be useful for the counselor to have the client practice putting the condom on a dildo during the counseling session. However, if the client is overly embarrassed or the counselor is of the opposite sex, avoid this exercise. Ask yourself as a counselor whether it is really worthwhile that the client be asked to do something that is potentially embarrassing when it is not clear that the client wants to use condoms with their partner(s) at all.
Why the client does not want to (or is not able to) use condoms is a higher priority counseling issue. Be sure that you are not over-demonstrating the use of condoms in the hopes that this will absolve you of the responsibility to address these larger and potentially thornier counseling issues. Counselors naturally have a tendency to emphasize the technological fix for what is a very complex issue of gendered power relations. So, always ask yourself if the condom demonstration is for your benefit or the clients?
Lube can be marketed by referring to one brand as better than another or remarking on the different qualities of various kinds (viscosity, stringiness, staying power, some get gummy). If clients complain that lube gets too thick, suggest that they keep a glass of water by the bed. A few drops will revive the lubricant.
I always recommend non-spermicidal lube and condoms since the spermicide might cause a burning or stinging sensation in the meatus (or pee hole) when lube is put in the tip of the condom. Recent research suggests that nonoxynol-9 can increase the risk for STD transmission by irritating the mucous membranes during sex. Moreover, if the client gets a stinging or burning sensation, this would make it unlikely that the client would try any kind of lube ever again. I also recommend adding some extra lubrication to the outside of the condom for both anal and vaginal sex. Again non-spermicidal is preferable. A little extra lube in the right place makes a big difference in sensation.
If you (the counselor) use condoms, it helps to refer to your own experience with certain condoms when speaking with a client. Salepeople do this all the time since it helps to personalize the recommendation. If you don't use condoms, then make sure you are not talking about them in a way that distances yourself, such as "I've heard that these are better." A middle ground between personal testimony and distancing is to simply say, "I would recommend this kind." This does not out you as a non-user of condoms yet helps to personalize the recommendation.
Finally, thinking about your own experiences with condoms and the reasons you use them or don't use them is an important way to reflect on the psychological and interpersonal complexity of condom use. Sexual negotiation is usually non-verbal and is accomplished through the eyes, breathing and bodily proximity. In the absence of words to discuss sex openly, an object like a condom condenses a lot of meanings, power relations, and assumptions. Condoms are often seen as dirty little reminders that you or your partner have slept with other people. Not surprisingly, people tend to underestimate the risk and find excuses not to use condoms. Help the client think about what condoms mean to them. Help them think about the consequences of whatever rationalizations they might have used when having unprotected sex. For example, condoms can help them avoid the worries about HIV exposure, STD infections, or betrayal by a "monogamous" partner that might have brought them in for testing in the first place.
[
Home ][ Training ][ Advice
][ Research ][ Links
][ Feedback ][ Submit
][About]
[ HIV Prevention Services ][ Berkeley
Free Clinic ][ Confession Box ]