Our Bodies, Ourselves (59 page)

•
Lack of information.
Unprotected sex is more common when information about STIs and pregnancy risk is not available. You can
obtain solid information from health-care providers at family-planning clinics such as Planned Parenthood. Other sex-positive and comprehensive sources of information can be found in Recommended Resources.

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Cost and access:
These remain formidable obstacles for many women. Call a health clinic or Planned Parenthood and explain that you'd like to discuss safer-sex options but your resources are limited. Many clinics offer safer-sex supplies free. At the very least, you can almost always get condoms from clinics just by walking in the door, without even having to register as a patient.

Look, I know how to protect myself. But it's just not that easy. When I hand him a condom, he says, “What's the matter, baby? Don't you trust me?” What am I supposed to say to that?

For many of us, a partner's resistance to safer sex may be the most challenging obstacle we face.

Some people feel that sex isn't as good with barriers, or that barriers reduce intimacy.

Courtesy of YWCHAC

Young Women of Color HIV/AIDS Coalition prepare to pass out condoms.

Some men are afraid they won't stay hard with a condom on, even though the base of
male condoms usually helps maintain an erection. Partners who are used to being in charge sexually may resent it when women initiate safer sex. Many sex workers' clients refuse to pay for protected sex, or they pay more for sex without condoms. A lesbian may believe there's no HIV or other STI risk for lesbians. Suggest using protection, and your partners may feel that you're accusing them of sleeping around or of using drugs.

Negotiating safer sex can be especially difficult in abusive or controlling relationships. Talking about safer sex is more risky for some of us; even if we understand that we need to speak up in order to protect our lives and health, it may be almost impossible, or even dangerous, to do so. The choice may be between unsafe sex or violence, abandonment, or homelessness. If your partner reacts to your request to practice safer sex with threats or with physical or emotional violence, see
Chapter 24
, “Violence Against Women.”

Being honest and direct with our sex partners is an excellent goal. But the
most
important thing in the short term is to reduce your risk of pregnancy or of contracting HIV or another STI. If you are not yet at the point where you can insist on safer sex (and your partner is male), here are a few things women have tried.

• With a new partner, say that you always use condoms because they are your preferred method of birth control.

• Say that you are about to get your period—or that you think you may have a minor infection—and want to use something so your partner isn't exposed. Even though it doesn't feel good to make up reasons, it may still be safer than not using anything for protection.

• If you use a female condom, point out that it's your body, your female condom, and your choice to protect your health and the health of your partner.

For more ideas about how to respond if you ever feel pressured to have sex without a condom, visit the American Social Health Association's page on negotiating condom use at ashastd.org/condom/condom_negotiation.cfm.

Conservative religious groups and political organizations in some parts of the United States have spent considerable energy blocking comprehensive health education in schools and advocating for abstinence-only sex education. Studies have shown that abstinence-only programs are not effective in preventing STIs. A large study of adolescents who pledged to abstain from sex until marriage, for example, found their rates of STI transmission to be similar to those of nonpledgers. The study indicated that even though pledge takers initiated sex later, they were less likely to seek STI testing and less likely to use condoms when they did have sex.
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Many states also experienced a rise in teenage pregnancy after putting in place abstinence-only curricula and later began to reconsider the approach. For more information on state and federal policies aimed at preventing STIs and teen pregnancies see
“Politicizing Reproductive Health,”

STI education programs work—if they are supported. School education programs that make condoms available report fewer students having intercourse and a higher level of safer-sex practices among students who are having sex.
6
And studies show that accurate sex information and vaccination against STIs, such as hepatitis B or HPV, do not increase sexual activity among young adults.
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We urgently need to keep developing and providing culturally relevant education, prevention, and treatment for everyone, especially young and low-income women who are at highest
risk. It's imperative for safer-sex education programs to engage the people they serve in designing and implementing programs. Attitudes about sex are shaped in part by community, economic status, and life experiences. Factual knowledge is essential, but cultural awareness is also necessary in discussing potentially successful strategies for negotiating safer sex.

© Can Stock Photo / Oscar C. Williams

A Latina from Chicago writes that in lower-income communities in particular, “Sexuality is one area over which men still feel like they have some control in their lives. If the women bring home the safer-sex message, we may become lightning rods for the frustration and anger the men feel as a result of racism, unemployment, and poverty. The educational strategy has to be developed by the community itself.”

What works best? The nonprofit organization Advocates for Youth lists the following characteristics of effective sex education, based in part on research by Douglas Kirby and Sue Alford.
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These are helpful starting points for any group or organization.

• Offer age- and culturally appropriate sexual health information in a safe environment for participants.

• Cooperate with members of the target community, especially young people.

• Assist young people to clarify their individual, family, and community values.

• Assist young people to develop skills in communication, refusal, and negotiation.

• Provide medically accurate information about both abstinence and contraception, including condoms.

• Have clear goals for preventing HIV, other STIs, and/or teen pregnancy.

• Focus on specific health behaviors related to the goals, with clear messages about these behaviors.

• Address psychosocial risk and protective factors with activities to change each targeted risk and to promote each protective factor.

• Respect community values and respond to community needs.

• Rely on participatory teaching methods, implemented by trained educators and using all the activities as designed.

CHAPTER 11
Sexually Transmitted Infections

E
very woman has a right to enjoy her sexuality without fear of disease. That means we need to know how to protect ourselves from sexually transmitted infections (STIs), how to find treatment if we get one, and how to avoid spreading an infection without giving up our sex lives.

Sexually transmitted infections range from a temporary bother to life-threatening. If left untreated, some can cause infertility or chronic pelvic pain, or be transmitted during pregnancy or birth to a fetus or newborn baby. Having an STI can make a person more susceptible to other infections, including HIV, the virus that causes AIDS.

You can catch some STIs just by touching or kissing an infected area. But the biggest risk for women is from vaginal or
anal intercourse without a condom. You can also catch some infections, like HIV, by sharing needles during drug use.

While it's in our interest to use protection during sexual activity, to get screened for STIs as needed, and to pursue necessary treatments, we don't always know how to do this or make the right decisions or follow the best practices. Most STIs have no visible symptoms, so we are often not aware that we or our sexual partners are infected. And because of lingering negative social attitudes toward sex, even the idea of having a sexually transmitted infection can bring up embarrassment, shame, anger, and fear. The social stigma attached to STIs (how others think about someone with an STI) can make it difficult to use protection or to seek needed care or resources:

My husband told me he'd slept with someone else and might have gotten an STI. I didn't know what to do…. I saw an ad yesterday for an STI hotline, and after a lot of hesitation, I called. It was a relief to get information without anyone knowing who I was
.

If one person in a supposedly monogamous couple gets an STI, it may be from sexual contact outside the relationship, either recently or in the past. Some infections can be present without symptoms for years and have been acquired before the current relationship. It can help to remember that STIs are a health problem—like any other health problem—and not a sign of wrongdoing.

I was diagnosed six years ago, and then found out my boyfriend at the time had been cheating on me…. I was hurt, embarrassed, felt unlovable, disappointed, and angry at myself because I knew I should have been using protection
all of the time
especially since I knew he had a history of being unfaithful in past relationships. Six years later, I see my diagnosis as a hidden gift … strange, huh? But it forces me to have conversations [with potential partners] about sexual history, my chosen form of protection which is condoms, and [about] readiness to have sex or not
.