August 7, 2006
“Talk to your partner about Sexually Transmitted Diseases.”
That’s the typical advice of public health agencies.
Often, though, they leave something out: How exactly does one do that?
“Hey, how ’bout them M’s? And by the way, I have herpes. How ’bout you?”
Or: “Wow, listen to the frogs out there tonight. I wonder if they have warts. Do you?”
Whether you’re contemplating your first intimate relationship, or re-entering the Wild World of Dating after a married or partnered hiatus, most people find starting that conversation roughly on par with cleaning dog poop off their shoes.
Necessary but awful. Messy if bungled. Can leave a lingering bad smell if not accomplished.
Think about the statistics: An estimated quarter of adults have genital herpes, although many haven’t recognized the symptoms. At any given time, 20 to 40 million Americans have sexually transmitted human papillomavirus (HPV) — some varieties of which can cause genital warts or cervical cancer — and most sexually active people will get it at least once, experts say.
Denial is a beautiful state of mind, but being STD-free is a beautiful state of body. And even if you have one, do you want two? Shouldn’t you be honest with someone you care about enough to have sex with?
No doubt about it, though, it’s a difficult conversation for most people — even for Brad Pitt when he approached Angelina Jolie, imagines Dennis Torres, health educator at the Madison Clinic.
Joseph, 25, a construction worker and rock climber, says he’s not offended when a woman requests he get tested before they become intimate. “They’re taking care of themselves,” he says, which helps allay his fears about her status.
At times he’s brought it up and offered to get tested. But, he admits, he’s also had sex without so much as a mention. That has led to “scares,” though, that now make him more willing to have “the talk” before sex.
Still, he tends to “beat around the bush” when he brings it up, he admits. “You could be Fabio and it’s not going to work to blurt it out,” he says. “It’ll be a turnoff.”
Scary but necessary
It might help to know that what you have to say or hear couldn’t be tougher than what 29-year-old single mom Kelly Hill has to tell a cute, interested guy: She has HIV.
She delivers the news in a straightforward way, says Hill, a peer counselor at BABES Network-YWCA, founded to build community among women facing HIV and AIDS. “It’s a matter of fact,” she says. “It needs to be known, but I don’t have a lot of drama around it.”
She’s never had a potential sexual partner react negatively, says Hill, who has been dating for the past five years. That may be because she’s educated herself about the disease, she says, and is comfortable and confident about her situation. “I’m not happy I have HIV, but it’s not all of who I am,” Hill says. “I don’t feel I did something wrong to get it, so I don’t come across as nervous or ashamed.”
Jordan, 32, who recently left military service, hasn’t had the conversation yet with the woman he’s been seeing.
But he thinks talking about their sexual histories has “great potential to deepen the intimacy of the relationship,” he says. “It’d be a lot easier to just jump into the sack, but that’s not the relationship I’m looking for.”
At the same time, he admits he’s intimidated at the prospect of talking about STDs. “It’s a scary conversation to me.”
Dr. Jeanne Marrazzo, a researcher at the University of Washington Center for AIDS and STD, isn’t surprised. The Institute of Medicine report on STDs noted: “Ironically, it may require greater intimacy to discuss sex than to engage in it.”
Not only is there fear of rejection, there’s misplaced shame about STDs and societal reluctance to talk about sex in any way, says Marrazzo. Most “traditionally trained” doctors and other providers likely won’t help get you in the groove, because “they’re really uncomfortable talking about sex.”
BABES Network-YWCA: A sisterhood of women facing HIV together: www.babesnetwork.org
The American Social Health Association: Offers information about STDs, chat rooms, newsletters and comprehensive booklets: www.ashastd.org/
More advice from “Dr. K”: (Dr. Jeffrey Klausner, director of STD Prevention and Control Services at San Francisco Department of Public Health): www.dph.sf.ca.us/sfcityclinic/drk/
Prepare yourself
OK, so you’re on your own. Where do you start?
With yourself, that’s where.
First, get screened and tested so you know your own status, says Robert Marks, disease intervention specialist supervisor for the public health STD clinic at Harborview Medical Center. “Don’t assume providers are testing you,” he says, because a lot of them “make assumptions based on appearance.”
Then, get comfortable with the facts, the lingo, with the questions this conversation may elicit. Educate yourself about treatment, protection and symptoms.
Try role-playing with a trusted friend, counselor, or even in front of a mirror, suggests Dr. Jeffrey Klausner, director of STD prevention and control for the San Francisco Department of Public Health. Play both parts, so you know how it feels to both give and get the question or information.
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Pay attention to your own body language, the pitch of your voice, the speed of your words. Can you speak calmly with confidence and clarity? “You are not lecturing or confessing,” says Klausner, who answers questions as “Dr. K” on the San Francisco City Clinic Web site. “You’re sharing personal information.” And remember: You’re doing it because you respect yourself and care for the other person.
Try to neutralize your “attitude” about STDs. Are you loading such a disease with all sorts of meaning that you wouldn’t attach to, say, a cold or athletes’ foot? Do you think having an STD is a sign of promiscuity, stupidity or shame?
Health educators work hard to “unload” all this baggage from STDs, Klausner notes. If you’re not ashamed about having had sex, then don’t be ashamed about STDs, he suggests. “I try to normalize it, routine-ize it, remind people that [STDs] are a common experience for anyone who is sexually active.”
Or take a page from a baby-boomer who said: “Anybody who was anybody in the ’60s has herpes.”
Try viewing the conversation as a modern ritual, a sort of expected “full disclosure” statement similar to that now demanded by medical journals from authors of research papers. Some people make testing a part of that pre-sex ritual. Marrazzo likes this opening line: “I really like you a lot, and I want this relationship to start out on a healthy footing. So let’s start out with a clean slate, and go in to get screened for STDs and other infections.”
Making the conversation and screening routine, says Marrazzo, helps “defuse blame and depersonalize responsibility for who might have brought whatever into a relationship and what your sexual past might have been.”
When and where? Not the first date, hopefully. Do it when you’re feeling relaxed and comfortable — and definitely before the clothes come off. The conversation can be the “anti-aphrodisiac,” as one doctor puts it, in the heat of the moment.
A good place is one that’s private and sexually “neutral,” such as the kitchen. Try to be on the “same ground,” both figuratively and literally, suggests Klausner, to minimize power imbalances. That means being at equal height, such as on the couch.
Here are some other openers suggested by health educators:
• “I really care about you, so there’s something I want to talk about together.”
• “I have something important to tell you.”
• Or wait until there’s a mention of STDs, or a sex scene on TV or in a movie, and go from there.
• You might say you were involved in a previous relationship and picked up an “infection.” Don’t instantly overwhelm the other person with facts, but offer to answer questions.
Be straightforward and specific, Marks suggests, not vague.
Instead of “Are you clean?” ask “What is your HIV status?”
“I encourage people to ask ‘What does that mean?’ ” Define terms, even common ones such as “monogamous” or “sex.”
If the issue is HIV, ask when a person’s last test was. “Just asking about someone’s status might not be enough,” Marks notes, because he or she may have had other encounters since then.
Expect the best of the other person if you’re disclosing your STD, Klausner says. “People usually act as you expect them to.”
But prepare for the worst. Some people will react badly to even having the conversation, much less being told their intended partner has an STD — or being asked to reveal an infection of their own.
One woman with HIV remembers a man angrily saying, “You wasted my time.” Now, she initiates the conversation as early as possible.
Hill says she would never disrespect or try to diminish a shocked reaction to her HIV disclosure. After all, that’s how she felt when the boyfriend she got it from told her.
“I do get nervous every time I tell someone,” she admits. “I’m still worried about rejection.”
“It’s never easy,” agrees Marks. “But the more you do it, the more experience you get. Let’s face it, everybody faces the issue of rejection. It’s one of the biggest barriers to bringing up the subject.”
But remember that many relationships weather bad news, Klausner suggests, and that you have survived other difficulties. “Put it in context,” he advises. “This is just another one of life’s challenges and people get over it.”
Initially, it’s a scary conversation to have, Marks says. “But once you do and you’re past it, the relief people feel can be amazing.”
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