I have a busy medical practice that includes quite a number of people who have HIV or who are at risk of HIV. Yet none of them ever brings up the issue of sexual risk behavior and what they can do to stay safe. How can I raise the issue with them?
Your position as a health care provider offers you a unique opportunity to talk about protected sexual behavior. Because this is such a sensitive subject, you cannot expect your patients to bring it up on their own. Instead, it is important for you to give them an opportunity to raise any concerns they may have, and then to take the time to have a discussion about risk behaviors. One way to approach the issue is to say “Some of my patients wonder whether HIV may be a risk for them. Do you ever think about that?” By bringing up other people, you make it less about them individually than about a general issue faced by everyone. This same approach can also be used to discuss other sensitive subjects, such as contraception and sexually transmitted diseases. It is especially important to bring up issues related to sexuality with younger people. Many school systems are doing an inadequate job of teaching youths about sexuality, for example, by having “abstinence-only” curricula that are increasingly being shown to be ineffective. Instead, it is crucial to provide younger people with accurate, scientific information and to reflect openness to their concerns. Discussing sexuality with a young person will not be “putting ideas in their heads.” Sex is “in their heads” already – they’re hearing about it ever day from their friends and peers as well as from a media-saturated society in which sexuality is everywhere. Based upon your expertise and comfort with discussing sexuality, you should be able to assess an individual’s risk and then also make appropriate referrals. Beforehand, you should familiarize yourself with a range of information sources and community-based organizations, and to share this information with your patients.