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|
 The Storm |
| For
a therapist, this can be a hard time. If your training, like mine, has
been in non-directive techniques in which we trust that each client
has within him or herself the seeds of wholeness and the potential to make
the right decisions, how do you answer a plea like Sarah's?
How do you answer it if you know that Sarah has some risk factors of HIV exposure? What if her actions could be infecting others? Does the Tarasoff case have relevancy when your client does have HIV or AIDS and is not informing his or her partner? Does HIV status have to be disclosed to the client's insurance provider or government agencies? What are the best ways to be supportive and empathic when HIV or AIDS impacts a client and his or her family? These are some of the issues that will be addressed in this course. |
According to the Center for Disease Control, over 900,000 Americans are infected with HIV, the human immunodeficiency virus which causes AIDS, the acquired immune deficiency syndrome. HIV impairs the body's ability to fight infections and some cancers by destroying or compromising cells of the immune system. Many of the 900,000 affected don't know they have HIV.
Worldwide, HIV and AIDS are
a huge concern. The UCSF HIV Insite: Gateway to AIDS Knowledge website
states: "Over 30 million people in the world have been infected with HIV,
the virus which causes AIDS. Ninety-three percent of these infections have
occurred in the developing world, with sub-Saharan Africa and Southeast
Asia two of the hardest hit regions. Over 16,000 people are newly infected
with HIV every day." Please go to their website to view a 
map
which shows the incidence of HIV and AIDS in the world today.
How does a person get HIV?
1. HIV is transmitted via
sexual contact with an affected partner. This contact must involve
the exchange of body fluids, such as semen, vaginal fluids or blood.
2. HIV can be transmitted
through needles shared during IV drug use.
3. HIV was transmitted through
blood transfusions prior to 1985. Since then, the U.S. blood supply has
been screened for HIV and heat treatment has been used to destroy HIV in
the blood supply. Many hemophiliacs have died of AIDS from contaminated
blood components, although now these products are being screened.
4. HIV has been transmitted
to health care workers who have received accidental needle sticks.
5. HIV can be transmitted
from an infected mother to her child, during pregnancy, labor, delivery
and through breast feeding. An infant can be born HIV positive.
While saliva has not been
found to contain significant amounts of HIV, oral/genital sexual contact
can be risky if there are small open sores, so use of latex protection
is recommended.
The National Institute of
Allergy and Infectious Diseases and National Institute of Health has an
on-line fact
sheet on HIV Infection and AIDS.
| How do we best help Sarah at this point? Although this course will follow Sarah's treatment, it also addresses the treatment issues of other women, men and children that are HIV positive or have AIDS. While we follow 33 year old Sarah in her journey, some of what is described also applies to 17 year old Carlos, 59 year old Jan, 41 year old Peter, to the parents of Eleanor, aged 7 months, and to many many others facing HIV and AIDS. All names and identifying details have been changed to ensure confidentiality. |
Sarah's anxiety increased as the session progressed. She bounced from fear and panic to a dissociative state, seeming to find no landing place. Her main sense was that it couldn't possibly happen to her. She kept repeating "I am not a gay man, I am not an IV drug user, I was never promiscuous...I just can't believe it." She had flashes of anger at her gynecologist, Dr. Marten, for suggesting that she be tested. "Who does she think I am?!!! I will never go back to her!"
Sarah has the same misconceptions
of many people. HIV and AIDS have never been conditions exclusive
to the gay or drug using communities. This attitude has prevented many
people from being tested and being treated with compassion. HIV and AIDS
can exist in any community.
| Where
do I go with Sarah at this point in the session? Do I educate her about
HIV transmission? Do I try to connect with the part of her that is
terrified, or that is angry at the doctor? Do I try to reassure her?
What should I do?
I had been working with Sarah for slightly less than a year. She had started therapy to resolve relationship issues, having had a series of what she called "bad boyfriends", men was dating after a brief first marriage. Sarah was the mother of six year old Rebecca and was in a relationship with Sam, whom she hoped to marry. Sarah was monogamous in each relationship, as were the boyfriends, to the best of her knowledge. Sarah had never used drugs intravenously, or shared drug paraphernalia ('cookers' or 'cotton'; apparatus for cooking and straining drugs.) Sarah had not received a blood transfusion. Sarah had never been sexually assaulted. I decided to follow Sarah in her process at this point, not to educate her regarding HIV transmission, but to see where she would go. I was able to do this because Dr. Marten had already raised the issue of HIV testing with Sarah. I could see that if I joined with Dr. Marten at this point in the therapy, there was a possibility that neither Dr. Marten nor I would ever see Sarah again. |
Sarah
continued to rapidly cycle through a multitude of feelings for the remainder
of the session. She left feeling exhausted and very shaky. We confirmed
our appointment for the following week.
| I
took a good look at myself when Sarah left. I was frightened for her and
frightened that her story could be my story or the story of almost any
woman that I knew. I wondered if that thought was homophobic, because
it could also be the story of most men too. We all want love and sometimes
where we find it has repercussions.
I was scared at another level because in the early 1980's I volunteered for an organization called "The Shanti Project", which was run out of a small house in Berkeley. I remember hearing about a thing called "The Gay Cancer", knowing men who had these sores called KS (Kaposi's Sarcoma) and watching them die one by one. Over the years the illness these people had became known as AIDS, the acquired immune deficiency syndrome. A lot of my friends died. Was I suffering from post traumatic stress disorder or compassion fatigue, having been near the front lines of the epidemic? Did I have the heart to go on Sarah's journey wherever it would lead? |
Sarah
came back to therapy the following Tuesday. She described a very rough
week with fear and anxiety. She still had not decided to get tested, but
started to think about her relationships. Could it have been Joe? or Alan?
or even her ex-husband, Stan, who was older than she was and came to the
marriage more experienced sexually than she had been? What about Sam, her
current boyfriend? She described a week in which every twinge in
her body was magnified and she was convinced she was dying. Then, she described
a nightmare:
'I
dreamed I was with Rebecca, my daughter, at the beach. We are sunbathing,
and there is a shadow on my striped beach towel. I look up, and there is
a huge spider between me and the sun. I grab Rebecca and we try to run,
but I can't run in the sand. I wake up and am very scared. I am sweating.'
| I
sat silently with Sarah at this point, knowing that sometimes the best
words are no words. I knew that she was already using latex
condoms, both for birth control and to try to control her repeated yeast
infections.
My decision to wait a bit for Sarah's internal process to catch up with the external process (in her case the symptoms she was experiencing, and her doctor's recommendation that she be tested) allowed me a luxury that the therapist doesn't always have. Imagine for a moment that Sarah is your client: What would you do? Supposing Sarah was an IV drug user...would you do anything different? How about if Sarah was married? How about if Sarah was pregnant? How about if Sarah was married, and her only sexual partner ever was her husband? What if Sarah was lesbian or bisexual? How about if Sarah were a gay man? How about if Sarah was Caucasian? African American? African? Native American? Hispanic? Orthodox Jewish? Amish? Asian? From any other cultural or ethnic group? Please take a moment to examine your preconceptions about each ethnic/cultural group and HIV. These are important questions because HIV and AIDS elicit a powerful counter-transference. It is essential to explore our own selves as honestly as possible to be able to be present and compassionate for our clients. |
After
telling me her dream, Sarah began to cry. "I am so scared; so, so scared.
I am scared for Rebecca, that she won't have a mommy..." Here Sarah's tears
turned to sobs. Finally, she looked up at me. "I should get tested, right?"
I
nodded in agreement, not escaping to 'therapist neutrality' but trusting
that Sarah had dropped to that wise center within herself. Sarah still
did not want to go to the clinic to get tested. Fortunately we lived
in an area that offered anonymous HIV testing.
| If you are unsure of where
to locate anonymous HIV testing, do an internet search now! Go to
your search engine and type in "anonymous HIV testing", using the quotes
to get all three words in the search. At this time (July 1999) Yahoo
currently lists 714 sites. AltaVista has 1104 entries. AOL
has 346 sites. Without the quotes, AOL had 899,379 listings!
You also could add the name of the nearest city, to define your search.
The UCSF HIV Insite: Gateway to AIDS Knowledge website has a U.S.
State by State listing which includes HIV/AIDS information by state.
Please
check the link for your state.
There is one home test for
HIV approved by the FDA. The link from their |
888-777-3773
|
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