A topic that you might expect to enter into HIV education more frequently than it does is risk management. How do people make decisions around managing risk? It’s a topic that I know very little about, and I certainly hear very little about it in this field.

While we put a fair amount of effort towards understanding social and cultural nuances that affect sexual decision making, a part of me wonders if we could be drawing on the body of knowledge that exists around how people interpret and manage risks in their daily lives. This occurred to me today, during an early morning conversation about HIV transmission. I say “early morning” because, at quarter past 8, as I was taking the first few sips of my coffee, I found myself explaining to a friend, visiting from out of town, what particular sex acts are at higher risk for HIV transmission and why.  (Innocent questions about my job quickly transition into talking about vaginal lining or anal mucus… hence my previous post on how the job never ends).

 My friend asked an interesting question – do different at-risk groups pay more or less attention to the nuances of different levels of risk? Specifically, he wondered about sero-discordant couples. My response was that partners who make a decision to engage in a sero-discordant sexual relationship would likely be interested in learning about the different levels of risk; a more relevant issue is that many people tend to take a completely “hands-off” approach when it comes to risk management around HIV infection, attempting to avoid dealing with sexual risk completely.

I do, unfortunately, often encounter HIV negative people who seem to believe that having sex only with only HIV negative people is the best solution to protecting themselves from HIV. Of course this avoidance of risk is an illusion; they fail to recognize that they may be having sex with HIV positive people without knowing it (because not everybody knows their status, nor will they necessarily always disclose it) and this false impression may lead people to increase their level of risk by failing to use condoms, for example.

But this led me to a question. Why do people make such severe judgements about risk when it comes to sex and not when it comes to many other aspects of our lives?  Everyday many of us get in the car and drive to work, even though there is a significant risk that we get into a car accident.  In fact, the risk of an accident likely trumps the risk of acquiring HIV by unprotected sex. The number of car accidents per year far exceed HIV infections, yet people get into their cars every day, buckle their seatbelt as a matter of harm reduction, and go ahead with their day without thinking, calculating, or questioning these risks, let alone judging others who also put themselves at risk by being on the road.  But many of these HIV negative car drivers would not carry this same approach to sero-discordant sex, even though it could be argued that a car accident could potentially have worse consequences than HIV acquisition and that missing out on a great love or even great sex would be a tremendous loss.

So what are the psychological or sociological factors that make people behave so illogically when it comes to decisions around risk taking?  As we work to address stigma, disclosure, condom use and other issues, it may be information worth knowing.

Enjoying the nice warm weather we had recently, a colleague and I headed out for an evening beer on a patio.  My colleague informed me that tonight she and her husband would be meeting their new neighbours. “What are you going to tell them you do for a living?” I asked.

It’s THE question to ask when you’re meeting someone new.  It is a difficult question for a lot of people to answer. When I was growing up, my father was an independent agricultural market analyst & strategist. Try explaining that to the kids at age 8.  I myself have rarely found myself in positions where my job is easy to explain. For example, when I was getting my Masters degree in Sociology, I often had to explain that no, Sociology is not psychology, no I am not secretly analyzing you, and no, being a graduate student does mean I am an unemployed recent graduate. 

But being in the HIV & AIDS field is a whole other ballgame, because people are really ignorant on the issues, and where ignorance looms, so does stigma.  You’re never quite sure when it’s going to make an appearance.

When I was signing the lease to my new house, I received the inevitable question from my landlord - “what do you do for a living?” I knew it was coming and I had been worrying about how to answer this question. I feared that my landlord would be totally ignorant of HIV transmission methods and would have concerns that I could potentially infect him through using the toilet or you know, breathing in his house.

Even if you don’t encounter stigma, educating people can be plain exhausting. Usually you get one of two responses: complete silence, or a barrage of questions. Sometimes silence, although annoying, can be somewhat relieving. You may remember from my post Living in Two Worlds what it’s like when you’re trying to have a beer but end up lecturing someone on the difference between HIV and AIDS: 

"I am happy to educate people and hope that it does some good. I’m a patient person. But I usually end up secretly wanting to smack someone, especially when their queries have subtle or not-so-subtle undertones of a judgemental attitude - or are just plain stupid. And I often end up wishing for an opportunity to drink my beer without having to explain how HIV is transmitted, or what the difference is between HIV & AIDS, or, as was in the case last week, that my – or anyone else’s - sero-status is none of their business."

I know some people who lie outright about what they do. At a vicarious trauma workshop I heard of one woman who tells people she works in “manufacturing.” Another said she calls herself a dog groomer.

So, my colleague and I hatched a plan to help her avoid having to talk about injection drug use over cocktails. Mostly it involved being honest but vague, by using broad terms like “youth” “outreach” “education” and “blood-borne diseases”.

I deduced my own plan of what to say, too. Borrowing from terms I used when I worked in a hospital, I have now prepared the following script:  I’m in health care. What field? Psycho-social. Where? At a private clinic. 

Okay. So it’s not really the truth but frankly, it’s close enough.

I actually used this on the weekend. When my teardrop-tattooed, 6ft 6”, all-muscle mover asked me what I did for a living, I used the “I work in health care in a private clinic” line. No further questions. Done. Believe me, I did not want to get into the HIV transmission discussion in that moment.

Am I contributing to stigma by not telling people what I do?  Maybe. But in the defence of myself and others who may lie, we talk about the issues all day long and almost ceaselessly put ourselves in the role of advocates and educators. Our work doesn’t end at 5:00; it continues at the salon, the hairdresser, the dentist’s office, the auto-body shop (yeah, that one was a doozy), the bar and at the gym, and on Facebook, Facebook, Facebook.

When you work in an ASO, you don’t have to have HIV to be the recipient of stigma. Sure, many times people make assumptions that I am HIV negative because I’m a young woman, but they may easily assume I am HIV positive, and thanks to the aforementioned ignorance and stigma, that makes me fear discrimination in housing and other areas. So between fearing discrimination and simply needing a break from the role of an educator, maybe a little white lie once in a while doesn’t hurt.

When I met up with Bob at the Gay Men’s Sexual Health Summit in Toronto in February, he urged me to do a “more personal” post involving a big change coming up in my life: moving in with my partner.

Partner. Should I have said that? Or am I moving in with my boyfriend?

PositiveLite blogger Danny Miller wrote about this dilemma in his hilarious post on Gay Marriage: 

“After 12 years we were way past boyfriends, the term “lover” just makes me think of secret sex interludes, and “partner” just flat out pisses me off. Love is not a business, and I washed the man's dirty underwear for 10 years dammit.  I'll call him my husband if I damn well please!”

I can relate. In my last relationship I cringed when people referred to my partner as my “boyfriend”. To me, a boyfriend is someone you go on dates with. Not someone you live with, share finances with, and are comfortable farting in front of.

What other term besides partner is there? Common-law spouse? “Last night, my common-law spouse and I went to the movies…”  Even if that sounded remotely okay it has all sorts of technical complications, like when one legally becomes common-law. To my recollection, the (Canadian)  federal government considers you common-law if you’ve been living together for one year, but the provincial government requires three consecutive years of co-habitation.  How does that impact how you identify your relationship? “And this is Joe Smith, my federally-sanctioned common-law spouse”.

For Danny, the word partner conjures up a business relationship, and he’s not the only one. Remember the scene in American Beauty where Frank confuses his neighbours for business partners? To me, the word makes me think of two people that live together within a committed, supportive romantic relationship. I like the word partner because it implies teamwork, equality and mutual support.

Sometimes when I reference my “partner” among people who don’t know me, they wonder if I am referring to a female partner since I haven’t specified a gender. They say, “oh, what does he or she do for a living?” Which is fine with me; actually, I think it’s nice that the gender is open because it reminds people not to be heterosexist, that people can have a partner of any gender.

So, now that I am moving in with my boyfriend, can I now call him my partner? Or is he my live-in boyfriend?   When does a boyfriend become a partner? Does it happen once the furniture has been merged or is it something bigger than that? Am I waiting for him to get down on his knee and ask me to be his partner? Or is feeling love and commitment enough?

Just over a year ago, our Executive Director (Tom Hammond,) and I were returning home from the OHTN research conference, feeling inspired by the number of exciting and innovative research projects being shared. We started to think aloud about the kind of research we would do in our community if we had the means, and we immediately got talking about barriers to sex among people living with HIV.

We’re doing this study to better understand what these barriers are all about and how we can address them as a community and as an agency. We’re trying to understand what the challenges are – such as fears of transmission or criminalization, stigma, disclosure, changes in body image and sex drive, and so on. We’re also aiming to understand resilience, so from those who are in satisfactory relationships and having the kind of sex they want, we hope to learn about how they overcome challenges or navigate through them. Gaining this kind of data will help us drive future programming or community-based initiatives that can help us respond to some of these issues.

The study is a Community Based Research Project, funded by the Ontario HIV Treatment Network. Because this is a community based research project, this means that the community we are studying is playing an important role in the creation and execution of this study. This includes identifying needs, conducting interviews and analysis, guiding the project, and then learning about, sharing, and benefiting from, the data.  PHAs have contributed to an unbelievable amount of research, but we feel that this study is especially relevant to those participating and the data should yield findings that are actionable at an agency and community level.

We’re conducting qualitative face-to-face, semi-structured interviews, and will be conducting a thematic analysis. Part of the analysis will include a member-checking session where previous participants have the opportunity to review the key-themes that have been identified and elaborate on, add to, or correct, preliminary findings. It’s a way of making sure that the data has been interpreted by the researchers in a way that is congruent with the participants’ interpretations.

I should mention that this study is governed by a Working Group that includes me and Tom Hammond as Principle Investigators, one peer research assistant, another community research assistant, and a consultant. We also have an Advisory Committee that includes representation from Public Health, ACCKWA (the AIDS Committee of Cambridge, Kitchener, Waterloo and Area), the University of Guelph, and ACG’s Board of Directors and client base. We have three PHAs involved in advising and conducting this study.

After our proposal was approved by the University of Toronto Research Ethics board in the fall, it was all systems go. Despite only using passive recruitment methods, people have been signing up quickly to do this study, which is pretty surprising considering we’re asking people to talk about sex.  I’m not sure if it’s because participants feel passionate about the subject matter, feel comfortable with our peer researcher and agency, or simply need money around the holidays (participants are given $40 for their participation) but I’m very happy to say that within just a few weeks we managed schedule nearly 75% of our interview quota.

I look forward to sharing the findings with PositiveLite, com readers. Please let me know if you would like to participate or have any questions about the study. To hear one participant’s experience of being interviewed you can read Wayne Bristow’s account on Show Me the Love and his related musings on love and sex.