Michael Walker and Dr. Katherine Fordham
By Michael C. Walker and Kate A. Fordham
Now that we - Mike and Kate - are both in the San Francisco Bay Area, we find it much easier to work closely together on this advice column and other projects pertaining to the sexual health of young, gay, people. Right now, we are writing a manuscript for publication in a medical journal detailing our various ideas for using the Internet as a powerful means of communicating sexual-related health information to gay adolescents who might not have access to such information anywhere else.
We are delighted with the response we have had from this column alone and see the success of our efforts as proof that given a quality resource for this kind of information, gay youth will flock to it and that such a resource would help fill a great void in the empty space which, unfortunately, can be a day-to-day reality of adolescent gay life. We want you, the reader, to always remember that there are many people out there who care about you and who have experienced many of the struggles and problems which you find yourself encountering.
This month we received several questions and regret that we cannot address them all in this one column. When we respond to a question which one of our readers has sent in via e-mail; we want to be able to devote adequate time and space to that question in the column and therefore choose to deal with only a limited number questions within each monthly column. We apologize to anyone whose questions we have not as of yet addressed; stay with us --we'll get to them as soon as we can! Now, on to this month's questions:
Dear Mike and Kate,
Could you explain exactly what the AIDS virus is and HIV is? We just finished our unit on sex and sexually transmitted disease in school but they never really explained about AIDS and everything. I am just wondering because I keep hearing different stuff from people about this disease and none of it really makes sense.
Will, age 15
Charlotte, North Carolina
Thanks for your question, it's a very good one as we are sure that there are many other teens out there who do not fully understand what AIDS is and the difference between AIDS and HIV. Although AIDS-related education within the public schools has improved drastically over the past seven years; we feel that such education still has a ways to go before it will really be effective in helping young people understand sexually-transmitted diseases and, most importantly, be able to prevent themselves from acquiring these diseases.
AIDS is an acronym which stands for Acquired ImmunoDeficiency Syndrome. HIV is another acronym which stands for Human Immunodeficiency Virus. As the name implies, HIV is the organism -the virus- itself which causes the disease that we call AIDS. That is, HIV is the actual organism which infects the human body. This is why someone might refer to a person as "HIV positive" meaning that they have the HIV organism inside them. Some people acquire HIV without displaying the symptoms of the disease that we call AIDS. It is possible to get HIV and have several years pass before you become sick with the symptoms of AIDS. Doctors call people who are like this "asymptomatic" because they do not exhibit the symptoms of AIDS even though they are infected with the HIV.
AIDS is called "acquired immunodeficiency syndrome" because there are other immunodeficiency disorders -that is, diseases which affect the body's ability to defend itself against pathogenic -or disease-causing- organisms. These other disorders are not diseases which one person can pass to another through sexual or other types of contact but are instead disorders which are passed from parent to child genetically. AIDS and diseases such as malaria, influenza (the flu), and even the common cold are all examples of communicable diseases as they can be transmitted through the environment or via interpersonal contact, such as sexual intercourse. We do not wish to confuse anyone here, however, because AIDS can be transmitted from a mother who is infected to her child but this is because mother and child share bodily floods while the child is still in the womb and not because there is any transmission of genetic material during the conception of the child. We realize all of this can be somewhat confusing and hope that the explanations which we have offered here make sense and help you, the reader, to understand a little more about these diseases and how diseases are transmitted.
Since we are on the subject of what AIDS is and what it is not, let us say once again how you can "catch" -or acquire- the disease in the first place. AIDS is what doctors call a "blood-borne pathogen", or a disease which is transmitted through the blood and other bodily fluids. These other fluids include semen, vaginal secretions, saliva, and possibly urine. Researchers know for a fact that blood, semen, vaginal secretions, and saliva can transmit the virus but they also know that saliva contains enzymes which inhibit the transmission of HIV. No one really is sure why, but these enzymes seem to destroy HIV or at least prevent it from being transmitted with the same ease as it is in blood and the other fluids we just mentioned. Still, research indicates that HIV CAN be transmitted through saliva so we are not suggesting that it is not possible but are simply saying that the chance is a lot less of acquiring the disease from saliva than from any of the other bodily fluids. Again, it may sound confusing, but we wish to present the facts as they are known and neither inspire undue fear nor encourage risky behavior due to what we say. As we have mentioned in past columns, anal sex is the riskiest sexual practice (in terms of possible HIV transmission) followed by vaginal sex, then oral sex. We strongly encourage the use of a condom in ALL types of sexual intercourse, yet we realize that many people will not use a condom during oral sex, and therefore recommend still that such a person and their sexual partner avoids ejaculation (coming) inside the mouth if they don't choose to use a condom.
As far as non-sexual transmission of HIV is concerned, any direct contact with fresh blood or other bodily fluids and an orifice or open wound could allow for such transmission. Sharing of intravenous (IV) needles in drug use would be the most common example of non-sexual transmission. Year ago, when AIDS was an uncommon disease and scientists had very little understanding of its routes of transmission, blood was not screened for HIV and some people did acquire the virus through blood transfusions. Nowadays, in America, Canada, and Western Europe, blood banks and hospitals test donated blood to make sure it does not contain HIV or other blood-borne pathogens. Therefore, should you ever need a transfusion, you can rest assured that you will not get AIDS or anything else from the donated blood. Also, you will not get AIDS from touching someone who has the disease (or who is HIV-positive) or through any other means of causal contact. Remember this: the virus must pass through bodily fluids, so as long as you are not in contact with such fluids you are not in danger of acquiring the virus. While both of us want to do all we can to prevent any gay teen -or anyone, for that matter- from becoming HIV-positive, we do not want people to be fearful of persons who do have AIDS. In fact, we both work with people who have AIDS everyday, and there is nothing different about someone just because they have this disease. Some of these people are extremely ill, -due to AIDS- and some are HIV-positive yet are not "sick" at all: they are asymptomatic as mentioned before. But none of them are a threat to anyone else through casual contact. We encourage people to look at person who is infected with HIV as just that: a person who happens to have a disease, but NOT a diseased person. Do you see the difference?
Dear Mike and Kate:
My boyfriend and I have been seeing each other for about three months and he has been wanting to have sex ever since about the second week of the relationship. We are both 15 and I don't know if I want to have sex yet but I want to keep the relationship. I don't think he has AIDS or anything but just don't want to do this yet. What should I tell him? Am I being stupid not to want it yet or is this normal?
There's nothing wrong at all with you wanting to wait to have sex, -for whatever reason. As you stated, both you and your boyfriend are only fifteen years old and that is still quite young to be having sexual intercourse. Often we are asked "when" a person should lose his or her virginity and the best response we can give is when it is right for you, personally, and when you're certain that you are mature enough to handle all the aspects of a sexual relationship. Despite the fact that many young people -both gay and straight- are having sexual relationships at younger and younger ages; it is not always a good idea to begin having sex in your early teens. Taking a romantic relationship to the level where sex is involved requires a great deal of maturity and mutual respect from BOTH of the people in that relationship. If one of those people feels that he is not ready for that experience it is best to wait until he feels more confident, and there is nothing wrong with waiting at all.
As far as explaining your feelings and your desire to wait to your boyfriend; we would suggest that you tell him honestly that while you love him, you don't feel like you are ready for sex, and perhaps -since you are both the same age- suggest that he may not be ready for sex, either. Ask him why he wants this level of intimacy, why he feels that sex is so important to the relationship. He may desire sex simply because it is something which -from the strong emphasis on sex in our culture- he believes should be part of a romantic relationship. When the two of you sit down and talk about this subject he may realize that sex is not as important as a meaningful, loving, relationship and that he can wait until you are both older. Being fifteen and in love is rough; it's a time of growth and transition in life and therefore one where things are changing rapidly. Even though the two of you have been seeing each other for three months, that really is not such a long period of time and at your age introducing sex into the picture might complicate things at this point.
Dear Mike and Kate:
I am gay and sixteen years old and had my first relationship with another guy last summer. I am wondering if I should tell my doctor that I'm gay because there's things that I would like to ask him about AIDS and other stuff. But he's my parent's friend, too, and I would not want him to tell them yet.
We're very glad to see that you are thinking about that importance of your health now that you appear to be becoming sexually active. We both feel that if you believe that your physician will not reveal to your parents that you are gay, that you should certainly make this fact known to him. Any decent physician should be able to maturely and professionally accept your sexual orientation and, having that information, be able to provide accurate and helpful information concerning sex-related matters and sexually transmitted diseases. Of course, since you are still underage and in your parents' care, your physician may -especially if he is good friends with your parents and even more so if he has some prejudice against homosexuals- elect to share the fact that you are gay with them. We would hope that any physician who is dealing with a sixteen-year-old and this topic would have the respect and sensitivity to keep this information in confidence and not tell your parents, yet that is not something which we can guarantee. However, taking this topic on step further, we would like to say that everyone who is homosexual -either gay or lesbian- should seek out a physician who will be sympathetic to your sexual orientation and with whom you will not be afraid to share information concerning your sex life which may have implications on your health.