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By Kate Fordham, M.D., M.P.H.

August 1998

I apologize to all my readers for the absence of a July column. I had to travel overseas in late June and this trip was somewhat expectedly prolonged to a fortnight, making it difficult for me to produce column material, much less check my e-mail and communicate with Oasis. I try to have a column for each month but sometimes this proves next to impossible given my other obligations.

In the meantime, I received some interesting questions. Lately, I have received no less than five questions regarding heterosexual relationships, and although they would not be especially appropriate to reprint in the column, I always try to answer these questions and provide useful guidance to these readers. My question is why are heterosexual teens turning to this column and to myself as a source of advice? I don't mind them doing so at all, but it makes me wonder if they have no other place to go for advice on sexual health matters; when Michael Walker and I started this column back in the winter of 1996, we did so because we both felt that there were very few places where young people could obtain reliable information about sexual health matters relevant to gay lifestyles and same-sex relationships. That's why we brought our mission to Oasis, and didn't approach a more mainstream teen-targeted publication instead. Perhaps something along the same lines as this column should appear in an Internet-based magazine for straight teens, too, because there are apparently straight young people who are currently not finding such a resource readily available.

Another item that concerns me is the number of readers who have wrote with a case of some form of sexual abuse. Two individuals wrote last month with regard to rape and molestation, and there have been similar letters over the months of June, May, and April. I am always glad to receive letters on any health-related subject where I may be able to provide assistance or advice, but I want to stress that in cases of sexual abuse, you must turn first to your local police and your personal physician or other health care provider. Victims of sexual molestation and rape need support and therapy to help them cope with the horrible experiences they have survived, and such professional help should be obtained as soon as possible following the event of abuse. An advice columnist such as myself can only do so much, and the same is true of any on-line resource or on-line "friend" you may encounter. There are a lot of well-meaning people on the Internet but none of them can be a substitute for professionals working within your own community who can care for your needs directly. I cannot over-emphasize the importance of seeking such help as soon after you have been abused as possible. Also, remember that sexual abuse is defined as any sexual act or any action that is sexually motivated which someone attempts to have with you and that you object to, or that they institute through force or coercion. Coercion being defined as any threat or other means --whether physical or verbal-- of making you do something that you do not want to do. Sexual abuse differs from rape because while rape involves some penetrative act of sex, sexual abuse does not have to be a penetrative sexual act. If someone is touching you in any sexually-connotative manner and you do not want this to be done and let that person know that their advances are unwelcome yet their behavior continues, then their acts can be considered as sexual abuse. Remember, your body is your property alone and no one else has any right to violate it or take any physical advantage of it without your consent.

The main reason for my overseas trip was to attend a major conference on AIDS and HIV in Geneva, Switzerland that was held from late June to early July of this year. This conference was an exciting event with professionals from many different nations and representing all the various fields of expertise that are working together to end the threat of AIDS the world over. Aside from the physicians, nurses, social workers, epidemiologists, and other health care workers we most often associate with efforts to prevent and treat AIDS, there were also chemists, geographers, lawyers, teachers, and many others at the conference. It really is amazing --even to me, while I work in AIDS prevention all the time-- how many people, how much knowledge, it takes to combat this horrible disease and the virus that causes it. I was pleased to see alongside all the scientific and medical information presented at the conference also a strong showing of presentations dealing with the social aspects of AIDS and prevention efforts. Furthermore, I was extremely pleased to see a greater emphasis on youth and prevention/education efforts than ever before. While I did not present anything myself at the conference, I did mention my work --including the survey Oasis co-sponsored last year-- to many people I spoke with at the conference. I ended up writing the URL for Oasis on the back of my business card more times than I can remember because when I shared my work with Oasis with other professionals, they were quite interested to learn more about what I was doing and the purpose of the magazine.

Now, let us move on to some reader questions. Since I did not write a column for Oasis last month, these questions shall include some submitted from June, ones that ought to have appeared in the July 1998 issue. Please realize that even when I don't write a column over a given month, I always will respond personally to reader questions as quickly as possible. Those of you who have had your questions featured in past columns know this as do some who have received personal responses without ever seeing their questions included in the column. And also, remember that if you do not want your question to appear in an Oasis column, then please make me aware of that intention when writing.

Dear Dr. Fordham,

Hi. My name is Lisa and I am seventeen and have been dating another girl for nearly two months. We can be open about it around our friends and her mother because her mother's brother is gay so they're all pretty okay with it. But I can't really let my parents know and they are trying to set me up with a boy who we know whose parents have always known my family [. . .] in movies this stuff is funny but in life it's just irritating. I don't want to upset anyone but what should I say to this guy because I don't want to date him and I can't say I'm seeing a girl and I can't say that I am seeing some other boy because he knows that's not true. Any ideas?

Dear Lisa,

Would it be possible to be friends with this boy and simply let him, his parents, and your own parents know that you really do not want the relationship to go any further? If his parents and yours are close, this might be the best situation for all concerned. If you do not even desire a friendship with him, I would suggest being polite yet firm in letting him know that you are not interested in dating and then letting any other possibilities fall by the wayside gradually. I agree that it is important to not offend anyone or put anyone in an awkward position since this situation goes far beyond just you and the boy concerned and also affects your families. I personally do not endorse parents trying to foster relationships between their children and the offspring of their own friends, but that's something of another subject.

That you are a lesbian should not even really need to come into this picture unless it is something which you wish to bring up; this same situation could happen to a girl who is not dating anyone at all and who finds the prospective boyfriend to be unappealing for whatever reason. Those of you who read my column regularly know that I endorse the coming out of teens when it is the right choice for them, but that I try to examine each situation on an individual basis and take a pragmatic stance on the matter of involving gay issues within family issues. Some families are more adept with handling a child's coming out than others, and this must be recognized as an important factor. Lisa, don't feel that you need to involve your lesbian relationship in this matter unless it is the right thing for you to do, based upon all the circumstances of your life and family situation.

Dear Dr. Kate:

My boyfriend has been sleeping around and I know this for sure but I can't prove it yet; I know who he's been with, too, and that person is really nasty and sleeps around a lot so I'm worried about having sex now and getting something even though we've used condoms in the past.

George

When you are in a steady sexual relationship with someone, the issue of the other person's fidelity should not rest on the burden of proof. In other words, you should be able to trust your boyfriend to not have sexual relations with other partners if this is how the two of your understand the basis of your relationship --which seems to be the case here-- and you should not have to "prove" anything if you know that he has been unfaithful. I would strongly suggest confronting your boyfriend with this issue and expressing not only your own concern for the relationship and your dismay in the fact that he has been sleeping with someone else, but also your concern that he is perhaps endangering his own health in the process, and your health, as well. Condoms are at the moment the best technology we have to prevent the transmission of HIV and other diseases via sexual intercourse, but condoms are not one-hundred percent effective and it is wise to avoid having multiple partners and especially having sex with someone who is known for his/her promiscuity. I must add another warning to that, however, because rumors can cause as much damage as nearly anything else and when you say that you "know" your boyfriend has been sleeping around and you "know" that this other person involved is "nasty", be sure you have all your facts straight (no pun intended). Handle this touchy situation with care and thoughtfulness for all the parties involved and things should stand a much better chance of working out for the best.

Dear Dr. Fordham,

My name is Bryce and I'm gay and fifteen. I go to school in a small town in Kansas and I'm not out to anyone here, even my mom. I told my dad who lives in New Jersey last summer when I was there and he took it pretty hard but my step-mom there was cool and helped him understand it wasn't his fault that I'm gay but she was really worried about me, too. I had not met anyone gay my age here and thought I was alone but I found this guy last week who's gay and sixteen and since he has a car we can go out and stuff but even though he's sixteen he seems a lot older and seems to hang out with friends who are out of school and stuff and I don't know what he will tell them like if he'll say I'm his boyfriend or what. I'm worried because this town's really tiny and my mom or teachers could hear something fast just because that's how it is here. What should I do?

Bryce, you present two distinct questions for me, and for yourself, in this letter. First, there is the question of whether you are ready to enter a relationship with this person whom you've met just recently. This is the question I hear you asking yourself, and very much the question that you should be asking yourself. If you have never been in a relationship with another guy before and feel this person may take things too fast and tends to hang with an older set of friends, then maybe you should be slow and cautious in how you approach this matter. Maybe you should hang out with him without taking the relationship any further until you know this person better. I take it that you know this guy from school or somewhere else or have some information on him so that you know him to be at least a basically decent individual. Always be careful when getting involved in a relationship with someone who apparently has a fair amount more experience in relationships than you have yourself.

The second question is one of confidentiality. The assurance or lack thereof that this boy, his friends, and other people who may be aware of the relationship will not allow this information get back to people with whom you are not ready to share such information. If you do not know his friends well, then there is no real way that you can predict how trustworthy they may or may not be, so I would suggest that you are careful as to how much information you provide them concerning the relationship and also that if you do become involved with this guy, you sit down and talk to him about your family situation and your desire to keep your sexual orientation something of a secret for the meantime. Even if he does not agree with your choices, you must be certain that he will respect your choices and your right to make your own choices. You did not mention if this person is "out" himself or not, so that may be another issue worth discussing with him before the relationship goes very far. The bottom line here is that you cannot complete control nor guarantee the outcome of a relationship like this or the possible ramifications of a relationship so you need to be cautious in becoming involved in the relationship and then you should make your intentions clear so at least everyone knows what your desires and opinions are. I wish you the best of luck with this situation and encourage you to write back and keep me apprised of how things progress.

I want to talk now some more about the issues of confidentiality that came up in Bryce's letter. When dealing through official channels such as school, health care, work, or a legal process of any sort, there are safeguards to ensure that everyone's privacy is protected and these measures are largely effective most of the time. However, social situations have no clear safeguards of this kind, and any time you enter a social situation where your sexual orientation may be more or less obvious through your actions with another person, anyone else involved in that situation may interpret what is happening through their own perceptions and may even spread that information around. If you are young and gay but not ready to have your sexuality made public knowledge, it is essential that you exercise some discretion in whom you let know about your sexual orientation. I do not like this state of affairs and I hope for the day when each one of us can be who we are without fear of prejudice, but until these days become reality, gay youth must be wary of the social situations they enter and their exposure of their sexuality. This is my personal view and the editors of Oasis as well as many others in the gay press and the gay community may disagree with me, but as a health care provider I believe in putting the welfare of the person --especially when that person is a child or adolescent-- before any other political or social concerns.

There's another issue I want to take some time to address, even though no reader letters have approached this topic. The topic at hand concerns the new street drug known as "chiva", which is a mixture of high-purity heroin and antihistamines. Most of you (I hope) are already aware that heroin is an extremely addictive and dangerous drug in its own right. Chiva appears to be even worse in terms of the possibility for an adverse physiological reaction or overdose. Across the United States, a number of deaths have resulted from such adverse reactions and overdose involving this drug either alone or in combination with alcohol or other drugs. Many of these tragic deaths have been those of teenagers and college students; most of them have not been in our inner cities or other areas well known for their incidence of drug-related deaths but instead in average middle-class neighborhoods. I stress this because it is important to realize that death is a possible outcome for anyone who abuses drugs, not just from those who are poor or people who are rich and famous and live a "wild" lifestyle. All it takes with chiva is one instance of using the drug where it is not of the correct purity or dosage for the user to have a deadly reaction to the drug. The combination of heroin and antihistamines makes this drug all the more dangerous and also more problematic than normal heroin because when a person overdoses or has an adverse reaction this strange combination of drug types makes it difficult for health care personnel to counteract the effects of the drug. The antidotes typically used for cases of narcotic overdoses are less effective due to the presence of antihistamines and often, other drugs, perhaps anything from ecstasy (3,4,MDMA) to rat poison. Like with any street drug, the purity of the drugs is impossible to discern because the drugs are manufactured illegally without the procedures and protocols that govern the production of legal medical drugs and keep these pharmaceuticals safe.

I know this topic strays a little from the original purpose of this column, but this drug scares me, and the idea that young people are dying from it really scares me. By urging all of my readers to avoid this drug --and illegal drugs in general-- I am doing perhaps the most effective thing I can do to help reduce the numbers of teens who die each year from drug abuse. With chiva, I don't know that even the most able and experienced physician could save someone who has overdosed on the drug, because I know several excellent doctors who have tried to do just that and have failed; this drug is really that bad. Heroin in any form is that bad. It takes years for a person who has become addicted to heroin to recover while it takes only mere seconds for heroin to send a person into cardiac arrest. I've seen adolescents die from both the long-term effects of heroin and from immediate overdoses, and I don't want to ever have to see either happen again. Stay away from this stuff.

Please keep the questions coming in to my e-mail address at: KFordham@hotmail.com

I love to hear from you guys and gals!

Special thanks this month to David Friedman, M.D., for his consultation regarding "chiva", its clinical effects, and pharmacology.


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