Helping Women Talk With Their Partners About Contraception and Safer Sex
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A billboard in Gaborone, Botswana, encourages men to get involved and help reduce mother-to-child transmission (MTCT) of HIV. Women who have HIV need the support of their partner to discuss and decide about issues of safer sex, whether to plan for future children, and contraception.
(Photo: © 2007 Lee Mantini, Courtesy of Photoshare)
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Women with HIV face many decisions about living with HIV. Decisions about sex and childbearing can be among the most important. For a woman who is married or otherwise has a steady sex partner, making and carrying out those decisions successfully usually involves talking with her partner.
This can be difficult. She first needs to tell him about her HIV status if she has not already done so. She may also need to ask her partner if he knows his HIV status and, if not, encourage him to seek HIV testing. Then there are issues of safer sex, whether to plan for future children, and contraception to be discussed and decided. These topics can be very hard for many couples to discuss, even when both partners do not have HIV. When one or both partners have HIV, these topics can be even harder to discuss and yet all the more urgent.
A health care provider can help a woman with HIV plan how to talk with her partner. A provider and client can discuss when, where, and how the woman can bring up these sensitive topics and how she can prepare to do so. The client can practice what she might say in a role-play with the provider.
The counseling points that follow outline some guidance for providers that they can offer their clients. In the box at the bottom are key suggestions for providers. This guidance is adapted from a tool prepared by the World Health Organization to help clients and providers with decisions about family planning and childbearing. The complete tool is available at: http://www.who.int/reproductive-health/ publications/fphiv_flipchart/index.htm
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For counseling a woman with HIV
Tips for talking with her partner
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Where
- Choose a place that is comfortable for both of you.
- Suggest a quiet place, but close to safety if needed.
- Find a neutral ground.
When
- Talk at a time when you are both relaxed and comfortable.
- Avoid distractions or rushing.
- Can be discussed over a period of time, not just at one sitting.
- Discuss before sex starts.
How
- Stress the good things.
- Emphasize partner’s caring, your concern.
- Start with what you both agree on.
- Focus on safety and good health, not mistrust.
- Talk about good examples, such as people that your partner respects.
- Try to reach agreement.
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Be prepared
Stay safe
- Don’t risk your safety.
- Consider having another trusted person there.
- Start with general facts and watch reactions.
Get the facts right
- Provider can answer your questions.
Plan
- Decide, where, when, and how to start.
- What if discussion goes badly? Turns violent?
- Counseling as a couple?
Practice
- Rehearse with provider or friends.
Adapted from World Health Organization 2006 (251).
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How to help a woman with HIV talk with her partner:
- Offer suggestions but let client decide what can work.
- Discuss doubts and fears. Don’t dismiss them.
- Reassure clients that they can succeed. With permission, tell the stories of others who have succeeded.
- Suggest that seeing a health care provider together as a couple is sometimes very helpful.
- Help the client practice what she will say.
- Arrange a follow-up visit to discuss what happened.
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