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Many people assume they need to consume Alcohol to have Good Sex? For most Americans, consuming alcohol seems to be part of our cultural heritage. We drink at weddings, funerals, birthdays, and pretty much to celebrate anything and everything. We learned from a young age by watching our parents and other adults, that drinking is a sign of maturity. Many people, especially young adolescents, expect that alcohol use will lower tension and anxiety and increase sexual desire and pleasure in life (Seto & Barbaree,1995). About 1 in every 7 adults in the United States meet criteria for alcohol dependency, according to a large NIMH epidemiological study (Grant, 1977). Men are four times more likely than women to be heavy drinkers and are twice as likely to be alcohol abusing or alcohol dependant. Most males and many females find it difficult to imagine not drinking any alcohol at least on weekends and find it almost impossible to think of having sex without previously having a few drinks. These fundamental values appear to be deeply embedded in our culture. Somewhere along the line, we got the message that we need alcohol to have good sex. Does Alcohol Enhance or Hurt our Sexual Performance? I recently heard a stand-up comedian refer to the term, “Whiskey – Dick” when describing his “friends who had drank too much and had difficulties with orgasm even while using Viagra. Shakespeare once said that excessive drinking, “provokes the desire but takes away the performance.” Alcohol reduces inhibitions and gives us a mellow feeling. It makes us more relaxed and more talkative. It can make shy people fe//el confident and bold. These effects can facilitate our sexual desires by developing our social skills. However, these positive effects are only present in the early stage of intoxication i.e. when we’ve consumed 1-2 drinks (assuming you haven’t already developed a tolerance for alcohol). Sexual Impotence On the other hand, alcohol’s negative effects on sexual performance have been widely documented. Men and women who have several drinks may find it very hard to achieve orgasm. Difficulties with achieving orgasm after alcohol consumption can be understood because alcohol dilates small blood vessels all over the body so that there is less engorgement of blood in the sexual organs. This leaves the penis flaccid or only partially erect so that sexual penetration is difficult. Women may find that they have decreased vaginal lubrication making sexual intercourse unpleasant and sometimes painful (Raff, 2006). Impotence is the constant inability of a man to maintain an erection for sexual purposes. It is estimated that impotence affects over 30 million men in the United States (NIHCS, 1992). Masters and Johnson, identified alcohol as a common factor in impotence in their monumental work on human sexual inadequacy. Alcohol damages the central nervous system and destroys brain cells, and if the damage is prolonged enough, it can result in irreversible sexual impotence even while a person is sober. Alcohol is also a factor in loss of sexual control or premature ejaculation. Even a couple of beers before sex can spoil a man's erection and ruin his ejaculatory control. Up to 80 percent of men who drink heavily are believed to have serious sexual side effects, including impotence, sterility, or loss of sexual desire. Heavy drinking over a long period of time can irreversibly destroy testicular cells, leaving men with shrunken testicles. Both sexual drive and sexual capacity can be damaged. Alcohol also suppresses testosterone levels even in social drinkers by suppressing the secretory activity of the Leydig cells (Flatto, 1990). Alcohol and High-Risk Sexual Behaviors A history of heavy alcohol use has been correlated with a lifetime tendency toward high-risk sexual behaviors, including multiple sex partners, unprotected intercourse, sex with high-risk partners (e.g., injection drug users, prostitutes), and the exchange of sex for money or drugs (Windle,M.,1997). There may be many reasons for this association. For example, alcohol can act directly on the brain to reduce inhibitions and diminish risk perception (MacDonald,T.K.,2000). However, expectations about alcohol’s effects may exert a more powerful influence on alcohol-involved sexual behavior. Studies consistently demonstrate that people who strongly believe that alcohol enhances sexual arousal and performance are more likely to practice risky sex after drinking (Cooper,M.L.,2002). Some people report deliberately using alcohol during sexual encounters to provide an excuse for socially unacceptable behavior or to reduce their conscious awareness of risk (Derman,K.H.,1998). According to McKirnan and colleagues (McKiran,D.J.,2001), this practice may be especially common among men who have sex with men. This finding is consistent with the observation that men who drink prior to or during homosexual contact are more likely than heterosexuals to engage in high-risk sexual practices (Avins,A.L.,1994). Alcohol and AIDS People with alcohol use disorders are more likely than the general population to contract HIV (human immunodeficiency virus) - the agent that causes acquired immunodeficiency syndrome (AIDS). Similarly, people with HIV are more likely to abuse alcohol at some time during their lives (Petray,N.M.,1999). Alcohol use is associated with high-risk sexual behaviors and injection drug use, two major modes of HIV transmission. What are signs of problem drinking? The primary signs of problem drinking are: Having health, legal, social, academic or financial problems as a result of drinking. For example, missing class or work because of drinking or hangovers, not be able to have fun or express oneself without drinking, fights or problems with roommates or significant others, spending excessive amounts of money on alcohol, blackouts/passing out, trips to the ER, being defensive when someone mentions your drinking, needing to drink more to achieve the same effects (tolerance), frequently drinking with the primary purpose of getting drunk, and/or repeatedly driving under the influence. These are only guidelines and each case is different. If you're concerned about your drinking or a friend's drinking, get more information! Screening for Alcohol Dependence Screening tools are available to assist counselors and therapists with diagnosing alcohol abuse and dependence such as the SMAST below. Short Michigan Alcoholism Screening Test (MAST) 1. Do you feel you are a normal drinker? (By normal we mean you drink less than or as much as most other people.) 2. Does your wife, husband, a parent, or other near relative ever worry or complain about your drinking? 3. Do you ever feel guilty about your drinking? 4. Do friends or relatives think you are a normal drinker? 5. Are you able to stop drinking when you want to? 6. Have you ever attended a meeting of Alcoholics Anonymous? 7. Has drinking ever created problems between you and your wife, husband, a parent, or other near relative? 8. Have you ever gotten into trouble at work because of drinking? 9. Have you ever neglected your obligations, your family, or your work for two of more days in a row because you were drinking? 10. Have you ever gone to anyone for help about your drinking? 11. Have you ever been in a hospital because of drinking? 12. Have you ever been arrested for drunken driving, driving while intoxicated, or driving under the influence of alcoholic beverages? 13. Have you ever been arrested, even for a few hours, because of other drunken behavior? Individuals that answer – Yes to three or more questions indicate probable alcoholism, two yes answers indicate probable alcoholism, and fewer than two yes answers indicate that alcoholism is not likely (Selzer, M., Winokur, A. & Van Rooijen, C.; 1975). Note: If after reading the above, you started rationalizing to yourself, “Well, I can stop drinking anytime I want to, but I usually stop when I run out of money.” (As my old graduate professor use to say) STOP BULL-SH#%ting yourself and go see a certified alcohol counselor. Co-morbidity & Alcohol Dependence Alcohol abuse and dependence are among the most destructive of the psychiatric disorders (Volpicelli, 2001). Addictions such as alcohol dependence and other addictions as a rule do not develop in isolation. Over 37 % of alcohol abusers suffer from at least one coexisting addiction and/ or mental disorder (Rovner, 1990). Individuals can shift from one addiction to another or sustain multiple addictions at different times. The National Co-morbidity Survey (NCS) that sampled the entire U.S. population in 1994, found that among non-institutionalized American male and female adolescents and adults (ages 15-54), roughly 50% had a diagnosable Axis I mental disorder at some time in their lives. This survey’s results indicated that 35% of males will at some time in their lives have abused substances to the point of qualifying for a mental disorder diagnosis, and nearly 25% of women will have qualified for a serious mood disorder (mostly major depression). A significant finding of note from the NCS study was the widespread occurrence of co-morbidity among diagnosed disorders. It specifically found that 56% of the respondents with a history of at least one disorder also had two or more additional disorders. These persons with a history of three or more co-morbid disorders were estimated to be one-sixth of the U.S. population, or some 43 million people (Kessler, 1994). Poor Prognosis We have come to realize today more than any other time in history that the treatment of lifestyle diseases and addictions such as alcoholism are often a difficult and frustrating task for all concerned. Repeated failures abound with all of the addictions, even with utilizing the most effective treatment strategies. But why do 47% of patients treated in private treatment programs (for example) relapse within the first year following treatment (Gorski,T., 2001)? Have addiction specialists become conditioned to accept failure as the norm? There are many reasons for this poor prognosis. Some would proclaim that addictions are psychosomatically- induced and maintained in a semi-balanced force field of driving and restraining multidimensional forces. Others would say that failures are due simply to a lack of self-motivation or will power. Most would agree that lifestyle behavioral addictions are serious health risks that deserve our attention, but could it possibly be that patients with multiple addictions are being under diagnosed (with a single dependence) simply due to a lack of diagnostic tools and resources that are incapable of resolving the complexity of assessing and treating a patient with multiple addictions? New Proposed Diagnosis Since successful treatment outcomes are dependent on thorough assessments, accurate diagnoses, and comprehensive individualized treatment planning, it is no wonder that repeated rehabilitation failures and low success rates are the norm instead of the exception in the addictions field. Treatment clinics need to have a treatment planning system and referral network that is equipped to thoroughly assess multiple addictions and mental health disorders and related treatment needs and comprehensively provide education/ awareness, prevention strategy groups, and/ or specific addictions treatment services for individuals diagnosed with multiple addictions. Written treatment goals and objectives should be specified for each separate addiction and dimension of an individuals’ life, and the desired performance outcome or completion criteria should be specifically stated, behaviorally based (a visible activity), and measurable. To assist with resolving this problem a multidimensional diagnosis of “Poly-behavioral Addiction,” is proposed for more accurate diagnosis leading to more effective treatment planning. This diagnosis encompasses the broadest category of addictive disorders that would include an individual manifesting a combination of alcohol and substance abuse addictions, and other obsessively-compulsive behavioral addictive behavioral patterns to pathological gambling, religion, and/ or sex / pornography, etc.). Behavioral addictions are just as damaging - psychologically and socially as alcohol and drug abuse. They are comparative to other life-style diseases such as diabetes, hypertension, and heart disease in their behavioral manifestations, their etiologies, and their resistance to treatments. They are progressive disorders that involve obsessive thinking and compulsive behaviors. They are also characterized by a preoccupation with a continuous or periodic loss of control, and continuous irrational behavior in spite of adverse consequences. Poly-behavioral addiction would be described as a state of periodic or chronic physical, mental, emotional, cultural, sexual and/ or spiritual/ religious intoxication. These various types of intoxication are produced by repeated obsessive thoughts and compulsive practices involved in pathological relationships to any mood-altering substance, person, organization, belief system, and/ or activity. The individual has an overpowering desire, need or compulsion with the presence of a tendency to intensify their adherence to these practices, and evidence of phenomena of tolerance, abstinence and withdrawal, in which there is always physical and/ or psychic dependence on the effects of this pathological relationship. In addition, there is a 12 - month period in which an individual is pathologically involved with three or more behavioral and/ or substance use addictions simultaneously, but the criteria are not met for dependence for any one addiction in particular (Slobodzien, J., 2005). In essence, Poly-behavioral addiction is the synergistically integrated chronic dependence on multiple physiologically addictive substances and behaviors (e.g., using/ abusing substances - nicotine, alcohol, & drugs, and/or acting impulsively or obsessively compulsive in regards to gambling, food binging, sex, and/ or religion, etc.) simultaneously. New Proposed Theory The Addictions Recovery Measurement System’s (ARMS) theory is a nonlinear, dynamical, non-hierarchical model that focuses on interactions between multiple risk factors and situational determinants similar to catastrophe and chaos theories in predicting and explaining addictive behaviors and relapse. Multiple influences trigger and operate within high-risk situations and influence the global multidimensional functioning of an individual. The process of relapse incorporates the interaction between background factors (e.g., family history, social support, years of possible dependence, and co-morbid psychopathology), physiological states (e.g., physical withdrawal), cognitive processes (e.g., self-efficacy, cravings, motivation, the abstinence violation effect, outcome expectancies), and coping skills (Brownell et al., 1986; Marlatt & Gordon, 1985). To put it simply, small changes in an individual’s behavior can result in large qualitative changes at the global level and patterns at the global level of a system emerge solely from numerous little interactions. The ARMS hypothesis purports that there is a multidimensional synergistically negative resistance that individual’s develop to any one form of treatment to a single dimension of their lives, because the effects of an individual’s addiction have dynamically interacted multi-dimensionally. Having the primary focus on one dimension is insufficient. Traditionally, addiction treatment programs have failed to accommodate for the multidimensional synergistically negative effects of an individual having multiple addictions, (e.g. nicotine, alcohol, and obesity, etc.). Behavioral addictions interact negatively with each other and with strategies to improve overall functioning. They tend to encourage the use of tobacco, alcohol and other drugs, help increase violence, decrease functional capacity, and promote social isolation. Most treatment theories today involve assessing other dimensions to identify dual diagnosis or co-morbidity diagnoses, or to assess contributing factors that may play a role in the individual’s primary addiction. The ARMS’ theory proclaims that a multidimensional treatment plan must be devised addressing the possible multiple addictions identified for each one of an individual’s life dimensions in addition to developing specific goals and objectives for each dimension. The ARMS acknowledges the complexity and unpredictable nature of lifestyle addictions following the commitment of an individual to accept assistance with changing their lifestyles. The Stages of Change model (Prochaska & DiClemente, 1984) is supported as a model of motivation, incorporating five stages of readiness to change: pre-contemplation, contemplation, preparation, action, and maintenance. The ARMS theory supports the constructs of self-efficacy and social networking as outcome predictors of future behavior across a wide variety of lifestyle risk factors (Bandura, 1977). The Relapse Prevention cognitive-behavioral approach (Marlatt, 1985) with the goal of identifying and preventing high-risk situations for relapse is also supported within the ARMS theory. Conclusions Considering the wide range of alcohol abuse and sexual behaviors in our world today, one should always take into account an individual’s ethnic, cultural, religious, and social background prior to making any clinical judgments, and it would be wise to not over-pathologize in this area of Dependency. However, since successful treatment outcomes are dependent on thorough assessments, accurate diagnoses, and comprehensive individualized treatment planning - poly-behavioral addiction needs to be identified to effectively treat the complexity of multiple behavioral and substance addictions. Since chronic lifestyle diseases and disorders such as diabetes, hypertension, alcoholism, drug and behavioral addictions cannot be cured, but only managed - how should we effectively manage poly-behavioral addiction? The Addiction Recovery Measurement System (ARMS) is proposed utilizing a multidimensional integrative assessment, treatment planning, treatment progress, and treatment outcome measurement tracking system that facilitates rapid and accurate recognition and evaluation of an individual’s comprehensive life-functioning progress dimensions. The ARMS hypothesis purports that there is a multidimensional synergistically negative resistance that individual’s develop to any one form of treatment to a single dimension of their lives, because the effects of an individual’s addiction have dynamically interacted multi-dimensionally. Having the primary focus on one dimension is insufficient. Traditionally, addiction treatment programs have failed to accommodate for the multidimensional synergistically negative effects of an individual having multiple addictions, (e.g. nicotine, alcohol, and obesity, etc.). Behavioral addictions interact negatively with each other and with strategies to improve overall functioning. They tend to encourage the use of tobacco, alcohol and other drugs, help increase violence, decrease functional capacity, and promote social isolation. Most treatment theories today involve assessing other dimensions to identify dual diagnosis or co-morbidity diagnoses, or to assess contributing factors that may play a role in the individual’s primary addiction. The ARMS’ theory proclaims that a multidimensional treatment plan must be devised addressing the possible multiple addictions identified for each one of an individual’s life dimensions in addition to developing specific goals and objectives for each dimension. Partnerships and coordination among all service providers, government departments, and health insurance organizations in providing treatment programs are a necessity in addressing the multi-task solution to Alcohol Abuse and Poly-behavioral addictions. I encourage you to support the addiction programs in America, and hope that the (ARMS) resources can assist you to personally fight the War on poly-behavioral addiction. References Avins, A.L.; Woods, W.J.; Lindan, C.P.; et al. HIV infection and risk behaviors among heterosexuals in alcohol treatment programs. JAMA 271(7):515–518, 1994. Boscarino, J.A.; Avins, A.L.; Woods, W.J.; et al. Alcohol-related risk factors associated with HIV infection among patients entering alcoholism treatment: Implications for prevention. Journal of Studies on Alcohol 56(6):642–653, 1995. Cooper, M.L. Alcohol use and risky sexual behavior among college students and youth: Evaluating the evidence. Journal of Studies on Alcohol (Suppl. 14):101–117, 2002. Dermen, K.H.; Cooper, M.L.; and Agocha, V.B. Sex-related alcohol expectancies as moderators of the relationship between alcohol use and risky sex in adolescents. Journal of Studies on Alcohol 59(1):71–77, 1998. Dermen, K.H., and Cooper, M.L. Inhibition conflict and alcohol expectancy as moderators of alcohol’s relationship to condom use. Experimental and Clinical Psychopharmacology 8(2):198–206, 2000. Fromme, K.; D’Amico, E.; and Katz, E.C. Intoxicated sexual risk taking: An expectancy or cognitive impairment explanation? Journal of Studies on Alcohol 60(1):54–63, 1999. George, W.H.; Stoner, S.A.; Norris, J.; et al. Alcohol expectancies and sexuality: A self-fulfilling prophecy analysis of dyadic perceptions and behavior. Journal of Studies on Alcohol 61(1):168–176, 2000. Grant, B. F.: Prevalence and correlates of alcohol use and DSM-IV alcohol dependence in the United States: Results of the National Longitudinal Alcohol Epidemiologic Survey. J. Stud. Alcoh., 58(5), 464-73., 1977. MacDonald, T.K.; MacDonald, G.; Zanna, M.P.; and Fong, G.T. Alcohol, sexual arousal, and intentions to use condoms in young men: Applying alcohol myopia theory to risky sexual behavior. Health Psychology 19(3):290–298, 2000. Malow, R.M.; Dévieux, J.G.; Jennings, T.; et al. Substance-abusing adolescents at varying levels of HIV risk: Psychosocial characteristics, drug use, and sexual behavior. Journal of Substance Abuse 13:103–117, 2001. Maslow, C.B.; Friedman, S.R.; Perlis, T.E.; et al. Changes in HIV seroprevalence and related behaviors among male injection drug users who do and do not have sex with men: New York City, 1990–1999. American Journal of Public Health 92(3):382–384, 2002. McKirnan, D.J.; Vanable, P.A.; Ostrow, D.G.; and Hope, B. Expectancies of sexual “escape” and sexual risk among drug and alcohol-involved gay and bisexual men. Journal of Substance Abuse 13(1–2):137–154, 2001. Petry, N.M. Alcohol use in HIV patients: What we don’t know may hurt us. International Journal of STD and AIDS 10(9):561–570, 1999. Purcell, D.W.; Parsons, J.T.; Halkitis, P.N.; et al. Substance use and sexual transmission risk behavior of HIV-positive men who have sex with men. Journal of Substance Abuse 13(1–2):185–200, 2001. Rovner, S.; Dramatic overlap of addiction, mental illness. Washington Post Health, 14-15. 1990. Selzer, M., Winokur, A. & Van Rooijen, C.; A self-administered Short Michigan Alcoholism Screening Test. Journal of Studies on Alcohol, 36, 117-126, 1975. Seto, M. C. & Barbaree, H. E.; The role of alcohol in sexual aggression. Clin. Psych. Rew. 15 (6), 545-66, 1995. Stall, R.; McKusick, L.; Wiley, J.; et al. Alcohol and drug use during sexual activity and compliance with safe sex guidelines for AIDS: The AIDS Behavioral Research Project. Health Education Quarterly 13(4):359–371, 1986. Volpicelli, J. R.; Alcohol abuse and alcoholism: An overview. J. Clin. 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Dial 1-800/AIDSNYC Every Monday and Wednesday morning, promptly at 10 a.m., I leave behind my daily life and turn to volunteering as an AIDS Hotline counselor at New York City’s GMHC [Gay Men’s Health Crisis], the nation’s largest social service agency for AIDS. For the next four hours, my co-volunteers and I sit in front of a bank of constantly-ringing telephones, talking to men, women, and teens who call in from across the nation with urgent questions about AIDS, the ravaging disease that has left 13.9 million people dead worldwide. After almost 20 years, a whole generation, families are still facing the heartache of tending the sick, while scientists continue to be confounded by this stubborn, ravaging virus. Although the federal government currently spends$4 billion per year on AIDS research, and $15 billion worldwide, there is no cure in sight for the viral infection and no vaccine available. Small wonder that the GMHC AIDS Hotline, the nation’s first, is flooded with more than 40,000 calls each year. Listening to callers 8 hours each week, I often think the Hotline is actually a direct link to the soul of callers--an anonymous forum that allows each to reveal secrets and fears that they might otherwise never discuss with anyone. A Morning in May This is the way it began: “Good morning, GMHC AIDS Hotline, can I help you?” “Yes...I have a question...[hesitantly] My son...he’s 21...and he just found out...he’s HIV-positive [voice breaking] I’m.....alone, divorced. And I need some help...someone to talk to...” “Of course....happy to talk to you...it sounds like this has been devastating for you....” “It’s terrible. He told me two nights ago....he’s...he’s so young....I don’t want him to die. He’s my only child....why did this have to happen?” [crying] Her son, she explains, had sometimes neglected using condoms, convinced he wouldn’t contract HIV infection from his female partners. “How could he be so stupid?” she now asks angrily. “Why didn’t he know how to protect himself? I don’t understand. What am I going to do?” We talk for 35 minutes, and by the end of the conversation, I notice I’m barely breathing. The distraught woman’s anguish is palpable. Her situation is every mother’s worst nightmare.The life of her child is in jeopardy and she feels helpless and afraid. I can’t imagine anything worse. During the call, I do my best to employ the GMHC Hotline protocol of “active listening,” which involves using silence, empathy and gentle probing with open-ended questions. I’m also having my own emotional reaction to the panic in her voice, and I’m worried about whether I’m doing enough. Toward the end of the clal, when she exclaims: “I don’t want my baby to die,” my heart plummets: “I know....I understand that, but there is hope,” I tell her. I find myself on the verge of tears. The Bad News This mother’s story is too common. According to the Centers for Disease Control in Atlanta, Ga., 40,000 Americans (half of them under 25) are newly infected with the AIDS virus each year. Unprotected sex and intravenous drug use remain the principal modes of transmission. “Teenagers,” notes AIDS activist Elizabeth Taylor, “are being very hard hit.” She refers to the three million adolescents who contract a sexually-transmitted disease annually. “Heterosexual teenage football players who are healthy and drink milk can get it too!” says the 71-year-old actress, who has singlehandedly raised $150 million for AIDS research. “But teens are very ignorant and feel invincible. They believe there’s an invisible shield protecting them from the virus, when it’s actually aimed right at them.” Taylor believes in addressing the problem head-on: “Tell your teenage son: ‘Maybe a condom doesn’t feel as good, but if it saves your life, it’s better than being six feet under.’ Intelligence must replace random sex.” Although a new generation of AIDS-fighting medications is prolonging the lives of thousands, nearly half of the 900,000 people infected with HIV in the U.S. cannot afford these drugs. Since the virus was discovered in l981, 410,800 Americans have died from AIDS-related complications, and the disease has left 13.9 million dead worldwide. Who Calls a Hotline? Not long ago I took a call from a 15-year-old boy living in a small town who said he feels guilty about his sexual attraction to other boys and is scared to discuss this with his parents. I ask him if there’s a school counselor or relative he might talk to, but he says he’s too afraid to confide in anyone. Being a teenager is hard enough, I thought, without the pressure of keeping this kind of secret. I felt angry and saddened that this child can’t comfortably discuss his feelings with his own parents. I encourage him to call the Gay Community Center Youth Program in a nearby city. In the meantime, I assured him that he could call our Hotline anytime, that we’d be there for him. This call was typical of the many we get from teenagers,whispering from their parents’ homes, confiding their blossoming sexual feelings and concerns. Our Hotline also receives calls from married men who phone from their offices, worried about extramarital sexual encounters; gay men suffering side effects from medications; mothers caring for a sick child or grieving for one lost to AIDS; even health care professionals themselves confused and requiring burnout support. One particular morning, I’m struck by the number of single women who turn to our hotline for help. At 10:15 a.m. a distraught young woman calls, explaining that she had been dating someone “very charismatic,” after a two- year period of sexual abstinence. “At first we used condoms and I was taking the pill to avoid pregnancy,” she says. But after her partner assured her he was HIV-negative, the couple began having unprotected sex. A few months into the relationship, she recounts, his behavior became “unpredictable,” until he finally admitted he was sleeping with other women and was addicted to heroin. Now she has to withstand the “terror” of waiting 3 months before getting an HIV antibody test. To help her cope, I give her the names of three terapists in her area. The call lasts 43 minutes. At 11:15 a.m. I take a call from a woman who is breathing heavily. She says that four months earlier she’d had a brief affair with a limousine driver, “not out of passion, but because I felt lonely. This was so totally unlike me,” she continues. “I come from a traditional Orthodox Jewish family...” Although they used condoms, and she has since tested negative for HIV, she feels deeply ashamed, and has stopped seeing him. And because she has both a persistent vaginal yeast infection and a rash on her neck, she’s convinced she must be infected by HIV. Although rashes, high fever, swollen lymph glands, heavy night sweats, sore throat, or other flu-like symptoms may indicate HIV, they can just as easily accompany the common cold or flu, or other type of infection. I encourage her to seek medical help and counseling, but the calls ends on a down note. “I must have it [AIDS],” she moans. I’m exasperated because it doesn’t sound that way to me, yet I can’t get through to her. The call lasts 22 minutes. It’s 11.38 a.m. when a well-spoken woman, who says she’s an attorney, calls from her office, asking for the names of anonymous testing sites. At first very businesslike, she calmly takes down all the information. I ask her why she’s considering a test. Total silence. Then she begins to cry: “I....I can’t talk....I’m sorry...you see, I have swollen lymph glands....[crying]....And my doctor wants to rule out HIV...I feel overwhelmed...” Then, abruptly: “Where can I send a donation?” She thanks me and hurries off the phone after just 3 minutes. These were one-time callers, but, as in any epidemic, an element of panic prevails, and our hotline also attracts an army of “chronic” or repeat callers who are intensely fearful no matter how benign their risk, many revealing continued misconceptions and paranoia about a disease that can be effectively prevented. We do our best to help them, but often they’re impervious to counseling. Most poignant are calls we get from AIDS patients, phoning from their hospital beds, attempting to navigate the exhausting labyrinth of insurance and health care matters. One man, in hospice care, said he craved companionship and missed the “good old days” when he was handsome and healthy. That call was a tough one for me as just the day before a close friend of mine, Joe, who had battled HIV for 16 years, had finally succumbed. Although at the end Joe was a mere skeleton, he was nonetheless at peace. “I’ve done what I wanted to,” he told me on our last visit. An avid gardener, he insisted on a final trip to his country house to see his garden one last time. For a moment the caller’s reality and the memory of my deceased friend blurred in my mind and I was overcome. Time for a break. Face to Face One of the most and unique services GMHC offers is called “A-Team Counseling,” a one-time, in-person session that’s free and anonymous. Recently, I was on an A-Team counselling a 26-year-old HIV-infected mother from the Midwest. She had traveled to Manhattan by bus to find her estranged boyfriend, who, she recounted tearfully, had kidnapped her 7-year- old son. Disheveled, painfully thin, the woman was a disturbing sight. She’s learned that the two had already returned home where the boyfriend was, and the child put in his grandmother’s custory. custody of his grandmother. Meanwhile she’d run out of money for the return trip, been refused a loan by her family, lost her ID, gone hungry and spent two nights on the street. Fortunately, this woman was registered at a local AIDS organization in her town. I telephoned her caseworker and persuaded him to buy her a one-way Greyhound bus ticket for $115.00. I also gave her subway tokens, a basket of food, juice and coffee. Smiling shyly, she thanked me for caring. Shaking hands good-bye with this woman was a bittersweet farewell. What will happen to her? I wondered will her health deteriorate or improve? Will she gain control of her life and be able to provide for her son? I’ll never know. One thing I do know: She’d appeared with the sorrow of a difficult life in her eyes, but when she left, she was elated at the thought of being reunited with her child. It seems that with faith and a helping hand, almost anything is possible. * * * * * 10 BIGGEST MISCONCEPTIONS ABOUT AIDS AND HIV (This list would probably be most effective when presented in a vertical chart, the misconception on the left, the correct answer on the right.) 1)The AIDS virus can be transmitted through saliva, sweat, tears, urine or feces; also through deep kissing. 1) HIV can ONLY be transmitted through four bodily fluids: blood, semen, vaginal secretions and breast milk--and can also be transmitted from a mother to her child before birth, during birth, or while breast feeding. The exchange of saliva through kissing is no-risk, unless the saliva has blood in it and both you and your partner are bleeding in the mouth simultaneously. 2) HIV may also be transmitted through casual contact with an infected person. 2) You can’t get infected from toilet seats, phones or water fountains. The virus can’t be transmitted in the air through sneezing or coughing. You can’t get HIV from sharing utensils or food or from touching, or hugging. HIV dies after being exposed to the air. Therefore, touching dried blood on a shaving blade, a toothbrush or a bathroom counter top is no risk. In any case, unbroken skin is impermeable, like a rubber raincoat, and cannot absorb the virus whether it’s alive or dead. Blood transfusions and medical procedures in the U.S. are safe. Giving blood is completely risk-free. The chance of getting HIV from dentists or other health care providers is too low even to measure.You can’t get it from mosquitoes or other insect or animal bites. 3) Oral sex is just as risky as vaginal or anal intercourse. 3) Although not 100% risk-free, oral sex is considered a low-risk activity,except if: you have bleeding gums, recent dental work, open sores such as a herpes lesion, any cut, blister, or burn in the mouth, or if you’ve just brushed or flossed your teeth. Also, oral sex with an infected woman is riskier if she is having her period, since menstrual blood can contain HIV. Overall, latex barriers, (such as condoms or dental dams) used during oral sex reduce the transmission of not just HIV, but other sexual transmitted diseases. 4) Animal skin, latex and polyurethane condoms are all equally effective in preventing HIV infection and you can use ANY lubrication on the condom desired. 4)Only latex or polyurethane condoms may be used, as HIV can pass through an animal skin condom. With latex condoms, only water-based lubricants--like K-Y jelly or H-R jelly--may be used. No lubricants with oil, alcohol, or grease are safe.Petroleum jelly,Vaseline, Crisco, mineral oil, baby oil, massage oil, butter and most hand creams can weaken the condom and cause it to split. However, with polyurethane condoms, petroleum-based lubricants can be used. 5) Women have to rely on men using condoms during intercourse to protect themselves against HIV. 5) Women may employ the “female condom,” a plastic sheath that can be inserted in their vaginas and used for protection against HIV. It can be inserted up to 8 hours before sex, has rings at both ends to hold it in place and can be lubricated with oil-based lubricants that stay wet longer. In addition, women can carry conventional condoms for their male partners’ use. 6) If a woman is HIV-positive, her offspring will automatically be born infected with HIV. 6) With no medical treatment taken, about 25% of HIV-positive women will give birth to infants who are also infected. However, the use of anti-HIV medications has resulted in a significant decrease of mother-to-child transmission of HIV in utero and during delivery to less than 5%. (NYT 10/19/ 99]. 7) AIDS is fundamentally a gay disease contracted by white males. 7) Recent data compiled by the Centers for Disease Control and Prevention indicate that young gay Hispanic and African-American men and heterosexual women are the fastest growing segment of the population being infected with HIV. Women now account for 43% of all HIV infected people over age 15. [NYT 11/24/98] African-American and Hispanic women account for more than 76% of AIDS cases among women in the U.S. 8) Heterosexual men are not really at risk for contracting HIV, even if they don’t use condoms. 8) The inside opening of the penis is composed of highly-absorbent, sponge- like mucous membrane tissues, which can provide a route for HIV-infected vaginal secretions or blood to enter the bloodstream. Proper condom use protects men from infection. 9) The AIDS epidemic is largely over because new AIDS medications like protease inhibitors and others have turned AIDS into a chronic, not a terminal disease. 9) In the U.S., AIDS is the fifth leading cause of death for people 25-44 years old. Roughly half of all those infected with HIV in the U.S. are not receiving any medications or medical care. AIDS now kills more people worldwide than any other infection, including malaria and tuberculosis.[NYT 11/24/98] In 1998 alone, 2.5 million people died of AIDS worldwide. 13.9 million people have died since the virus was discovered in 1981. 10) If you think you’ve been exposed to HIV through unprotected sex, you can take an HIV antibody test 2 weeks later and get an accurate result. 10) The standard “window” or waiting period remains a full 3 months. However, because the widely-used HIV antibody tests (The ELISA and Western Blot) have become so sensitive, about 95% of people will procure an accurate result 4-6 weeks after a possible exposure to the virus. * * * * [Note:The information stated above was reviewed for medical accuracy by Dr. Todd J. Yancey, an infectious disease specialist practicing in New York City and affiliated with New York Presbyterian Hospital, NY, Cornell Campus.] THE CHILD LIFE PROGRAM “Mommy takes a lot of medicine and Mommy’s really tired sometimes and she can’t take you to the park as much as she used to. It’s not that I don’t love you...and that I don’t want to...but Uncle Jack’s going to take you to the park today.” --A mother living with AIDS, a client at GMHC, talking to her 6-year- old son. In New York City alone, 28,000 children have been orphaned by AIDS since the epidemic began [NYT 12/13/98] GMHC’s unique Child Life Program serves HIV-infected parents and their children--who may, or may not, be infected with the virus. “We help families strengthen their ability to cope, relieve the pressure of parenting with support services, and teach parents how to talk to their kids,” says Child Life Program Coordinator Alison Ferst. “Unfortunately, should a parent or child be sick enough to be facing death, we also help them walk through it with grace and dignity---as opposed to feeling alone, isolated and frightened. “We also encourage sick parents to make stable legal plans for their children who may be left behind,” adds Ferst, “and to have disclosure conversations with the children in advance, so you don’t have a child standing at her mother’s funeral, not sure where she’s going next.” When an HIV-infected Mom arrives at GMHC to have lunch, attend a support group, consult with a lawyer, or access the acupuncture clinic, she can leave her children in a spacious playroom, decorated with fanciful murals and a giant tree hand-painted by the famed children’s story writer and illustrator, Maurice Sendak, who donated his art. [see photos] The program provides: child- sitting, nutrition services, a food pantry, art and magic classes, and recreational trips--church picnics, seasonal apple-pumpkin picking, amusement parks, zoos, museums, beaches. Also: homework help sessions, holiday parties, hospital visits, summer sports and weekly support groups for HIV- positive parents and their HIV-negative children. This unique program also features: Cooking classes for kids who sometimes prepare meals for sick parents; Pediatric Buddies, GMHC adult volunteers who play with sick children and also assist with family chores; Fun With Feelings Support Group, Friday Evening Family Time, Birthday parties, and a Holiday Gift Drive. “Children infected or affected by AIDS,” concludes Ferst, “want to be like other kids: They want to play with their friends, want to know that someone will always take care of them, want to know they’re not alone, and often wonder if it’s their fault when Mom or Dad gets sick.” These children need a helping hand and any of us can provide one.