HIV Serodiscordant Male Couples Special Considerations for Sex Therapy

1. HIV Serodiscordant Male Couples Special Considerations for Sex Therapy Alex Carballo-Dieguez, Ph.D., Robert H. Remien, Ph.D., and Timothy Frasca, M.P.H

2. What is HIV • Human Immunodeficiency Virus • Weakens the immune system by destroying cells that fight diseases and infections • T-cells and CD4 cells • Referred to as the “generals’ of the human immune system (http://aids.gov/hiv-aids-basics/hiv-aids-101/what-is-hiv-aids/)

3. Numbers • A normal CD4 count ranges from 500–1,000 cells/mm3 • When your CD4 count is 350 cells/mm3 or less treatment is consider http://aids.gov/hiv-aids-basics/just-diagnosed-with-hiv-aids/understand-your-test-results/cd4-count/

4. Treatment • Antiretroviral treatment (ART) • Slows down the growth of the virus • Zidovudine (Retrovir, AZT) • Didanosine (Videx, Videx EC, ddI)• Stavudine (Zerit, d4T)http://www.aidsinfonet.org/fact_sheets/view/403

5. Medical Side Effects • Physical effects include nausea, vomiting, headaches, skin rashes, numbness in legs/arms, fever, diarrhea • Psychiatric effects include insomnia, somnolence, abnormal dreams, impaired concentration, severe depression, aggression, extreme fear, maniac reactions • Sexual side effects classified into two categories • sexual inhibition- desire arousal, orgasm • sexual function- premature ejaculation

6. Psychological Issues • HIV infected male • More likely to experience sexual dysfunctions ( Cove & Petrak, 2004) • Absence of treatment • Loss of sexual interest, erectile dysfunction and endocrine abnormalities • Antiretroviral Treatment • Increases erectile dysfunction, decreases libido, & other sexual dysfunction • Testosterone deficiency is common in symptomatic HIV-infected men • Prominent leg/arm veins (lipodystrophy) & obesity

7. Emotional Issues HIV positive • Emotional adjustment to the diagnosis • Timing & content of disclosure in context of relationship • Risk of infecting partner or others • Anxiety or guilt • Not being able to enjoy sex • Inability to engage emotionally with sex partners • Shunning or hostility from potential boyfriends or groups

8. Emotional Issues HIV-Negative • Decision to continue relationship? • Over obsessive for safe sex practices • Does not change attitude or sexual behaviors

9. Behaviors • Low to high risk interactions between partners • Condoms use • Decrease sexual sensation • Only about half of men use condoms • Half see advantages such as improved hygiene (Carballo-Dieguex & Dolezal 1996)

10. Behaviors cont. • Alcohol and Recreational Drugs • Sudden stop when being diagnosed with HIV • Extramarital sex • 31% both members acknowledging outside sex • 27% reported knowledge of some sexual partners outside of the relationship • 24% had no knowledge outside sex was kept a secret

11. Therapeutic Approach • Integrative approach • Has both process and product aspects • Process = problem discernment • Product = intervention/solution • Utilizes incremental steps aimed at producing more effective marital relationships • HIV-positive partner • More difficult to disentangle from the effects of treatment, psychological, and interpersonal problems

12. Therapeutic Approaches • Couple • Open communication between partners • Therapist needs to help guide elicit questions • Directive approach to generate discussion of avoided topics • Sex-affirmative mode • Hypothesis testing • Lets couple analyze, criticize, reject the therapist hypothesis • Observing the consistency between over and covert narrative and behaviors

13. Personal view • It is important for communication between couple about their relationship • HIV negative partner gaining the knowledge of HIV and side effects • Safe sex practices • Both individual and couples counseling