Being Alive Newsletter, Being Alive/Los Angeles - May 1993
Charles R. Caulfield

In helping these couples, we determine whether there is a sexual dysfunction in either of the partners. Sexual dysfunction is common in people with any chronic illness. There may be fears of intimacy when either or both individuals have changes in their physical body images caused, for example, by weight loss or progression of Kaposi's sarcoma. Sexual dysfunction, if successfully treated, could make safer sex practices more acceptable.

If, after dealing with all of the physical and psychological issues, it is apparent that the stresses of practicing safer sex are so great as to have an impact on overall well being, then the couple is advised to make their own decision regarding safer sex practices within their relationship. If they decide to be unprotected, then I reinforce that they must practice strict safer sex if they ever go outside the relationship.

It is always difficult giving informed advice when there aren't statistics or adequate data to answer patients' questions. I am reminded of the commonly held belief some ten years ago, before AIDS, that one could have as many partners as one wished as long as one made the monthly trip to the sexually transmitted disease clinic. It is for reasons like this that I must temper all advice with both scientific fact and common sense.

(Howard Aaron Aronow, MD, is Medical Director of the West Hollywood HIV Health Care Center.)

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