Creating safer spaces for women’s HIV prevention

1. Creating safer spaces for women’s HIV prevention

2. Purpose of this workshop • To share skills and knowledge that will facilitate the creation of safer spaces to offer HIV prevention information & support to women • Sections: • HIV/AIDS 101: The basics • Safer spaces: Why and how? • Discussing safer sex from a harm reduction perspective

3. Introductions

4. Underlying principles/values • WOMEN-CENTRED • SEX & SEXUALITY POSITIVE • HARM REDUCTION FOCUSED • ANTI-OPPRESSIVE

5. Why women? • Women represent increasing proportion of people infected with HIV in Canada • 26% of new HIV infections attributed to women • Prior to 1998, women represented only 12% of cases • Young women (15-24 years) are the highest rising group of new HIV infections • African-Canadian and Aboriginal communities disproportionately affected

6. HIV/AIDS 101: The basics

7. HIV Human:The virus can only infect & harm people. Immunodeficiency: HIV attacks the body’s immune system. The virus weakens the body’s natural ability to defend itself against illness & disease. This makes it easier to get sick and harder to recover. Virus: A virus is a small infectious agent that gets into the bloodstream. HIV can only reproduce once it is in the white blood cells. This is how it attacks the body.

8. AIDS Acquired: It is not something someone is born with & does not develop on its own. It is acquired . Immune: The body’s natural defense against germs, bacteria, and viruses. Deficiency: When HIV attacks the immune system it loses its capacity to fight off colds & flus as well as more serious illnesses like pneumonia & cancers. Syndrome: a combination of symptoms and/or diseases

9. Medical definition of AIDS In Canada, AIDS is diagnosed if a person has: • undergone testing for HIV and received a positive result & • has one or more of the clinical illnesses, or indicator diseases, that characterize AIDS. (Public Health Agency of Canada)

10. How is HIV transmitted? • 3 conditions must be met for HIV infection to be possible: • Source of infection • Route of entry • An activity that facilitates transmission

11. 1. Source of infection Infectious fluids Non-infectiousfluids Sweat Tears Feces Urine Vomit • Blood • Pre-ejaculate (pre-cum) • Semen (cum) • Vaginal fluids • Breast milk

12. 2. Route of entry • Mucous membranes • Minute tearing of mucous membranes • Cuts, open sores • Directly into veins

13. 3. An activity that facilitates transmission • Unprotected sex • Sharing needles • Mother-to-child • Blood/blood product transfusion

14. How are women becoming infected? • Vast majority through heterosexual contact • 71% • Injection drug use • 29%

15. What makes women susceptible to HIV infection? • Biological factors • Vaginal contact with infected fluids • Socio-cultural factors • Societal beliefs & women’s socialization re: sexuality • Poverty, racism, heterosexism, sexism, etc. limit access to resources & sexual decision making power • Sexual violence against women

16. HIV prevention involves… • HIV testing • In Canada, approx. 26% of people living with HIV don’t know their status • Key elements of HIV testing: access, informed consent, anonymity, pre- & post-test counseling • Types of tests available in Nova Scotia: • Nominal • Non-nominal • Anonymous

17. HIV prevention involves… • STI testing • Sexual violence prevention & sexual assault care • Harm reduction • Sex positive information, resources & support

18. Safer spaces for HIV prevention: Why & how?

19. What is a safer space? • A physical space or interaction where... • a woman feels welcomed and valued; • her right to self-determination is respected; • her strengths are recognized; • her individual lived experiences and needs, as defined by her, are understood and addressed • she can access accurate information & non-judgmental support • services are accessible & confidential

20. Why is there a need for safer spaces in women’s HIV prevention? • Barriers • Real or perceived lack of confidentiality & privacy • Stigma & discrimination regarding sexuality & HIV/AIDS • Lack of awareness regarding risk • Lack of resources to access services • Intersecting lived experiences of discrimination • etc., etc., etc.

21. How can safer spaces be created? • Starting within ourselves & our organizations • Recognizing & engaging with our values around sexuality & HIV, expanding knowledge base & building on strengths • Making information & resources visible & accessible • Creating an environment that is sex positive & woman-centered • Offering individualized support • Thinking about women as individuals with complex intersecting social locations, personal histories, needs, desires, etc.

22. Making sex safer: A harm reduction approach

23. SAFER SEX… what is it?! • Safer sex encompasses all practices that promote & protect physical, emotional, mental, & spiritual aspects of sexual health • Central elements are self-determination & freedom of consensual sexual expression • SAFER sex is different than SAFE sex

24. A spectrum of risk… HIGH LOW NO Unprotected anal sex Unprotected vaginal sex Shared sex toys Unprotected fellatio (giving head) Unprotected cunnilingus (going down, eating out) Unprotected anilingus (rimming) Unprotected manual sex (fingering, hand job) Kissing Massage Dry sex Cybersex Phone sex

25. Safer sex: Barrier methods • Male condoms - $7-12/box of 12 • Latex or polyurethane (for those with latex allergies) • Lubricated for vaginal & anal sex • Non-lubricated for oral sex • Condoms with ribs or dots inside increase sensation • Thinner condoms offer greater sensation & comfort • Avoid condoms containing spermicides such as nonoxynol-9 • Don’t double up! • Don’t use flavored condoms for vaginal or anal sex • Keep condoms in a cool dark place

26. Safer sex: Barrier methods • Female condoms - $20/package of 5 • Used most commonly for vaginal sex • Polyurethane & lubricated • Can be inserted up to 8 hours before intercourse • Should not be used at same time as male condom • Can be quite noisy & uncomfortable (especially if there isn’t enough lubrication)

27. Safer sex: Barrier methods • Dental dam - $1.50 each • Used for female-receptive oral sex or oral anal sex • Light talc coating should be rinsed before use • Use only one side & use only once • Not widely available (cut open condom or latex glove can be used as an alternative) • Latex gloves - <$.50 per pair • Used for manual sex (fingering, hand jobs, etc.) • New set of gloves must be used each time

28. Safer sex: Lubricant • $5-20/bottle • Can be used with barriers or alone • On condom, lube inside tip can increase sensation • With dental dam apply lube directly to genitals • Amount of lube used is matter of preference; however, there should be enough at all times to keep barrier from becoming dry & to keep genitals comfortable & slippery • Water- or silicone-based lubes are latex-safe (NOT OIL!!!) • Body lotions suitable for male masturbation only • Flavored lubricants should not be used vaginally or anally

29. Safer sex: Additional ways to minimize contact with body fluids • Pulling out/finishing with hand • Taking extra precautions during menstruation • Limiting number of sexual partners • Limiting duration, frequency & roughness of sex • Being aware of each others bodies (look for cuts, mouth ulcers, evidence of STIs, etc.)

30. Thinking about sexual diversity • These guidelines can be helpful for everyone regardless of sexual orientation & gender identity • Risk is not determined by identity!!!

31. Let’s talk about it! Negotiating safer sex • Thinking beyond physical protection: • Acknowledging one’s own sexuality • Sense of worth & personal power • Communicating feelings & personal needs • Establishing trust • Clear judgment (considering substance use) • Ability to set limits & boundaries

32. Bringing it all together… • HIV prevention has no single script • Safer sex can be empowering & fun!

33. Thank you, thank you, thank you