Abstract
alking about sex is an inherent part of the counseling and health care interactions related to HIV disease and other sexually transmitted infections. Although this may seem obvious, providers sometimes seem to lose sight of this fact, minimizing the difficulty of sexual behavior change for clients. Focusing on disease processes, treatment outcomes, and the prevention of sexually transmitted infections (STI) can lead providers to overlook the ways in which disease unfolds in the context of a person’s life and the complexity of each individual’s life. This focus may obscure an individual’s specific barriers to behavior change—barriers that are not overcome simply by reiterating prevention or treatment messages. Providers may also feel more uncomfortable talking about sex than they realize or care to admit, or they may be confused about the place of such discussions within the context of counseling or treatment interactions. Given these factors and the power dynamic of the provider-client relationship, it is the responsibility of mental health and health care providers—not clients themselves—to encourage the discussion of relevant sexual issues and to maintain a safe interactional “space” for such discussions. It is unlikely that clients will raise sexual issues unless they feel safe doing so, even if these issues are of paramount concern to them
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