Fear & Absence

A Call to Revise HIV and Sexual (Mis)Education

Vital Subjects
by Keiko Lane, MFT

chair[dropcap]I[/dropcap]t happens almost once a week: A Facebook friend posts a photo and description of a missing adolescent. Sometimes my friends know these kids, and sometimes they’re just reposting messages from their communities. Usually these young people turn up quickly, having roamed outside of the temporal and spatial knowledge of their parents and caretakers for teenage adventures. Girls are posted about more often than boys, perhaps because boys are still given more leeway to explore before communities become concerned.

Once the girls come home or are found, I hear of conversations starting about STIs, birth control, and the morning-after pill (Plan B). When the boys come home or are found, I rarely hear of conversations about STI testing. And I never hear of any conversation about PEP, which needs to be started within seventy-two hours of HIV exposure. When I bring it up, sometimes people know what I’m talking about. Sometimes they don’t.
There are so many concerning issues connected to this one moment.

How are we educating young people? The dominant cultural sex education discourse in this country still harbors fear and hesitancy in talking about actual sex practices and embodied sexual desire and their intersections with gender identity and erotic partner choice. Adults and educators feed shame and fear along with (mis)education. What we forget is that young people absorb information from the cultural surround, consciously and unconsciously, just as we do. We forget that they live with knowledge and dailiness different from ours and craft their logic and decisions from them.

When I asked one young man in my psychotherapy practice about his safer sex negotiations and practices with the other young men he was dating and experimenting with, he said that he didn’t ask people about their HIV status on purpose and he didn’t want to know his own. He’d read stories about people charged with reckless endangerment for potentially exposing sexual partners to HIV when they knew their status. This young client worried that in the climate of HIV criminalization, ignorance was legally safer. He did, he assured me, use condoms most of the time. And even though Truvada is approved as part of HIV treatment for people much younger than he, as a legal minor, he was too young to be a candidate for PrEP.

Another young client, who is genderqueer and bisexual, hadn’t really understood that even though they did not identify as female, they needed to think about birth control because they had an XX reproductive system. Though their sexual partner did not identify as male, they were in possession of XY chromosomes and a penis, and they were having penetrative vaginal/penile sex, so they were at risk for an unplanned pregnancy. These young people are not ignorant about the politics and malleability of bodies. They are young people who have been so anesthetized by an outdated sex education system that equates pregnancy risk with heterosexual intercourse between a cismale and a cisfemale*, that they had no practice and no guidance translating reproductive and sexual health information into their embodied experience.

What both of these cases have in common is that young people are making the best choices they can based on the residue of fear and absence in HIV and reproductive health education. Their lives are not adequately represented, and the very real fears of criminalization are enforced by the lack of easy access to information and conversation. Not only were the intersections of bodies, genders, reproduction, and serostatus left out of the conversations these young people had been subjected to, but also, so was any reference to desire and joy. What would it mean to teach a sexuality of choice that is organized around consent, negotiation, and mutual desire and pleasure?

My young client who worried about the climate of criminalization was right. The attacks on seropositive people in consensual relationships, the attacks on abortion-providing women’s health clinics, and the attacks on affordable health care are all issues at the core of how we educate young people (and remind ourselves) about the centrality of agency in health decisions and how deeply threatened we are at all times.

I’m overwhelmed sometimes, as I sit in my psychotherapy practice envisioning how to update the conversation to match and meet the experiences of young people when we therapists and educators are still updating the conversations for ourselves. The HIV treatment options and reproductive possibilities for all of us are in constant flux, in wonderful and mindboggling ways.

Here’s the problem: There is no concrete, unchanging curriculum for talking about sexuality and sexual and reproductive health. That’s the point of any kind of cultural, epidemiological, or individual development. We don’t stop developing at some set point in our lives. This is in fact what we hope for: that we teach our young people how to have conversations that shift and change as the world changes around us. PrEP and PEP aren’t perfect solutions. Just like Plan B isn’t a perfect solution. But twenty years ago we would have given anything for them. The language we need to learn and develop for talking about them won’t come from those of us who came of sexual age before them, but from listening to those who are coming of age with them.

Maybe the answer is that we can’t know more than these young people know—not about the contexts in which they live. Education is a reciprocal conversation: You tell us what your lived experience is. We’ll tell you what we know about how you can stay safe without unnecessary fear and risk. We may not be able to anticipate the questions. We won’t have all the answers. But we’ll try to find them together.


* Refers to a person whose gender identity is the same as the gender as that assigned at birth (i.e., not a transgender man/woman). Colloquially shortened to “cis” or combined as ciswoman or cisman. The word “cisgender” distinguishes without assuming that cisgender is the neutral or normal state. Source: National Lesbian and Gay Journalists Association


In all case examples from my clinical practice, clients’ identities and details are changed significantly to disguise their specificity and identity. The issues raised are actual questions and issues from my clinical practice, clinical supervision, and teaching.


Photo by Michael Dumas
Photo by Michael Dumas

Keiko Lane, MFT, is a Japanese American writer and psychotherapist. She writes about the intersections of queer culture, oppression resistance, racial justice, and liberation psychology. She has a psychotherapy practice in Berkeley, California, specializing in work with queers of all genders, artists, activists, academics, people affected by HIV/AIDS, asylum seekers and other clients self-identified as post-colonial. Keiko also teaches graduate and post-graduate psychotherapy courses on queer and multicultural psychotherapies, the psychodynamics of social justice, and the embodied literature of exile. She is a long-term survivor of ACT UP/Los Angeles. Visit: www.keikolanemft.com.

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