Differences in Perceptions of What Constitutes Having “Had Sex”
After nearly two hard-fought decades focused on minimizing the spread of HIV among various “at-risk” groups, such as men who have sex with men (MSM), youth and injection-drug users (IDUs), the period from 1999-2001 marked a disturbing increase in HIV infection among MSM and heterosexuals in the United States. In 2003, the Centers for Disease Control and Prevention (CDC) announced a new strategy for attacking the HIV epidemic in the United States. This initiative shifted the emphasis of HIV prevention efforts away from at-risk groups and toward those already infected, a practice more commonly known as “prevention among positives” or “secondary HIV prevention.”
A key aspect of this strategy is the provision of guidelines to help clinicians incorporate HIV prevention into the medical care of their HIV-positive patients. The CDC’s guidelines identify the need for clinicians to screen HIV-infected patients for behavioral risk factors associated with the transmission of HIV and other sexually transmitted diseases (STDs). Important behaviors to address in risk screening include: whether the patient has been engaging in sex, number and HIV serostatus of sex partners, types of sexual activity, and condom usage.
However, before clinicians begin asking such questions as, “Have you been sexually active?” “Are you using condoms?” or even “Tell me about your sex life,” there needs to be a firm understanding of the range of behaviors considered by their clients to be sex. If screenings for sexual behaviors are to be successful from the standpoint of secondary HIV prevention, then clinician-patient consensus regarding what is sex must be present. Clinicians must first understand what individuals’ consider to be sex and the degree to which perceptions of sex or what constitutes having had sex might vary. Researchers have explored the question of what constitutes sex or having had sex in a variety of con texts. Insight into perceptions of sex have also been made by attempts to define what is not sex, or abstinence. Demographically, research in this area tends to focus on the sexual perceptions of teens and young college-aged adults. One such study on this issue was conducted by Sanders and Reinisch on a sample of college students from a large Midwestern university. Their random sample of 599 students matched the university demographics and was >90% white, 59% female, with 96% self-identifying as heterosexual. Sanders and Reinisch found that individual attitudes varied with regard to behaviors defined as “sex;” 59.1% of respondents felt that oral-genital contact did not constitute having had sex, and 19.9% responded similarly regarding penile-anal intercourse.
In a review of the literature, we found minimal research investigating this issue among an HIV infected population. Our goal in conducting this study was to: 1) replicate Sanders and Reinisch’s study (a sample in which HIV status was unknown) in an HIV-positive sample, and 2) determine the extent to which perceptions of what constitutes having had sex vary within an HIV-positive population.