High-Risk Sexual Behavior in the Treatment of HIV-Negative Patients

How we think and feel about sexual risk-taking behavior affects our capacity to treat patients. This paper notes the tendency of the media, clinical research literature, and conventional wisdom to understand sexual risk-taking as characteristic of a damaged “other.” The paper explores how these ideas evolve and how they influence our approach to clinical treatment as well as patients' views of themselves. In marginalizing the risk-taker as a damaged other, anxieties and fears about risk of infection are quelled for patients and clinicians alike. However, when risk-taking behavior is seen as situational, treatment provides a context for inquiry, articulation, and understanding of the patient's unique experiences, feelings, and circumstances. The paper outlines examples of situational factors in clinical work with sexual risk-taking patients. A clinical vignette with a patient highlights how sexual risk-taking emerges in a context of a patient's attempts to assuage or avoid difficult feelings and experiences of self that preclude some, but not all, capacities for self-care. The paper illustrates the psychotherapeutic need to understand the anxieties, fears, hopes, interpersonal contexts, and manners of organizing experiences of self which may supersede self-care during moments of potential high-risk sexual behavior. Rather than seeing sexual risk as an abandonment of self-care, this paper argues that sexual risk-taking behaviors may alternatively reflect intersubjective struggles to care for one's self.