Sex can enrich everyone’s life – even a doctor’s! - HIV doctor Luc Gelinck

There are a lot of reasons why I enjoy being an HIV doctor. People with HIV are often colourful people. The chances that someone will get HIV are related in part to his or her lifestyle. That means that a higher-than-average number of pleasure-lovers are infected with HIV. You won’t get HIV just by looking out your window all day.

HIV and sexuality
HIV is intricately connected with sexuality. Sex can be a lot of fun and it can enrich your life. That’s true for the patient, but also for the doctor! But sex can also lead to a lot of problems. Unfortunately, many people with HIV have had unpleasant or even traumatic experiences with sexuality. Not daring to come out for your homosexuality can also lead to traumas.

The medical or technical side
As an HIV doctor, I normally discuss the more technical or medical side of sexuality: How can you pass on HIV and how can you not do that? How can you safely become pregnant? Patients will normally discuss the more social and psychological issues with nurses who are specialised in HIV. Yesterday I met a new patient who has some serious problems with his sexuality. Now that he has HIV, that is much harder for him to ignore. The nurse spent quite some time with him discussing how he can learn to deal with it. People don’t go to the doctor to talk about their day-to-day life. I think it’s wonderful to hear about what people are doing with their lives, but when someone starts talking about a trip to a far-off country, I immediately start thinking about the vaccinations they will need. Call it my force of habit!

Gay man and African woman
Two out of every three people with HIV in the Netherlands are men who have sex with men. But HIV is also relatively common among heterosexuals from Africa and the Caribbean. We discuss very different topics with a gay man than we talk about with a woman of African descent. Sometimes a patient will want to discuss the figures from a medical journal about the risk of passing on HIV in case of an undetectable viral load. Then it is up to me to discuss that, including any factors that might play a role in that regard and the chances that other sexually transmitted infections (STIs), such as hepatitis C, could be passed from one person the other.

Difficult to bring up an intimate topic
Many people find it difficult to bring up an intimate topic. But if I bring up sexuality, the patient is often relieved that we can talk about it and he or she will often have a lot of questions. Even with people who have been living with their HIV for years already, sexual problems can suddenly arise. Someone might ask, for example: ‘Oh, so that means you can prescribe pills that will help me keep my erection?’ When that happens, I will discuss it with him. In some cases, I will indeed write a prescription – his family doctor can also write such a prescription, but if I do it I can keep close track of any possible interactions with his HIV medicines myself. In other cases, it can turn out that all sorts of things are going on in the man’s relationship or that psychological problems appear to be playing a role.

Preaching
Naturally it won’t help matters if you have an STI and your doctor starts preaching to you about that. Why shouldn’t you be allowed to do certain things? Who says you can’t? The law? The Bible? The doctor’s own sense of ethics? Everyone makes his or her own choices in life, and as a doctor you are supposed to respect those choices. The advice I give as a doctor depends only on objective health aspects. To give an example: smoking and being overweight are more likely to damage your health than a ‘normal’ case of gonorrhoea or chlamydia would. When it comes to something like hepatitis C, factual information will be more useful than some general rule that won’t be followed.

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