I have a rough plan in mind for how and when I share things, and the order in which I am going with my story. However, I received some comments today that I feel I must skip ahead and respond to...
Anonymous wrote:
I realize you do not understand why you were medically separated and are not being reinstated, but there are a number of reasons, not the least of which are your own health and that of people with whom you would come in contact.
On another note, hating to be the negative voice, I wonder why on Earth you even went into a sexual situation in a country where the rate of HIV infection is MORE THAN one in seven, WITHOUT protection of any kind, with a virtual stranger. I am sorry if you feel this is harsh, and certainly do not think anyone "deserves" to get HIV, but why? You were serving in an extremely high-risk country, in an extremely high-risk area. You are young enough to have grown up knowing about HIV and how to avoid it. Peace Corps gave you good training about it as well (I am also a PCV). Thus I wonder about your choices. Was it the naivety and arrogance of youth, thinking it would not happen to you? Was it ignorance - did you really not think it was possible?
Sorry if my comment offends you or anyone else, but I am mystified at how you could have exposed yourself to this illness in the first place. ANY unprotected sexual contact in a country where one in seven people have it (and where it is more commonly found in middle and upper class people) baffles me.
Dear Anonymous,
First off, I would like to clarify the fact that I DO understand why I was medically separated. I was medically separated because my body was not healthy enough after 45 days of Medevac status to be thrown back into an environment where I would be prone to more infections and sickness without an up to par immune system. As I said before, I do understand, accept, and even agree with that. I Was Not medically separated for any reasons relating to the health of other people with whom I would come into contact with. That, my dear anonymous friend, would be incredibly ridiculous and discriminatory.
As to the rest of your questions, I would like to start by saying that we are all humans. And humans are, by nature, sexual beings. Stack on top of that the loneliness, stress, and some of the other hardships of being a PCV, and I think many people would agree that we end up up with a strong desire/need to seek out some kind of companionship, comfort, or support. During my training, I remember PC giving us a statistic that at service entry only 20% of volunteers claim to be sexually active, and by close of service nearly 90% are sexually active. In my intake group of 29 volunteers, I can tell you (with absolute certainty) that over 50% of us have already engaged in sex (with Zambians, ex-pats, or other volunteers) in country. This group has been in country for less than 1 year. I am not alone. Volunteers were having sex before me, and they will continue having sex after me. (In fact, this comment has inspired me to stop my poll early, and start a new one. Please take a moment to contribute your vote on the new question!)
Now, is what I did stupid? Did I make mistakes? Yes! Absolutely! But, I also made attempts to protect myself and lower my risks. I did what I thought Peace Corps told me to do to be safe. I asked if he had been tested. I used condoms when I had sexual intercourse. One of my biggest MISTAKES was believing that oral sex is a "low risk" activity, and equating that to "no risk". Peace Corps trainings (and other HIV trainings) emphasize this idea of "high risk" vs. "low risk" activities. I've come to believe now that this is an extremely horrible way to go about teaching people. To me, there is no such thing as "low risk" anymore. It doesn't matter if you are having oral sex or anal sex, or whether the HIV rate is 1 in 7 or if it is 1 in 100! A risk is a risk is a risk.
I sent an e-mail to my Peace Corps HIV Educator very shortly after my diagnosis, and although my writing may not quite have been so elegant at that time, I wanted to share a bit of it with you...
"I think it is very important to talk about and stress the message that low risk is different than no risk. Because I can definitely say that this message did not and does not come out clearly enough. I feel like in our trainings, and other HIV sessions and information I've gotten in my life, oral sex and "mutual masturbation" have always been encouraged as safer alternatives to vaginal sexual intercourse. But, the reality is that they are still not totally safe. I don't think we always hear that clearly. We think, vaginal sex= HIV, but oral sex is okay. And furthermore, I feel like we are given this message over and over that oral sex is okay, as long as you don't have any open sores or cuts in your mouth. And, we even hear, or think we hear, the message that if you use condoms, you will be safe and okay. But, the reality is that I had oral sex, and I didn't have any open sores or cuts in my mouth. I used condoms, and they didn't break or come off. I thought I was being safe. But, the reality is that there were still risks involved, even if they were of the smallest percentages. Someone has to make up those small percentages... and I guess that someone is me.
My advice? Nothing and no one is totally safe. There is no 100%. Best thing you can do? You and your partner get tested, and then get tested again 3 months later. Use condoms for sex, and put it on as soon as bodies are naked and fluids of any sort are available. Even though its hard to imagine, consider using condoms for oral sex. And even after you consider all these things, make sure you know and realize and are comfortable with the fact that even though you are taking the right precautions and being as safe as you can, you are always still taking a risk."
Do I blame Peace Corps training for what happened to me? NO. But, it definitely did contribute to my understanding of HIV transmission, my thought process about what risks I was taking, and ultimately played a role in the choices I made. I know now that sex (of any kind) is a risk... always. This is what I hope others can learn from my experience. I hope this helps... please follow up with any additional questions you may have.
Great response!!! When emotions and hormones and life in a world unknown is kicking you in the stomach, anyone and everyone would seek companionship! I am so sad that this is the outcome for you, but what you did was human, and PCVs around the world are all doing the same. I say so from experience. Keep your head high and thank you so much for such an honest and thoughtful blog that can help others be more informed and more aware. You are an inspiration to me and i hope to many others!
ReplyDeleteI was in PC over 30 years ago. Hindsight is 20 20. I know what it was like to be in your very shoes, being lonely, homesick and vulnerable. There but for the grace of God go I.
ReplyDeletejessica,
ReplyDeleteThis was such a fantastic post and response to that anonymous reader. you are so level headed when I would've just raged at them. I love how you got right to contacting your peace corps educator. I don't feel like I have gotten a lot of HIV training and I'm even in the health field. That bit about the thinking oral sex is ok as long as there are no open cuts or sores was an eye opener because that's what I would assume as well! keep on posting woman!
in admiration of your strength, stephannie <3!
Just because a certain percentage of people are sexually active doesn't make it right.
ReplyDeleteJust because a certain percentage of people are judgmental and without compassion doesn't make it right.
ReplyDeleteWay to go, Jess! Really, anywhere we go, we take risks everyday. We all take precautions to mitigate risk but again, we can never eliminate it. The most dangerous thing we do everyday is get in a vehicle and drive. No one thinks twice about it. Life is taking a risk. Even here in the US and during my PC training 10 years ago, we've always been told about oral sex being low risk. You are right to say that perhaps it's been unclear for so long, even here in the US. Many overlook it. It's how we live. And, from my personal experience, knowing what went on in my group, what I've heard from other RPCVs and currently serving PCVs, there will still be people engaging in risk much higher than you (not just PCVs, have you seen the expats overseas?!?!). You did everything you could to mitigate risk. It's really unrealistic to think that PCVs or anyone will abstain from sex over a two+ year period. If one hasn't lived overseas, it is difficult to comprehend the emotional roller coaster. I know too many people who have engaged in high risk activities and have come out unscathed. Your situation surely saddens me and frustrates me. How can such an outstanding person deserve this after doing all the practical precautions?? We may never know. But I'm amazed by your courage to help others understand and learn from your experience. I know you will be helping more and more people, PCV or otherwise. There's no point in questioning the situation and looking back. What good does that do, Anonymous poster? There's only forward for Jess and only forward for the people who will read this blog, learn something new, and use that information in their day-to-day lives. What a gift she's giving us all.
ReplyDeleteI agree, this was such a great response. If you're a PCV you know what life is like, it's lonely. We've talked about how we didn't like men in the country we're serving and in 5 months I've heard volunteers say that the men are starting to look more cute. And great for you for writing your PCMO. Maybe you could help develop the PC wide curriculum for HIV awareness. As I said before, the video that you watch, not so inspiring. They should make all PCVs read your blog instead!
ReplyDeleteAgree! All PCVs should know your story. Maybe new cases would drop to zero!
ReplyDelete-Alison, RPCV China 07-09
"Anonymous said...
ReplyDeleteJust because a certain percentage of people are sexually active doesn't make it right."
Dear Anonymous,
It may not be RIGHT, but it is REALITY.
Maybe you should read my post about judgment and punishment...
<3Jessica
And now unfortunatley you are dealing with the REALITY of your choice to have unprotected "low-risk" sex with a stranger in Africa.
ReplyDeleteThis post breaks my heart. I am a parent, and a PCV parent to boot. I know from my child (in nearby high HIV rate country), that the loneliness can be unbearable and people seek comfort where they can find it. We are aware that coming in for medical hold for PEP is not that uncommon.
ReplyDeleteWhat really pains me though is what I realized immediately when I saw your journal: not enough education. Not in the Peace Corps, not in your country, and definitely not here in the USA. Did I ever think to caution my child about oral sex? Nope, sure didn't.
Jessica, I hope you continue to write and to share. Your courage makes me proud. I am going to make sure that everyone that I know currently serving in PC sees it. I also hope that the journal gurus can figure out a way to anchor it at the top of the "most popular" list because it is so darn important.
And try to disregard people like Anonymous #1. S/he probably thinks that the kids who died in Mozambique brought it on themselves because they got into a vehicle with a driver they didn't know (I wonder if Anonymouse ever does that as a PCV?). And that sex education leads to promiscuity....
ReplyDeleteI don't know if anyone has addressed this yet or if the Peace Corps emphasized this, but this is some information I found useful learning about HIV transmission in college:
ReplyDeleteAn infectious bodily fluid with very high concentrations of HIV (semen, vaginal fluid, blood, breast milk) MUST come into contact with a mucous membrane- any part of the body that is involved in absorption and secretion, including the mouth, anus, and genital area. Thus, unprotected oral sex with ejaculation or an HIV+ mother breast feeding to her infant will transmit HIV to the receiving person. On the other hand, if the ones receiving milk/semen are HIV+, then the ones delivering the semen or milk will not get exposed to HIV because saliva is not one of the four infectious bodily fluids (unless there's blood in the mouth). There doesn't have to be a "break" or "tear" in the mucous membrane for HIV to be transmitted. HIV can't get through the skin unless there is a cut or open sore.
In short, any activity that brings one of the four HIV-infected bodily fluids onto a mucous membrane will transmit HIV. Period. There's no low or high risk if the activity meets this criterion. Of course, some activities have higher risks than others e.g. Unprotected anal sex is riskier than unprotected vaginal sex because the mucus membrane covering the anal region has more area of exposure, is extremely delicate/easy to tear, and contains a lot of the cells that HIV likes to infect. However, both activities carry big risks nonetheless. I agree that more people should be educated and aware that a risk is a risk and should take action to protect themselves.
Another thing my teacher helped me appreciate is that condoms can actually provide A LOT of protection from HIV as long as the condom is used properly, is not expired, contains a water-based lubricant, and is made of latex or polyurethane (a rubber-like substance).
Of course, all those public health campaigns stress that abstinence and being faithful to one uninfected partner (get tested together!) ensures better protection than condoms, and all the stuff I said may sound nice but like the blogger said, we're all human beings. I'd like to think that I'm an educated person, but my teacher told me this: there is a huge disconnect between knowledge and actual behavior. I'll admit that I do things I'm told not to do because it's bad for me. But I hope that this information on HIV transmission and condoms can helps a few people. Was this emphasized in the Peace Corps? If not, perhaps this information could be included with your suggestions on how to improve the class. I hope it didn't come off as overly scholarly: it just pains me when America's compassionate and dedicated Peace Corps workers are getting sick overseas when they can prevent that and keep doing the great things they do.
Thank you for reading this!
I haven't read your entire blog, but I've read over 75% of. Thank you for your courage to share this painful experience as to make others aware. But, did I miss the part where perhaps abstinence should be(have been) considered? I know this isn't the "in" idea or thought, but...
ReplyDeleteTo Anonymous above:
ReplyDeleteAlthough abstinence is 100 percent effective in preventing HIV/AIDS sadly, it's not the reality of the world we live in today. We are humans and therefore we make mistakes. In the end I'm sure we all could come up with a mistake that we have made in our lives and debate the should of, could of, and would of's, surrounding the mistake to prevent it if we were given a second chance to do it over again. But without mistakes where would we be in the advancement of our species? From mere science to maturity levels, we have EVOLVED because of our "mistakes". We ARE our mistakes and sadly enough, in Jess's case, without these experiences the stigma of these cases would never be told. In less than 2 months look at how many lives she has touch with her blog...she's reaching thousands.
With that being stated there is no need for judgment but rather support in what Jess is doing here. She's trying to break the cycle...the cycle in which so many of us fall into without knowing the truth. If you want to talk about abstinence BECOMING the reality in preventing HIV/AIDS then by all means, start your own blog about it and stop criticizing others will ya? Thanks;-)
SN: Great Job JESS!
Jess, I just found your blog and have been reading it all afternoon. I also served as a Peace Corps Volunteer in a high-prevelence country and I also was involved in a sexual relationship with a host country national. When I entered my service, I had every intention of remaining abstinent and was openly disdainful of volunteers who weren't (at least with HCNs). As irony would have it, I ended up falling for my best HCN friend. Suddenly abstinence wasn't so appealing. While we used condoms during all sex including oral sex (made easier for me by the fact that he worked as an HIV-educator and expected to use condoms) he was the first guy who I had EVER used condoms with during oral sex. While your blog made me grateful for being vigilant about protection while in Peace Corps, it is also making me look back on risks I took before Peace Corps and vow to be more careful about my sexual relationships back in the US. I do agree that there needs to be more focus on teaching the risks of sexual behavior besides vaginal intercourse. Of course Peace Corps needs to modify their approach, but sex education in the US in general needs to teach that ALL sex is risky, even sex that can't get you pregnant, even in a low-prevelence country like the US. I say this not to be fear-mongering or anti-sex, but because people deserve to have all the information possible in order to make the safest choices. Thank you for sharing your story and for using what happened to you to educate and do good.
ReplyDeleteHi Jessica -
ReplyDeleteI am a PCV and I want to say thank so much for sharing your story! I have read all of your blog and just HAD to comment on this post to say that I'm SO SORRY to you for all of these (anonymous) people who are being so extremely judgmental - in my opinion, you did not make ANY mistakes. We all have the right to have sex! Be it with a "stranger" (as someone erroneously commented earlier - this guy was obviously not a stranger to you, and what difference would that have made anyway as far as his HIV status?) or not. And, as a PCV who has gone through TWO Peace Corps trainings in two different countries, one in Africa, I have to say that until reading your blog, I had NO IDEA that HIV could be transmitted through oral sex. Maybe I just wasn't paying attention well enough, but I would be very willing to bet that the grand majority of Americans (including these lovely people who are taking advantage of their anonymity to put you down and feel better about themselves) aren't aware that HIV can be transmitted through oral sex. And, as you indicated, you didn't (really) know either. Therefore, I think you did absolutely everything right in your situation - no mistakes. Just extreme misfortune.
In any case, I'd like to thank you so much for sharing your story. For me it's always been hard to realize that HIV is a real, live risk in my life (and everyone's) just from looking at statistics, but hearing your story makes it come to life and makes me even more motivated to make sure that I am doing all I can to protect myself (including, now, taking necessary precautions when it comes to oral sex). I am so sorry this happened to you, and I can't express how much I admire your courage for sharing your story. I don't think I could deal with the judgement that you are dealing with, and I certainly couldn't do it as gracefully. I wish you the best in this journey and thanks again.
Jessica, as a former PCV in Zambia myself, I want to once again thank you for your courage & encourage you to keep on sharing, as I know you're making a huge impact on the world.
ReplyDeleteI just wanted to add a thought I had that I think will help people who have never lived abroad the way we did to understand the loneliness and risk-taking that so many of experience. Living in a country like Zambia includes so many extra risks beyond our normal life in the US that risk becomes normalized. Some of the world's deadliest snakes just might slither into your home or toilet at any time. Going outside to the bathroom at night is risking your life, since you might stumble onto one of them. Transportation of any kind in Zambia has a higher danger than in the US, because road safety is much lower. Buses flip and roll often, while trying to meet ridiculous deadlines. Drunk driving is acceptable and the roads are poorly maintained with constant hazards at every turn. Getting to a meeting is a risky behavior. Even just eating at your neighbor's house could give you cholera. Sleeping in your own bed (alone) might make you wake up with malaria, because even with a mosquito net, they can still get in.
So, risking your life becomes a daily activity and you begin to accept it. Combine that with the extreme loneliness and lack of physical contact that PCV's go through & you can begin to understand why it gets easier for us to take sexual risks as well even though we logically know they are risks. Yes, I said us. I am incredibly grateful that this is not my story, but it could have been. Most of the PCV's I know could easily be here as well.
I hope that the people who keep passing judgement will take a minute to consider that you are a human being going through an extraordinarily difficult life event with courage and honesty and you deserve our respect and support, not more difficulty.
In gratitude & much love!