Who should read this chapter? All parents.

Summary: While the schools and peers are often the source of sex education for many children, some of the difficult discussion subjects that have an important impact on our teens have been ignored or given only superficial treatment. Even if the information is provided to adolescents, the method of teaching may have been ineffective if the teacher feels uncomfortable with the subject matter. It is our job as parents to make sure that our children get the necessary information to make good decisions in their lives. They must not only hear the information, they must deeply understand it so that they can fully understand its importance. Only a parent can do this well. This chapter discusses some of the truly serious topics that teens should understand well.

A parent to teen discussion should include the consequences of sex such as pregnancy and sexually transmitted disease. This is best accomplished with serious role playing to see if they understand the seriousness of their actions.

Have them pretend what it's like to be pregnant. What would they do? Would they consider an abortion? An abortion might just seem like a means of after the fact birth control, but when it is actually your decision to make, it suddenly becomes very serious. Ask them to make a decision about an abortion. They should think about what is about to happen to the fetus. If an abortion is not done, the fetus grows up into a baby and then a person. Make the decision very difficult for them because this is the reality. The decision should be agonizing instead of an easy "fix." When their decision becomes agonizing, they are probably more seriously thinking about the consequences of sex. When they understand this well, their decision making will be improved; more mature and adult-like.

Have them pretend what it's like to get HIV. Imagine what it is like to be sick for long periods of time (like 10 years). Is there a medicine that can cure you? How much does this medicine cost and how long do you have to take it? Will you be able to get medical insurance? If you were an insurance company, would you want to insure someone with HIV? If you were an employer, would you want to hire someone with HIV? Would you want go out on a date or marry someone with HIV? Hopefully, as they answer these questions, they will begin to realize the seriousness of STDs (sexually transmitted diseases). The answers to these questions are listed at the end of this chapter.

I thought only drug addicts and homosexuals could get HIV? Not true. I thought you had to have sex with lots of different partners to get HIV? Not true. Is it possible to get HIV from having sex just once? Yes.

Here's are some good math problems for kids using hypothetical names. When presented as a "math" problem, it may be easier to bring this up as a "math" discussion rather than a "sexuality" discussion. This type of discussion may help to break the ice so that a more open discussion between teen and parent can follow.

RedGirl is 22 years old. Six months ago, she broke up with GreenBoy, her 25 year old boyfriend of 2 years. During the last year of their relationship, RedGirl and GreenBoy have had sex many times. SilverBoy is 19 years old and he is a virgin. After dating for three months, he and RedGirl have sex for the first time. How many different sex partners is SilverBoy exposed to?

You might think that SilverBoy is safe because his only sex partner is RedGirl who's only sex partner was GreenBoy. However, RedGirl does not know that when GreenBoy was 21, he had sex with a prostitute (only once). This prostitute had sex with 1600 "clients" prior to GreenBoy. This means that GreenBoy has been exposed to at least 1601 partners. RedGirl has been exposed to at least 1602 partners. Unknowingly, the first time that SilverBoy has sex with RedGirl, he is exposing himself to at least 1603 different sex partners. This is just as risky as if SilverBoy had sex with 1603 different partners himself.

Oh, by the way, the prostitute's clients each averaged 5 different sex partners and 60 clients had sex with a different prostitute in the past. These prostitutes had sex with 1500 clients each. So actually GreenBoy's single encounter with the prostitute exposed GreenBoy, RedGirl and SilverBoy to at least 98,000 partners ( (1600 X 5) + (60 X 1500) ). Put yourself in SilverBoy's place. Would you have anticipated that having sex for the first time would be so dangerous. If just one of these 98,000 or more persons had HIV, then it is very likely that SilverBoy just exposed himself to HIV. It IS possible to get HIV by having sex just once.

Next math problem example:

OrangeGirl is a 16 year old virgin who knows about the exposure risk that can result from a prostitute. She does not want anything to do with male partners who ever had sex with a prostitute. She has been dating 18 year old BlueBoy for about 10 months. She likes BlueBoy because he never had a steady girlfriend before her. He is kind of a nerd and seems very safe. OrangeGirl is very smart and she decides to ask BlueBoy about his sexual history. BlueBoy has never had sex with a prostitute. BlueBoy had a 16 year old girlfriend named VioletGirl last year but this only lasted for a month because she thought he was too much of a nerd. He admits that he had sex with VioletGirl twice during this time, but this is the only person he ever had sex with before dating OrangeGirl. OrangeGirl believes that she has done a good job of determining that BlueBoy's sexual risk is low. OrangeGirl is very conservative and the couple does not engage in sex. Two years later, BlueBoy and OrangeGirl are still dating each other exclusively. OrangeGirl is now 18 and BlueBoy is a 20 year old college sophomore majoring in science. After a graduation party, BlueBoy and OrangeGirl have sex for the first time.

What is OrangeGirl's risk of contracting HIV? This risk sounds low, but let's look at BlueBoy's sexual history more closely. Recall that two years ago, OrangeGirl was a virgin and BlueBoy's only sexual contact was with the then 16 year old VioletGirl. Three months before dating BlueBoy, VioletGirl had a one night stand with a 21 year old college student named BeigeBoy. VioletGirl never knew BeigeBoy well, but if she did, she would find out that BeigeBoy has had sex with 8 different women prior to his one night stand with VioletGirl. Five of these women have had sex with four other men and each of these men have had sex with three other women. OrangeGirl was careful to minimize her risk of sexual exposure by ascertaining that her partner's previous sexual contact was minimal and avoided any involvement with prostitutes. Without any other information, BeigeBoy has exposed VioletGirl to at least 63 partners. Potentially, the actual number could be more than 100 or 1000. BlueBoy has been exposed to these same 63 or more partners. After being as careful she could, OrangeGirl has exposed herself to at least 63 partners after sex just once with a single "low risk" partner. Unless your partner is truly a virgin, the risk is unpredictable. If only one partner in this chain has HIV, OrangeGirl has potentially exposed herself to HIV.

Role playing is a good way to get them to seriously think about the consequences of sexually transmitted disease (STD). HIV is the most serious STD. Get them to take on the roles of one of the colorful characters above. What would they do? Should they get an HIV test? When will the HIV test turn positive? Is there a medication they can take to prevent HIV? Should a condom have been used? Would they have used a condom? What if the male partner did not want to use a condom? Do condoms prevent the transmission of HIV? If so, how effective is this? If someone gets HIV, can they ever have sex again? Can they have children? Will their children all have HIV? If you or your teen does not know the answers to these questions, then a fully informed decision cannot be made. The answers to these questions must be known by all teens. The answers are listed at the end of this chapter.

After all these questions, they should get the message that sex should be taken seriously. It is OK to discuss the pleasant aspects of sex, so the adolescent is aware that ALL the information is being presented and not just the bad information. It is their decision to make. As much as we would like to, we cannot make this decision for them. It is our job as parents to provide them with as much information as possible so they can make the right decision.

Answers to the questions in this chapter: All parents and teens should know these.

1. Imagine what it is like to be sick for long periods of time (like 10 years). You will be chronically weak and ill. You will not be able to run long distances. You might be able to shoot a basketball if you're lucky, but you won't be able to play a basketball game. You won't enjoy eating. You might have to force yourself to eat or get fed by a tube in your nose. You will have to go to the doctor and hospital frequently. You will need to have blood tests drawn frequently. You will need to take many medications. Most of these medications can be taken by mouth, but many of these may have to be given by injection or through an IV.

2. Is there a medicine that can cure you from HIV? During the time that this book is being written, there has been great progress in the battle against HIV, but currently, there is no cure. Even with all the medications that we have against HIV, many people are still dying of HIV.

3. How much does anti-HIV medicine cost and how long do you have to take it? These medications can cost several hundred dollars per month. Many patients spend thousands of dollars per year on these medications. Currently, patients with HIV have to take these medications for the rest of their lives.

4. Will you be able to get medical insurance? If you are covered by an insurance policy when you get HIV, you can maintain medical insurance coverage under that policy. However, if this policy is through work, will you be able to continue to work if you are very ill and have HIV? Often, you will have to quit your job once you run out of sick leave because you are not able to work. You do have the right to maintain your medical insurance coverage, but you must now pay for it on your own rather than get it through work. Medical insurance plans obtained through your job are group deals negotiated by your employer. The rates for group medical plans are very inexpensive compared to individual medical insurance policies which are very expensive. Most individuals cannot continue to afford to pay for medical insurance once they lose their job.

5. If you were an insurance company, would you want to insure someone with HIV? HIV patients are very expensive to insure. They require lots of medicines, lots of tests, lots of doctor visits and lots of hospital services. Insurance companies lose money on such patients so they are reluctant to insure patients with any type of chronic disease.

6. If you were an employer, would you want to hire someone with HIV? Patients with HIV are frequently too ill to work. An employer would not want to hire someone who cannot work.

7. Would you want go out on a date or marry someone with HIV? You should answer this on your own.

8. What should you do if you think you might have HIV? You should see a physician for an exam and testing. If you prefer not to see a physician, you can go to a testing center that will test you anonymously. However, if your result is positive or negative, you will need some counseling on exactly what this test result means and what you should do about it. Even if your test result is negative, this is good, but you could still have HIV.

9. Should you get an HIV test? If you suspect that you may have been exposed to HIV, you should get a test. The earlier you find out about it, the earlier you can start treatment. It is very likely that early treatment has a better outcome than late treatment.

10. When will the HIV test turn positive? It may take a long time for the HIV test to turn positive. This is why a negative (normal) test is not definite good news. You could have a negative test and still have HIV.

11. Is there a medication they can take to prevent HIV? There are medications that can be taken to prevent HIV, but the effectiveness of these preventive medications is not known at this time. It might be highly effective, but it might only be weakly effective. These medications have significant side effects and can only be prescribed by a physician. It would be better to not expose yourself to HIV in the first place.

12. Should a condom have been used? Yes. Condoms are fairly effective at preventing pregnancy and preventing the transmission of STD. If you plan on having sex and are interested in preventing pregnancy and/or STD, you should speak to a counselor or physician on the different options that are available.

13. Would they have used a condom? You need to answer this.

14. What if the male partner did not want to use a condom? Women frequently get into a situation where their male partner is not willing to use a condom. In this situation women could insist that a condom be used or choose between having sex without a condom or not having sex with this partner. Many males engaging in casual sex who refuse to use condoms can often be characterized as selfish, self-centered, irresponsible, insensitive, vain and poorly informed about the risks of STD. Is this the type of partner that you want?

15. Do condoms prevent the transmission of HIV? If so, how effective is this? When condoms are used properly, they can prevent the transmission of HIV, but no method is 100% effective at preventing HIV.

16. If someone gets HIV, can they ever have sex again? Yes they can have sex again and they will probably infect their partners. Would you like to have sex with someone with HIV even if a condom is used? If you had HIV, would anyone want to be your partner?

17. Can people with HIV have children? Will their children all have HIV? Men with HIV will probably infect their partners. Women with HIV can have children if they are in the early stages of infection and not severely ill yet. Pregnant women with HIV will very likely infect their children with HIV unless preventive measures are taken. There is a way to prevent the transmission of HIV from mother to baby which is why all pregnant women should get an HIV test from their obstetrician. Preventive measures are not 100% and many babies even today are born infected with HIV.