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Answer to Case Study #2:Nelson is in the “maintenance stage,” according to the “stages of change” model. Nelson should be congratulated and praised for his behavior change. Acknowledge how difficult it is to change a behavior and how many people do not succeed. Acknowledge, too, that Nelson is being caring and protective of himself and his partners by using condoms. If he prevents infection in his casual partnerships, he is also protecting his wife (if he is not already infected). Explore with Nelson if there are any barriers to his continued use of condoms. Is he getting tired of them? Are any of his partners complaining about using them? Is cost a concern? For every barrier that he mentions, work through with Nelson how he could overcome it. For example, if he is getting tired of using condoms, find out if he is using them erotically (i.e., by having his partners put them on for him or making them a part of sex play). Depending on the availability and accessibility of HIV testing services, you might discuss the option of HIV testing with Nelson.
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