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Answer to Case Study #1:Explain to Rose that she and her husband are experiencing infertility, which is usually diagnosed when a couple does not experience a pregnancy after one year of regular intercourse without using contraception. There are many reasons that people may have fertility problems, some due to problems that the male partner may be experiencing, some due to problems that the female partner may have, and some due to problems in both. Ask Rose what she knows about STIs and HIV, clarifying any misinformation that she might have. Explain to her that if her husband does indeed have other partners, then they are both at risk for exposure to infection. Tell her that condoms are the best way to protect against infection, and that they also will prevent pregnancy. Explain that sometimes people may have STIs that they do not know about because they are asymptomatic. Tell Rose that untreated STIs may lead to complications, including infertility. The pain in her abdomen may be related to an STI, or there may be another cause. If diagnosis and treatment for STIs are available in your facility, recommend that she get a workup to determine if she has any STIs or PID from untreated STIs. If such services are not available, refer her to a location where she can access them. If special services in infertility are available, recommend that she and her husband get workups to determine whether there are hormonal or structural factors related to their problems getting pregnant. Finally, lend support and encourage Rose to talk to her husband about protecting themselves against infection and to discuss the infertility problems that they are having. Offer to see him separately or to invite them back together to talk to you more about their options. Practice communication skills with Rose through role plays with you acting the part of Rose and Rose playing the part of her husband; model ways that she can broach the subject and to better understand how she perceives how her husband may respond.
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