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Case StudiesThese case studies are designed to be completed after you have studied the content in each section, but you can complete them any time you feel ready. Case studies allow you to apply what you have learned in this course to real-world situations. Case Study #1:Ana is a 22-year-old woman who has been married for four years. She has two young children. She knows that her husband has other sexual partners and has recently convinced him to use condoms as a form of birth control because she told him that she would like to wait a while to have another child. She reveals to you that the real reason she wanted to use condoms is to protect herself from STIs (including HIV). Since they have been using condoms, however, her husband has been having problems maintaining his erection during sex. He now refuses to use condoms. The whole problem has gotten so bad that he is drinking a lot and even avoiding sex. Ana is confused and worried that his losing his erection is her fault. She really would like him to use condoms, though. How do you counsel her? Case Study #2:Josephine is a 16-year-old student who has recently been diagnosed with chlamydia. She has a steady boyfriend, and they have never discussed condom use. She knows nothing about chlamydia, including how it is transmitted or how it is prevented. She has heard people talking about AIDS, but she does not know exactly how it is transmitted. She has never considered that she might be at risk for STIs. What stage in the “stages of change” model is Josephine in? How can you help her progress to make changes to protect herself? Case Study #3:Virginia is 25 years old and married to Carlos, with whom she has four children. She got married at 16 and never completed her education. In the past year, there have been strains on their marriage. Carlos maintains strict control over the money in the household, but he has not been able to find steady employment as a laborer. When there is work, Carlos seems happy to provide for the family; however, when he is out of work, he takes what little money there is to spend on alcohol and, Virginia suspects, other women. When Carlos is out of work, he often comes home drunk and demands sex from Virginia. Virginia complies with his demands even if she does not feel like having sex because she believes it is her obligation as a wife. She has been to a health clinic to get a method of contraception. Carlos agreed that it would be a good idea for her to use the pill. About six months ago when she went for a follow-up appointment, the clinic doctor noticed an unusual vaginal discharge and subsequently diagnosed Virginia with an STI. She took medicine to treat the infection but did not tell Carlos for fear of his reaction. She knows that Carlos must have gotten it from one of the women he was with. Virginia has heard that condoms can prevent STIs, but she knows that Carlos would never use one. In fact, if she asked him to, he would be suspicious and defensive, and would, perhaps, accuse her of infidelity. He might even leave her, as he has threatened to do before. While they have their problems, Virginia loves Carlos. He is a good father, especially when he is working. She does not know how she and the children would survive if he left. What are some of the factors
(political, social, gender-related, economic, cultural, biological) that
place Virginia at risk for STIs, including HIV?
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