What do you need to know?

First, Mississippi is not a pure no-fault divorce state, meaning one spouse cannot decide on his or her own to end a marriage.

There are 2 ways to get a divorce in Mississippi Chancery Courts.

1. The easiest and quickest way is to get your spouse to agree to the divorce.
2. The other way is to prove fault of a spouse.

For the first way, you and your spouse have to consent to an irreconcilable differences (I/D) divorce, which has 5 requirements. The 5 requirements are:

1. You and your spouse must agree in writing to an I/D divorce and must specifically request an I/D divorce.
2. Your request for an I/D divorce must be on file with your county’s Chancery Clerk for 60 days.
3. You and your spouse must agree in writing to the terms of the divorce OR submit terms to the court acknowledging in specific statutory language that the court’s disposition of terms will be binding.
4. The Chancery Court must approve the terms for the I/D divorce to be valid.
5. All issues must be resolved before an I/D divorce is granted.

If your spouse will not agree to divorce, you must prove one of 12 fault-based divorce grounds. The 2 most commonly-used grounds are adultery and habitual, cruel, and inhuman treatment. Three other grounds are desertion (continuous for one year), habitual drunkenness, and habitual drug use.

Adultery

To prove adultery, a spouse either has to have direct or circumstantial proof.

1. Direct proof is either an admission by a spouse OR testimony from a witness of the sexual act.
2. Circumstantial proof is evidence showing an adulterous disposition (primarily infatuation) AND opportunity to satisfy such infatuation.

Does sex between persons of the same gender constitute adultery?

The Mississippi appellate courts have never addressed this question. However, decisions from other states suggest that sex between persons of the same gender counts as adultery.

Habitual, cruel, and inhuman treatment

Habitual, cruel, and inhuman treatment has 3 elements you must prove.

1. The husband’s or wife’s conduct must place his or her spouse in reasonable apprehension of danger to life, limb or health (physically, mentally or emotionally) OR be unnatural and revolting.
2. The husband’s or wife’s conduct must have a negative impact on his or her spouse’s health.
3. The impact on the spouse must have been caused by the husband’s or wife’s conduct.

Examples of such actions include:

• physical violence,
• verbal or emotional abuse,
• alcohol or drug problems,
• obsessive or addictive behavior,
• failing to assist in any chores,
• lack of affection or emotional support,
• willful failure to support,
• suicide attempts,
• abusive conduct toward children,
• unfounded accusations,
• controlling behavior,
• extreme jealousy,
• statements about a spouse’s undesirability,
• aberrant sexual behavior, and
• refusal to have sex for an extended period of time.

So what really is habitual, cruel, and inhuman treatment?

Is a same-sex relationship considered habitual, cruel, and inhuman treatment of your spouse?

A same-sex relationship may be a factor in finding habitual, cruel, and inhuman treatment. Morris v. Morris, 783 So. 2d 681 (Miss. 2001).

Is cross dressing considered habitual, cruel, and inhuman treatment?

A divorce can be granted based on the fact that the husband dresses in women’s clothing. Cherry v. Cherry, 593 So. 2d 13 (Miss. 1991).

Is watching pornography considered habitual, cruel, and inhuman treatment?

A husband’s use of pornography is not, in and of itself, a basis for divorce. Hodge v. Hodge, 837 So. 2d 786 (Miss. Ct. App. 2003); Tedford v. Tedford, 856 So. 2d 753 (Miss. Ct. App. 2003).

Child Custody

As if figuring out how to get divorced wasn’t difficult enough, add a dispute over custody of the children in the mix and you can have a complicated situation.

A Chancery Court may award any combination of legal and physical custody using 4 presumptions and 12 factors.

The 4 presumptions are:

• Presumption of parental equality
• Presumption that biological parents are best equipped to have custody of children
• Presumption against awarding custody to a violent spouse
• Presumption in favor of awarding joint custody if spouses request joint custody

The 12 factors are:

1. Continuity of care before you and your spouse separated is the most important factor – Person who has been the child’s primary caretaker has a substantial advantage.
2. Gender of the child – Courts are likely to award custody of girls to mother and boys to father.
3. Age of the child – If the child is less than 4, then this factor favors the mother.
4. Preference of a child over 12 is considered
5. Health needs of the child 6. Parenting skills of each spouse
6. Child-care capability/Employment responsibilities of each parent
7. Parents’ physical and mental health and age
8. Emotional ties of parent and child
9. Home, school, and community record of child
10. Moral fitness of each parent
11. Stability of home environment and employment of each parent Albright v. Albright, 437 So. 2d 1003 (Miss. 1983).

Courts may also:

• Try not to separate siblings;
• Consider whether one parent will try to alienate the child;
• Consider whether one parent takes the child to church.

Moral Fitness as 1 of the 12 Factors

How does a person’s sexual orientation affect custody? In 2001 the Mississippi Supreme Court abolished the rule that a parent in a same-sex relationship does not get custody of the children. Hollon v. Hollon, 784 So. 2d 943 (Miss. 2001). Being in a same-sex relationship is now one of many factors courts consider to determine a child’s best interest. The key is whether the relationship has an adverse effect on the children.

In a 2002 case, the Mississippi Court of Appeals reversed a custody decision that placed too much emphasis on a mother’s lesbian relationship; and the Court said,

“it is of no consequence that a mother was having an affair with a woman rather than a man.” Fulk v. Fulk, 827 So. 2d 736, 741 (Miss. Ct. App. 2002) (quoting Plaxico v. Michael, 735 So. 2d 1036, 1039-40 (Miss. 1999). However, if other factors also support denial of custody, an award will be upheld even though the decision was based partly on the existence of a same-sex relationship.

For example:

Custody was properly granted to a father who was married and in a stable home and employment rather than to the mother, who had only part-time income, was beginning a new and uncertain business, was living with a lesbian partner, and planned to relocate. S.B. v. L.W., 793 So. 2d 656 (Miss. Ct. App. 2001).

Custody was properly modified to a father because the mother had lived with three different women in a short span of time, shared a bedroom with her current girlfriend, and watched sexual videos with that girlfriend in the children’s presence. The chancellor found that the mother’s conduct had an adverse effect on the children. Davidson v. Coit, 899 So. 2d 904 (Miss. Ct. App. 2005).

The Court of Appeals emphasized that sexual relationships may not, in themselves, be a basis for custody decisions, but noted that custody may be modified if a relationship is coupled with other behavior that is harmful to a child or if the relationship clearly endangers the child’s well-being.

What about visitation rights for a non-custodial parent in a same-sex relationship?

Custody modification was refused to a father who was in a long-term, same-sex relationship even though the mother was married to an alcoholic ex-felon who repeatedly hit her. However, the father’s visitation rights with the child could not be limited to exclude his long-time partner from the child’s presence.

Weigand v. Houghton, 730 So. 2d 581 (Miss. 1999).

This information is meant solely for informational use and does not constitute legal advice. One should consult with an attorney when dealing with divorce or child custody issues. It was created in the Spring of 2009 by law student Hays Burchfield at the University of Mississippi School of Law under the supervision of Attorney Cameron Abel and Family Law Professor Deborah Bell.

They said researchers had assumed the human immunodeficiency virus, or HIV, sought out beaks in the skin, such as a herpes sore, in order to gain access to immune system cells deeper in the tissue.

Some had even thought the normal lining of the vaginal tract offered a barrier to invasion by the virus during sexual intercourse.

Read the full article at Reuters.

Between men, gonorrhea is transmitted primarily through unprotected anal intercourse and giving oral sex. Gonorrhea can be found in the penis, the rectum and the throat. The Rise in gonorrhea rates among gay men indicates an increase in high-risk sexual behavior. Because of the close link between infection with gonorrhea and HIV, the increase in gonorrhea rates may lead to a subsequent increase in HIV rates and other STDs as well, unless immediate public-health intervention takes place.

Genital/anal warts

Genital and anal warts are caused by infection with the human papilloma virus (HPV). Genital warts on the penis are common in both heterosexual and gay men. However, anal warts in males tend to occur more frequently in gay men. Anal warts are primarily a result of unprotected anal intercourse and direct penis-to-rectum contact during sex.

Hepatitis A

Hepatitis A is transmitted through the oral-fecal route. Sexually, this infection is transmitted by oral-anal sex (rimming). Sexually transmitted hepatitis A tends to occur more commonly among gay men. Outbreaks of hepatitis A among gay men are a recurring problem in many large cities in Western nations. There is now a very effective vaccine to prevent infection with hepatitis A. Unfortunately, despite the higher rates of hepatitis A infection among gay men, most members of the gay community are unaware of this vaccine. Most gay men who are at risk for this infection have never been vaccinated, despite the availability of the vaccine.

In addition to the risks of hepatitis A, rimming may also pose a risk for certain bacterial and parasitic infections, due to potential exposure to feces while rimming is taking place.

Hepatitis B

Hepatitis B is transmitted the same way as HIV, but is much more infectious than HIV. Between men, the infection is most commonly transmitted through unprotected anal intercourse and giving oral sex. Some gay men have been infected through sharing drug needles as well. In Western nations, sexually transmitted hepatitis B tends to occur more commonly among gay men. There is now a very effective vaccine to prevent infection with hepatitis B. Unfortunately, despite the higher rates of hepatitis B infection among gay men, most members of the gay community are unaware of this vaccine. Most gay men who are at risk of this infection have never been vaccinated, despite the availability of the vaccine. A strong effort needs to be made to increase hepatitis B vaccination rates among gay men.

HIV/AIDS

Worldwide, most of the people with HIV and AIDS are heterosexuals. But in North America, Western Europe and other developed nations, most cases continue to be transmitted sexually between men. In the United States, according to a recent report, most cases of recent HIV infection continue to be among gay men. This information also indicates that the rate of new HIV infections is relatively stable (it is not going down). We can therefore assume that the rate of infection among gay men is remaining relatively stable as well. Most cases of HIV transmission among gay men continue to occur through unprotected anal intercourse and, to a lesser extent, through giving oral sex (especially with ejaculation). Some gay men are also becoming infected through sharing drug needles. Based on all available data, the rate of HIV infection among gay men is not going down.

Cancer and the risks of smoking

Gay men may be at increased risk for certain forms of cancer, and illnesses linked to cigarette smoking.

Some cancers are more commonly seen in persons with HIV infection. For example, Kaposi’s sarcoma and certain types of lymphomas are more common in people with HIV. Since HIV is found in higher rates among gay men in Western nations, cancers associated with HIV infection are more common among gay men in these parts of the world.

Some strains of HPV — the virus that causes genital and anal warts (see above) — are linked to certain forms of cancer. When this virus causes cancer in men, it most often causes anal cancer. Anal HPV infection primarily occurs through unprotected anal intercourse, and direct penis-to-rectum contact during sex. Anal cancer occurs more frequently in men with damaged immune systems (including those with HIV). Smoking may increase the risk of cancer as well. HPV on the penis can also cause penile cancers, but this quite rare.

Gay men may also be at increased risk for liver cancer. As stated above, gay men are considered at increased risk for hepatitis B infection, which has been linked to liver cancer and other forms of liver disease (including cirrhosis of the liver).

In addition to anal and liver cancers, gay men may also be at increased risk for lung cancer and other cancers linked to cigarette smoking. It has been suggested that smoking rates among gay men may be higher than the general population. Of course, smoking also has many other health risks, including an increased risk for emphysema and heart disease.

Alcoholism and drug abuse

It has been suggested that alcohol use (and abuse) may be higher among gay men. This may, in part, be related to many gay men meeting in gay bars, where alcohol use is common. Alcoholism is itself a health-care problem since alcohol abuse can also lead to liver disease. In addition, alcohol use (and abuse) can also increase the risk for HIV and other STDs. While under the influence of alcohol, people tend to have sex more often, are less likely to use condoms or are less likely to use condoms correctly.

It has also been suggested that drug abuse may be a significant problem among gay men. Recreational drug use (and abuse) includes the use of poppers, cocaine, speed, crank, marijuana and other drugs. Like alcohol abuse, drug abuse leads to various health problems, including an increased risk for HIV and STDs, due to changes in judgment, while a person is under the influence of these drugs.

Gay bashing and gay domestic violence

These are often not viewed as health concerns, but they should be. Physical violence can lead to bodily harm, trauma, hospitalization, etc. Many gay “hate crimes” never get reported, due to the victims’ fear of further discrimination, shame, intimidation by police and similar concerns. On a related matter, gay domestic violence can also lead to significant bodily harm, and is also very rarely reported, due to victims’ fears of discrimination, intimidation by police, lack of services for male victims of domestic violence, etc. Due to the lack of reporting of these crimes, the rates of gay bashing and gay domestic violence are most likely much higher than statistics indicate.

Mental-health issues

Mental-health issues cannot be ignored. Many gay men suffer from depression and low self-esteem. Gay men live in a world where they are often told they are “bad.” Some gay men are abandoned by their families. Discrimination against gays is all too common. The way that society often treats gay men can lower their self-esteem and lead to depression. For example, suicide rates among gay youth are higher than heterosexual youth. When a person has low self-esteem, they tend to value their life (and their health) less seriously. They are therefore less likely to protect themselves against HIV and other STDs, and other health problems.

Safe sex, as it applies to HIV, is any type of sex which does not let one person’s blood, semen, vaginal fluid, or breast milk get inside another person’s body. Below is a useful set of guidelines produced by the San Francisco AIDS Foundation. These guidelines are useful in preventing transmission of other STDs as well.

• Wet Kissing: is safe unless either of you has a cut or sore in your mouth, or bleeding gums. (After you brush or floss your teeth, wait at least 1/2 hour before kissing.) Blood, not saliva, contains the virus.
• Touching your lover’s breasts is safe. You can lick, suck, kiss and bite them as long as there’s no blood or breast milk. Massage, dry kissing, masturbation (touching yourself), and body-to-body rubbing are all safe.
• Putting your fingers inside her can be risky. To be safe, wear latex gloves. If you use a lubricant, be sure it is water-based. (Oil-based lubricants like Vaseline and hand lotion will damage the latex.)
• Sores or cuts on your fingers, mouth or vagina-or hers- increase the risk. They can provide a way for the virus to get inside you. If you touch her vagina and then touch your own (or vice-versa,) you could spread the virus. Be sure to use gloves!
• Contact with menstrual blood is very risky. If she is infected, her menstrual blood (like other blood) will have a lot of virus in it.
• Oral sex on a woman is risky, especially when she has her period. To make it safe, cover her vulva (genital area) with a piece of plastic wrap. This will keep her fluids out of your mouth. Latex dams-also called “dental dams” – are safe to use for oral sex too.
• Sex toys are safe by themselves, but it is risky to share them. If you share dildoes or vibrators, cover them with a condom and put on a fresh one every time it is used by a different person.
• Getting pregnant can be risky. If you have sex with a man or have a man donate sperm to you, make sure he tests HIV negative at least 6 months after his last possible risk. (All licensed sperm banks test their donors carefully.)
• SM activities are safe if there is no blood involved. If you are piercing each other, clean the needle with bleach between users. Use different razors if you shave each other. Don’t let urine or feces of another person get inside your body.

Source: lesbianSTD.com
Reprinted with permission on 5/16/2006

Health Care

Health care is vitally important to everyone. As a transgender person, it is important that you find a physician that is knowledgeable of transitions and of your needs. Be warned (but not disheartened) that some providers may deny treatment because of their religious background, lack of knowledge or even fear. Do not let this deter you from seeking health care. It is important that you establish a relationship with a doctor that can understand your health-related needs and is willing to work with you to ensure optimized health. You should never be afraid to visit a doctor if you are in need of treatment or examination; your health and livelihood are more important than your own fears or the fears of others.

Health History

Be up front and honest about your health history, especially your transition. Doctors need a clear history of your health to better diagnose, treat, or understand your particular situation.

Hormones

Cross-gender hormone therapy gives desirable physical effects but it is not without risk.

Potential hormone risks include:

• Estrogen has the potential to increase the risk of blood clotting, high blood pressure, elevated blood sugar and water retention.
• Anti-androgens such as spironolactone can produce dehydration, low blood pressure, and electrolyte disturbances.
• Testosterone, especially when given orally or in high doses, carries the risk of liver damage.

Monitoring of hormone therapies and use should be done regularly by doctor and patient. Unsupervised hormones can produce undesired consequences. You should obtain hormones for cross-gender treatment through a licensed physician.

Heart Health

As with any human, trans people are at risk for cardiovascular disease and stroke. Conditions that may increase this risk include smoking, obesity, high blood pressure and even hormone treatments.

Cancer

Hormone-related cancer should be included in your health checkups. Breast cancer and liver cancer are especially but not rarely possible in trans women and trans men face risks of liver cancer from hormones. Cancer may also develop in reproductive organs. FTM may still develop cancer of the uterus, ovaries and breasts. MTF are at a low risk for cancer of the prostate.

STDs and Safe Sex

Safe sex should be practiced by all people including transgender persons. Please follow standard safe sex guidelines to ensure your safety.

Alcohol and Tobacco

Depression (commonly found in LGBT people due to reject and societal pressures) often lead to smoking and alcohol use. As a result, liver, lung and heart disease, as well as cancer, are all risks associated with alcohol and tobacco. Hormone use can actually increase risks of liver damage when used with alcohol. All risks are increased when combined with tobacco use.

Depression/Anxiety

Due to social pressures and family pressures, transgender people may face a higher level of depression and/or anxiety than most people. Post-transition, the risks of being exposed, criticized, and/or ostracized certainly can take their toll. Unchecked depression can also lead to depression before, during and after transition. If for any reason you are feeling anxious or depressed, consult a therapist or your physician immediately.

“Pumping” or Injecting Silicone

Pumping or injecting silicone is very risky and can lead to disfigurement, migration of the silicone, hepatitis and/or HIV/AIDS through use of contaminated needles, and also toxic poisoning due to low-grade, non-medical silicone. Hormones or plastic surgery are the safest options for feminizing the body.

State laws are not clear if a same-sex spouse may adopt his/her spouse’s child.

In general, most legal advisors recommend gay and lesbian couples execute common legal documents for protection.

Below, you will find the common legal documents that are recommended for LGBT couples:

• Power of Attorney for Health Care.
• Living Will or Advance Directive .
• Power of Attorney for Finances.
• Medical Emergency Card.
• Relationship Agreement.
• Will.
• Funeral Arrangements.
• Living (Revocable) Trust.

Power of Attorney for Health Care

A power of attorney for health care decisions allows you to appoint another person to make health care decisions for you in the event you are mentally or physically unable to make health care decisions yourself. Unless you limit your agent’s authority, your agent has authority to stop your doctor from giving you treatment, or stopping treatment to keep you alive. Chose a person you believe has the same or similar views as you do on health care treatment, and in continuing or discontinuing treatment if you have a terminal illness.

Sample Document

Living Will or Advance Directive

An advance directive tells your doctor what kind of care you would like to have if you become unable to make medical decisions (if you are in a coma, for example). If you are admitted to the hospital, the hospital staff will probably talk to you about advance directives.

A good advance directive describes the kind of treatment you would want depending on how sick you are. For example, the directives would describe what kind of care you want if you have an illness that you are unlikely to recover from, or if you are permanently unconscious. Advance directives usually tell your doctor that you don’t want certain kinds of treatment. However, they can also say that you want a certain treatment no matter how ill you are.

Sample Document

Power of Attorney for Finances

A legal document that gives someone authority to manage your financial affairs if you become incapacitated. The person you name to represent you is usually called your agent or attorney-in-fact.

Medical Emergency Card

In an emergency, getting vital health information to medical personnel quickly may be critical. Carrying a medical emergency card keeps your important personal profile with you at all times. A medical emergency card may detail allergies, previous medical conditions, etc.

Relationship Agreement

These are written agreements between people in a relationship setting forth how you will handle money and the ownership of property as well as how to handle debts. This agreement must be kept separate from any agreement with regard to sexual matters.

Three basic frameworks are (1) “Share everything”; (2) “Everything Separate”, and (3) “Some sharing and some separate”.

These are not the only models, but the most frequently found patterns. It is important that such agreements be in writing. Verbal agreements might seem “nicer” but memories change in time and usually verbal agreements lead to disagreements and arguments.

Will

A document in which you specify what is to be done with your property when you die and name your executor. You can also use your will to name a guardian for your young children.

Funeral Arrangements

LGBT partners may be excluded from making funeral arrangements by family members. This discounting of relationships can have a tremendous, painful effect on the gay men or lesbians involved. It is important to make specific arrangements for your funeral if you wish to have it executed properly and as you wish.

Living (Revocable) Trust

A living revocable trust (or lifetime trust) is used to avoid the probate process upon your death. By placing all of your assets in trust, all of the assets will automatically pass to the beneficiaries upon her death. With a will, the executor must submit the will to the local surrogate’s court to prove the validity of the will, get named executor by the court, and then proceed to distribute the assets as per the will. A living trust is another way to protect your assets in the case of your death.

• Allergic Vaginitis
• Bacterial Vaginosis (BV)
• Chlamydia
• Gonorrhea
• Hepatitis
• Herpes (genital)
• HIV/AIDS
• Human Papillomavirus (HPV)/Genital Warts
• Pelvic Inflammatory Disease (PID)
• Pubic Lice
• Scabies
• Syphilis
• Trich
• Yeast Infections (Candidiasis)

Allergic Vaginitis

Sometimes referred to as ‘chemical vaginitis,’ this condition is a great mimicker. Because it often affects not only the vagina itself but external tissues (the vulva), it is often mistaken for a yeast infection, or even new onset genital herpes. It’s due to genital contact with an irritant, the most common offending agents being latex or components of spermicides, lubricants, a new detergent/soap/bath gel, silicone sex toys, or ‘feminine’ deodorants. Anything that can cause an allergic skin reaction (like a rash) can cause a similar reaction on mucous membranes, including genital tissues.

• Symptoms: red, painful or irritated or itching vulva; increased vaginal discharge. The vulva may have whitish or grayish striations or hue, along with some scaly skin.
• Treatment: if you can figure out the offending substance, discontinue use. Antihistamines (Benadryl for example) may help relieve symptoms. Low-dose (0.5%) cortisone cream is also effective, but consult your health care provider before applying any steroid cream to the genital area.

Bacterial Vaginosis (BV)

BV is basically an imbalance of the normal bacteria that live in the vagina, most specifically in association with loss of the normal protective lactobacilli that normally live there in abundance. It is not clear what precisely causes BV; some researchers think women sex partners may actually transmit some undefined factor that causes it. Research continues on this question. We do know douching is a risk factor for BV (and douching is a bad idea in general). Join our BV study and help us find out what is up with this common condition!

• Symptoms: gray to yellowish homogenous discharge, sometimes with a fishy odor, sometimes causing vulvar &/or vaginal irritation.
• Transmission WTW: not clear. While one research article called BV a “STD among lesbians,” this has yet to be proven, and research is underway to look at this more closely. Whether or not partners should be evaluated or treated is not yet known.
  Join our new BV study! See Research for more information.
• Treatment: antibiotic vaginal cream or oral medication (metronidazole or clindamycin). Over the counter lactobacilli supplements do not contain the specific kind of bacteria needed to replenish the vagina’s natural balance.

Chlamydia

This STD is caused by bacteria transmitted to the vagina or rectum by contact with infected genital fluids. Chlamydia can infect the cervix, rectum or urethra (the passage through which urine exits the body) in women.

• Symptoms: usually none. Sometimes slightly increased vaginal discharge, spotting, burning with urination, abnormal bleeding (especially after penetration).
• Transmission WTW: theoretically possible but not yet studied.
• Treatment: oral antibiotics.(Azithromycin, Doxycycline. Pregnant women: Amoxicillin or erythromycin) All partners should be treated.

Gonorrhea

This STD is caused by bacteria transmitted to the vagina, throat or rectum by exchanging infected genital fluids during sex.

• Symptoms: often none. Occasionally, vaginal discharge—often yellow or yellow-green—and painful urination can occur, as can abnormal bleeding, especially after penetration.
• Transmission WTW: theoretically possible but not yet studied.
• Treatment: Antibiotics (oral:Cefixime, Ciprofloxacin, or Ofloxacin OR Ceftriaxone injection) Persons infected with gonorrhea are also treated for chlamydia. All partners should be treated.

Hepatitis

Inflammation of the liver. Many potential causes, including drugs, toxins and viruses. Hepatitis A, B, & C are the three major viruses that cause hepatitis.

• Symptoms: Often none. If symptoms do occur may include yellowing of skin & eyes, loss of appetite, nausea, stomach pain, extreme tiredness.
• WTW transmission: Hepatitis A is transmitted by fecal matter either in contaminated food or by oral-anal contact. Transmission between female partners has been reported.
  Hepatitis B is transmitted by exchanging blood or body fluids. Touching an infected person’s open sore or cut if you yourself have any skin breaks, or sharing a razor, toothbrush or nail clipper, can permit transmission. Even small amounts of blood or other body fluids can spread the virus if direct contact occurs. *Hepatitis A is preventable by vaccination: ask your health provider!
  Hepatitis B is not spread by food, water or casual contact. Transmission between female partners has not been studied, but has occurred. *Hepatitis B is preventable by vaccination: ask your health provider!*
  Hepatitis C is transmitted primarily through contact with infected blood. Sexual transmission between men and women is relatively uncommon; WTW has not been studied.
• Treatment: A complex issue. See our links for more information. .

Herpes (genital)

These infections are caused by the herpes simplex viruses (HSV-2 and HSV-1). Transmission can occur even when lesions are not present (in fact, probably most transmission actually occurs in the absence of skin ulcers or breakdown, which is why 90% of persons infected with HSV-2 don’t know they’re infected). See our Links for several excellent resources on this common infection.

• Symptoms: small blisters on the vulva, often painful, are classic, but at least 90% of people infected with HSV-2, which causes the majority of genital herpes, do not know they are infected. Itching is a common symptom. In the initial episode of HSV, symptoms can include painful/difficult urination, fever, swollen lymph nodes, and flu-like symptoms.
• Treatment: three antiviral medications (acyclovir, famciclovir, valacyclovir) are now available & all work equally well. Antivirals are also recommended for recurrences and suppression when there are more than 6 recurrences a year. Antivirals help the symptoms of HSV and speed healing; they do not cure the virus. They also reduce the likelihood that HSV is shed in the absence of outbreaks.
• Transmission WTW: very likely occurs, but data on specific prevalence and risks is very limited. In particular, oral-genital contact (oral sex) can transmit HSV-1 from the mouth to the genital area, especially when one partner has a cold sore.
• Precautions: because transmission can occur even when no lesions are present, any genital-genital contact should involve latex barriers 100% of the time; couples should abstain from sex during outbreaks, until the skin is fully healed.

HIV / AIDS

AIDS is caused by the HIV virus. It is spread through direct contact with blood, semen, vaginal fluids, or breast milk, usually during sex, birth, or sharing needles. The HIV virus slowly attacks white blood cells which constitute a major part of the body’s immune system. White blood cells fight infections. When the immune system is weak, harmful germs & infections take over, and AIDS (acquired immunodeficiency syndrome) becomes evident.

• Transmission WTW: while there is little research or documentation on this topic, the medical literature does have case reports of WTW sexual transmission of HIV. The most likely sources for transmission are menstrual blood, vaginal discharge when there is vaginitis (there are more white blood cells containing HIV present then), and traumatic sex practices. However, more research is urgently needed in this area; none of these mechanisms, or their relative risk, have been directly studied yet.
• Prevention: Please see Practices section.
• Treatment: There are numerous drug therapies to help the immune system and fight the HIV virus, though at this time there is no cure. Treatments are constantly changing so for the most up to date information we suggest visiting the San Francisco AIDS Foundation website and The Body website.

Human Papillomavirus (HPV)

HPV is probably the most common STD (some estimates say ~70% of all adults have evidence of previous infection), with most infected people never evidencing its two major effects: genital warts, and cervical neoplasia (pre cancerous or cancerous changes, detected as an abnormal Pap smear). It is an STD caused by skin or mucous membrane contact with an infected person. Different strains of HPV cause genital warts and cervical cancer.

• Transmission WTW: very likely occurs, probably through direct contact of genital skin, or contamination of hands/fingers. The role of insertive sex toys is not known for sure, but it’s possible that HPV could be transmitted on shared toys not thoroughly cleansed between use in one (infected) partner and the next.
• Treatment: if warts are present, the most common treatment is freezing using liquid nitrogen; more than one treatment may be required. There is no cure for the virus itself. Pap smears can detect HPV and cervical changes ; yearly exams are essential for all sexually active women, regardless of the gender of partners. Our research and others has shown that lesbians may be less likely to get Pap smears as frequently as they should. Get routine screening (every 1-2 years, depending on your Pap smear history) regardless of whether you have sex with men!

Pelvic Inflammatory Disease (PID)

An infection of the uterus, fallopian tubes and ovaries. Caused by many kinds of bacteria, but chlamydia and gonorrhea are the most common causes. It can also occur after childbirth, abortion, or surgery on the female organs. The infection usually starts 2 to 21 days after having sex with an infected person, but some infections do not start until several months later. PID can cause scar tissue that can block fallopian tubes causing infertility (after 1 PID infection 10% of women become infertile; 75% are infertile after 3 infections), tubal pregnancies (a woman is 7 times more likely to have a tubal pregnancy after PID), and abcesses. Some women continue to have lower abdominal pain for several months after PID.

• Symptoms: Mild to severe abdominal pain, back pain, may have fever, nausea, bleeding between periods, pain with sex, vaginal discharge. Some women have no symptoms.
• WTW Transmission: Transmission of the bacteria that cause PID is theoretically possible though not studied. A recent report did discuss PID occurring in two lesbians, in whom the diagnosis was initially missed because they were thought to be at ‘low risk’ for STD.
• Treatment: Mild PID is treated with a shot of antibiotics in addition to oral antibiotics. Severe PID is treated in the hospital with IV antibiotics. Routine treatment of sex partners.

Public Lice / “Crabs”

“Crabs” There are 3 kinds of lice that can live on humans: head lice, body lice, and pubic or crab lice. Lice move relatively slowly and cannot survive more than 24 hrs. without human contact.

• WTW Transmission: Absolutely! Any close contact w/ an infected person or their clothes or bed linens can allow for contact, so sex partners are at very high risk. However, you might be relieved to know that lice cannot hop or fly.
• Symptoms: Itching, finding nits or lice.
• Treatment: Special shampoos, cream rinses & lotions (obtained by prescription). All partners for the last 30 days must be treated. For washable clothing and bedding use HOT cycle of washer and dryer. Dry cleaning or keeping items isolated from body for 10 days will also kill lice and eggs.

Scabies

A skin infestation by mites (tiny bugs). Mites likes to burrow in warm moist places like between fingers/toes, the wrist, armpits, breasts, skin folds, and waist. The female mite gives off a chemical as it burrows under the skin. This chemical, not bites, is what causes the itching.

• Symptoms: Itching, especially at night. The first time a person gets scabies it takes 2-6 weeks for the itching to start. The second time a person gets scabies the itching starts in 1-2 days. Scabies can mimic other skin rashes and look differently on different people. Test for scabies is a small skin scraping for microscopic examination.
• WTW Transmission: Yes. Primarily by close contact, including sex, with an infected person. Mites can live a couple of days in fabric and dust. An infected person can transmit scabies even if they have no symptoms.
• Treatment: 5% permethrin cream (not the 1% used for lice). Be sure to put some lotion under finger and toe nails. All sex partners, close contacts, and anyone else living with you within the last month should be tested and treated. You may have to be treated more than once. Itching may continue for a few days even if the mites are dead, though it should lessen. For washable clothing, bedding, towels, rugs and toys use the HOT cycle of washer & dryer or dry clean. Things that can’t be washed in hot water can be placed in plastic bags and sealed for 3-4 weeks.

Syphilis

An STD caused by a spirochete that is usually detected with a blood test. Some of its most devastating effects occur when it is transmitted from a pregnant woman to her fetus.

• Transmission WTW: unknown, but theoretically possible. Contact with the sores or rash of an infected person during sex is the main mode of transmission.
• Symptoms: 10-90 days after sex a painless single sore appears in the area where contact was made. The sore “chancre” usually feels hard at the edges. It does not hurt. It can look like herpes, warts, scabies or hemorrhoids. The sore is very contagious. After 2-6 weeks the chancre goes away. If untreated, 6-8 weeks later, the second stage begins in about 30% of persons. Symptoms can last from 2 weeks to 6 months and include swollen lymph nodes, rashes, or a flu-like feeling. There may be different genital sores that look like flat grayish warts. Like other syphilis sores, these are highly infectious and can spread the disease. Symptoms start to go away in 2 weeks. Infection untreated beyond this point can eventually cause serious damage to the heart, nervous system, kidneys, eyes, and brain.
• Treatment: Penicillin injection, routine treatment of sex partners.

“Trich”, a tiny protozoa, can present like BV but in contrast is definitely an STD. It lives in the moist areas of the genitals of infected people (e.g. vaginal fluid, genital glands).

• Symptoms: Often causes foamy discharge with foul odor, but symptoms may be absent. Painful urination, itching or irritation are sometimes present. If symptoms occur, they usually occur 4-20 days after infection but can begin much later.
• Transmission WTW: clearly documented, and probably underestimated. Partners should absolutely be evaluated and treated. Both partners should abstain from sexual activity until treated.
• Treatment: metronidazole in a single dose. Partners should be treated.

Yeast Infection

This infection, also known as candidiasis, is caused by a yeast overgrowth which disrupts normal vaginal flora. Certain yeast (candida) normally live in the vagina in relatively low numbers without causing a problem.

• Symptoms: burning &/or itching of the vulva, vagina; thick white discharge with cottage cheese appearance; possible yeasty odor.
• Transmission WTW: unknown, but not considered an STD in heterosexual couples.
• Treatment: anti-fungal creams, suppositories, or oral anti-fungals (tablets).
• Note: While recurrent or difficult-to-treat yeast vaginitis usually occurs in completely healthy women, occasionally it may be indicative of diabetes (undiagnosed or uncontrolled), HIV infection, or genital herpes, and should be fully evaluated — consult your healthcare provider.

Many authors and theorists have written about the Coming Out process. There are many models and many different stages proposed. What follows is a good basic model for this process.

Self-Recognition as Gay

More than just an awareness of attraction to members of the same sex, it involves confusion, some attempt at denial and repression of feelings, anxiety, trying to “pass,” counseling, and often religious commitment to “overcome” sexuality. Eventually, acknowledgment and acceptance of one’s sexual orientation develops. There may be some grief over “the fall from paradise” and feelings of loss of a traditional heterosexual life.

Gay and lesbian people may be fairly closeted at this point. However, most seek out information about being gay.

Disclosure to Others

Sharing one’s sexual orientation with a close friend or family member is the first step in this stage. Rejection may cause a return to the Self-Recognition stage, but positive acceptance can lead to better feelings of self-esteem. Usually disclosure is a slow process.

Some gays and lesbians come out in “gentle” ways, admitting they are gay if asked but not volunteering it. Others do it in “loud” ways, proclaiming their sexuality to others to end the invisibility of being gay. As this stage progresses, a self-image of what it means to be gay develops, and the individual studies stereotypes, incorporates some information about gays while rejecting other information.

Socialization with Other Gays

Socializing with other gays and lesbians provides the experience that the person is not alone in the world, and there are other people like him or her. A positive sense of self, indeed pride develops, and is strengthened by acceptance, validation, and support. Contact with positive gay or lesbian role models can play a big role in this stage.

Positive Self-Identification

This stage entails feeling good about oneself, seeking out positive relationships with other gays or lesbians, and feeling satisfied and fulfilled.

Integration and Acceptance

Entails an openness and non-defensiveness about one’s sexual orientation. One may be quietly open, not announcing their sexual orientation, but available for support to others nonetheless. Couples live a comfortable life together and generally seek out other couples.

Openness is often mitigated by age. Older men may be less open in their lives, and may see no need to change. Younger men may be more open, politically active, and visible in the gay community.

Credit: Richard Niolon, Ph.D.

Below are some tips that may help make it easier.

Pick a Good Time

Don’t Come Out in an argument, or at a time when you feel angry or resentful. The message will be delivered to family in a time of bad feelings and will convey those bad feelings, making the process more difficult for you and your family in the long run.

Give them time to get used to it before you introduce them to your boyfriend or girlfriend. They may be willing to accept your “friend” more readily and more easily if the sexual nature of your relationship is not so quickly and constantly apparent. Let them see that your “friend” cares about you, knows you well, treats you well, and wants you to be happy just like your parents do. That is what you ultimately want them to know about your partner, not that they are sexually active.

It Takes Time

Understand that it takes time for them to accept this about you, just like it did for you. Your family will go through periods of rejection, acceptance, and then rejection again before they come to accept you for who you are and understand something of what it means to be gay or lesbian. If you are Coming Out to them, you’ve had more time to deal with this than they have.

Encourage Your Parents to Come Out

Suggest that they share this with a friend; you needed to come out to others for support, and they will need to do this too. Having a list of phone numbers, such as one for PFLAG (Parents and friends of Lesbians And Gays) could help too.

Consider having a “family contact” person. Sometimes a parent will be hurt that they were not the first to know. However, both you and your parents may benefit from having someone in the family to talk to about the issue, how the “Coming Out” went, and how things are going after. An aunt or uncle, sibling, or grandparent may help out tremendously.

Be Prepared and Patient

Be prepared for negative responses, religious fears, and suggestions for therapy. Often, when faced with some stressor we can’t handle easily, we wish that it would just change. This is something you may have gone through as well; you may have just “wished” to be straight. It is natural that when faced with the loss of the child they thought they had, the likelihood of grandchildren they dreamed of, and other fantasies your parents had for you, that they too will experience some shock and wish things would simply change and go back to “how they used to be.”

Consider how the “Worst Case Scenario” might go. Coming Out is hard enough as is; if you need your parents’ financial and emotional support and are really scared they would “cut you off” if you came out, then wait until you can tell them with less fear and anxiety. This may sound like “hiding,” but it’s not.

There’s no reason why you can’t build up a network of friends and other family who will be supportive of you and provide some “emotional backup” to get ready for and recover from a difficult Coming Out to family.

Be Ready to Teach

Explain that your sexual orientation is a biologically based thing, and you can’t control it any more than they can control their own sexual orientation. Being gay or lesbian isn’t their “fault” and does not result from something they did “wrong.”

Some parents suggest therapy. There are many who claim to do “reparative therapy,” and even some crackpots in the media, like the infamous “Dr. Laura,” who claim that such therapy is effective and necessary for happiness. It is not effective, and no sound scientific data has ever been gathered and confirmed to support this kind of “treatment.” The American Psychological Association has published a statement indicating that offering therapy to “correct” someone’s sexual orientation against their will is unethical. Often these groups of “recovered” gays and lesbians are simply made to feel very, very guilty about their sexual and intimacy needs. They simply focus on trying to deny all sexual aspects of their being, try to conform to heterosexual lifestyles and expectations, and avoid “relapse” through weekly religious “support groups” where a lot of hush-hush sexual activity goes on after hours.

When your parents read about how to talk to you about difficult issues, including potty training, sex, and marriage, they were told to use the same language they wanted you to use. Be patient as your parents learn to use the language you teach them. Explain the terms “gay” and “lesbian” as opposed to “homosexual” and “queer.” Allow them to refer to your partner as a “friend” for a while until they grow comfortable with “boyfriend” or “girlfriend.”

Be ready to talk about AIDS. While your parents may not be ready for any real details, and they may not ask for fear of finding out information they don’t think they can handle, they do need to be assured that you are safe and have tested negative. Of course, if you are positive, lying to your family at the outset may not be recommended. Be ready to discuss the issue as much or as little as your family wants.

Some people have a book or something for reading materials ready to give parents. It’s a nice way for them to be reminded gently about something they must learn about, and allow them to read and think about it at their convenience.

Explain Why You Are Coming Out

Explain that you are telling them this because you love them and don’t want to be dishonest with them. Tell them to that you are not alone, and that you have gay and lesbian friends for support too. Sometimes parents react with worry about their children; they know it is an unfair world out there. Assure them that while you know there is discrimination, you stick up for yourself and can handle what comes to you as a result of your decision to be what you are.

Sometimes helping parents understand the burden of being closeted, the stress it creates, and the ultimate separation from family that many gays and lesbians accept or suffer with helps. Urvashi Vaid, a spokeswoman for gay and lesbian rights, once said that her mother asked her why she had to be so open about her sexuality, and why it couldn’t just be a private thing. She explained that Coming Out was as much a political act as a personal one.

Coming Out lets others know that gays and lesbians exist around them; we are to a large extent an “invisible minority.” Coming Out makes us visible, and gives others the chance to be aware of and work through their own biases, to see the discrimination in the world, and to consider these issues on their own before being confronted with them somewhere else by someone else in a less understanding fashion.

Finally, some cautions should be offered on Coming Out. While it is in many ways a liberating process to acknowledge who you are to others and receive some support and validation for just being you, there are a lot of prejudiced people in the world. Some would hurt you, insult you, and generally go out of their way to make you unhappy if they know you are gay or lesbian.

Why do they do this?

Lots of reasons.

Personal discomfort is likely the top reason. People who feel bad about themselves often need an “Us” and a “Them” to organize their world. The “Us”‘s are invariably good, moral, smart, wise, good looking, and generally the backbone of the society. The “Them”‘s are bad, immoral, ugly, stupid, and the downfall of society. Simply put, being so sure that you are “sick” and immoral makes me feel healthy and righteous.

This can lead to violence, or “Fag Bashing.” Some people feel very threatened by their emotional and possibly sexually-tinged attachment to others of their own sex. Seeing you appear so comfortable expressing those feelings often makes them suddenly aware of feelings they would not like to admit to having. “Silencing” you silences the thoughts they don’t want to consider.

Overall, Coming Out is a normal process that is crucial to accepting who you are and feeling good about yourself. You can be more “Out” in some settings than in others, Come Out in different ways to different people, and expect it sometimes to go well and sometimes to go badly. It is a significant part of the process of identifying and becoming closer to your friends and loved ones.

You may also be interested in reading “The Stages of Coming Out.”