Itziana's Story

In 2019, I began interviewing older women about their sexual life stories. In part, I wanted these women to serve as stand-ins for my adolescent patients whose sexual stories were just beginning and whose full journeys I would never know. Itziana is one such patient about whom I wonder, “How has sex and intimacy evolved for her over the years? How has her strength and courage helped her navigate her own sexual life journey?”

Itziana walks into the school-based health clinic looking like an edgy cheerleader in Nirvana’s “Teen Spirit” music video. She wears a maroon letterman jacket with a bullhorn cheerleader patch and a perky high ponytail. But her eyes, rimmed with heavy black makeup, look paradoxically weary and dangerous. She requests an HIV test.

I begin my health screening questions cautiously. Itziana is skittish, like a cat who wants to be touched but may leap away at any second. I do my best to create a safe setting, to convey that she gets to make choices, to impart that she has control. Yet, she declines the blood draw and leaves without receiving the testing she had sought.

A week after her initial visit, she returns. She is an 18-year-old high school junior whose story she tells to me little by little over the next month.

In ninth grade, Itziana had carried a loaded gun to school every day. She had enemies and had needed to protect herself. At just 14-years-old, Itziana was an enforcer, una sicaria, for her gang. Her actions had served to honor the gang’s leader, known as La Lechuza. Itziana says that she encountered this mystical owl of Mexican legend only once. “La Lechuza was talking to me and I turned my head away for a second. I saw a flash, like wings, from the corner of my eye. When I turned back, she was gone.”

Forget the Nirvana music video; now she sounds like a character from an Isabel Allende novel.

During ninth grade, gang violence had not taken her down; despair had. She tells me that three friends had committed suicide that year. The grief and confusion had overwhelmed her like a thick fog. On the day that she lost her third friend, she sat in the spring grasses of a neighborhood park and texted some friends, but no one came. Years later, in my clinic, she revisits this painful moment, staring at nothing. “No one came,” she repeats. Alone in the park, she lost consciousness in a haze of heroin. The next thing she had recalled, she was in a car with men laughing as they raped her. Then, they dumped her in the darkness of the night on the side of the road.

When she had made it home, she told no one. It had taken just a week for her to decide she was done. She had numbly tied a noose and slipped it over her head. But fate had intervened. Her younger sister walked in. As her sister cried and pleaded, awareness came rushing back to Itziana. She had remembered her connections and her responsibility to her family. And so, she promised her sister she would not leave. “I had to figure out how to go on.”

As Itziana tentatively reveals her story explaining why she wants an HIV test, she sits with her torso as rigid and proud as a folklórico dancer. Her words, metered and controlled, divulge no emotion. She watches me intently, silently asking, “Do you believe me? Do you judge me? Will you betray me?” And, I observe myself silently responding in kind. “Do I believe her? Do I judge her? Can I give to her what she seeks?”

I can sense how deeply the HIV test scares her. She wants to know if she carries a viral legacy from the rape or the heroin injections. Yet, since I will be the one giving her the test results, she must vet me. She must determine if I am safe enough to convey news that may make her feel vulnerable.

When I meet her, Itziana no longer uses drugs or carries a gun. Even though, she explains, one can never really leave the gang, she has no active involvement. She has joined the cheerleading squad, where her past remains hidden from others. She hopes to become a surgeon.

Unfortunately, she cannot change her home life. She carries the burden of protecting her family from haunting but nonspecific gang threats. She knows that her father is having an affair. She suspects that her mother, who now attends church almost daily, may know, too. On top of that, Itziana’s younger sister has been diagnosed with schizophrenia. Itziana helps her mostly Spanish-speaking parents interpret the treatment prescribed for her sister by the American medical establishment. Her mother resists, favoring the herbs and rituals from the curandera. Neither modality seems to be helping her sister, who recently threatened to kill Itziana while she sleeps.

During one session, she reveals that she has four male sexual partners. Each enjoys pain and being controlled during sex. Carefully, but without a hint of shame, she tells me that she derives pleasure from hurting them. To me, it makes sense - the rape victim who had power taken from her by male aggressors - now takes control. She hurts back. Yet, this is a person whom I suspect has a history of inflicting final harm to others; she’s the enforcer. How safe are her sexual partners? I learn that she is unaware of the practice of BDSM*: she doesn’t refer to herself as a dominatrix; she has never heard of using a “safe word;” she doesn’t engage in much, if any, negotiation with her partners. In her presence, I search online (on my work computer!) and find a dominatrix who advertises through a sex-positive adult shop. I suggest to Itziana that she email her. She needs someone with more than what I can offer, to help guide her.

On another visit, I learn that her sister has been hospitalized for a psychotic episode. Her parents are separating. She allows me to draw her blood.

On her last visit, I tell her the good news - she has no infections - no hepatitis, no HIV. Her eyes fill with tears. She holds up her hand, indicating she needs a moment, and looks down. After some deep, measured breaths, she soon composes herself. She lifts her head and thanks me softly. Then, quite out of character, she says excitedly, “The dominatrix, she wrote back!” I hear a youthfulness in her voice. When she leaves, she gives me a genuine hug, thanking me once more. And, I never see her again.

*bondage and discipline, dominance and submission, sadism and masochism. BDSM is not necessarily associated with a trauma history.