UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 1...

UIC / HBHC TreatmentAdvocacy Program

Main MenuBasic Safety SkillsTAP: Sexual Safety 1. 12/9/03 1

The University of Illinois at ChicagoThe University of Illinois at ChicagoHoward Brown Health Center Howard Brown Health Center

Treatment Advocacy ProgramTreatment Advocacy Program

Sexual Safety Visit 1Planning for Sexuality &

Intimacy

Open



Module; Goals

Your sexual values and goals Your sexual values and goals

Issues that are most important for Issues that are most important for youyou in sexuality, intimacy and in sexuality, intimacy and safetysafety

Your concerns about sexuality, Your concerns about sexuality, intimacy and safetyintimacy and safety

Plans you might want to make for Plans you might want to make for sexual safety and intimacysexual safety and intimacy

Today we will discuss:Today we will discuss:



HIV Information

Before we begin…what questions do Before we begin…what questions do you have about:you have about:

Click for HIV information

HIV / AIDS?HIV / AIDS?HIV infection?HIV infection?HIV treatments?HIV treatments?This program?This program?



Continuing Safety: Super Infection

You can be infected with a whole new strain of HIV

Makes your HIV drugs less effective Makes your HIV drugs less effective

Makes your treatment very difficultMakes your treatment very difficult

Even though you are HIV+, sexual safety is still important:

The new strain would be resistant The new strain would be resistant to your current HIV drugsto your current HIV drugs

It may be resistant to other drugs It may be resistant to other drugs



Continuing Safety: Other STDs

Contracting a new STD (like syphilis

or gonorrhea)…

Increases your viral loadIncreases your viral load

Makes your HIV harder to controlMakes your HIV harder to control

Makes you more likely to infect othersMakes you more likely to infect others

Being HIV+ makes a new STD harder Being HIV+ makes a new STD harder to treatto treat

Sexual safety is still important:



Continuing Safety

STDs are common in infected STDs are common in infected men:men:

Half of recent Chicago syphilis Half of recent Chicago syphilis cases are in HIV+ MSMcases are in HIV+ MSM

HIV infections are increasing among HIV infections are increasing among gay / bi mengay / bi men

New HIV infections doubled between New HIV infections doubled between 1998 and 20011998 and 2001

Sexual safety is still important:Sexual safety is still important:



Continuing Safety: Drug Resistant Strains

You can transmit drug resistant You can transmit drug resistant HIV to others by unsafe sexHIV to others by unsafe sex

HalfHalf of new infections are resistant of new infections are resistant to an HIV drugto an HIV drug

As much as 1/3 may be resistant to As much as 1/3 may be resistant to more than one HIV drugmore than one HIV drug

Infection with a drug resistant strain Infection with a drug resistant strain can be much more difficult to treatcan be much more difficult to treat

Sexual safety is still important:Sexual safety is still important:



Safety: Bottom Line

Bottom Line:Bottom Line:Safety is still importantSafety is still important

To protect your partnersTo protect your partners

For your For your ownown protection protection

We are here to help infected men We are here to help infected men remain safe and develop intimacyremain safe and develop intimacy



How has being infected changed your relationship(s) or sex life?

Sexuality and Intimacy, 1

Let’s begin by talking about sexuality and intimacy

Dating & sex?Dating & sex?

Feelings about yourself?Feelings about yourself?

Feelings about your partners?Feelings about your partners?

Steady relationships?Steady relationships?



Personal concerns

What are your personal concerns about sex and safety?

How often do you think about safety?How often do you think about safety?

What risks -- to yourself or your partner What risks -- to yourself or your partner -- worry you?-- worry you?

What would you gain by being safer?What would you gain by being safer?

What would you lose by being safer?What would you lose by being safer?



Sexuality and Intimacy

New or more partners?New or more partners? Fewer partners?Fewer partners? More intimacy or closeness?More intimacy or closeness? Keep partners safe?Keep partners safe? Avoid new STDs?Avoid new STDs? Talk about HIV with partners?Talk about HIV with partners? Anything else?Anything else?

How would you like your sex life How would you like your sex life to be different?to be different?



Sexuality and Intimacy, 2

How satisfied are you with your relationships or dating?

What is going well?What is going well?

What would you like to What would you like to see different?see different?



Recent sexual patterns

Now let’s discuss what has been Now let’s discuss what has been happening in the recent past.happening in the recent past.

This will help us plan for safety & This will help us plan for safety & intimacy.intimacy.

We have discussed your sexual We have discussed your sexual concerns & possible changesconcerns & possible changes

Cite concerns / changes



Coping With Sexual Safety

How are you handling sexual How are you handling sexual safety now?safety now?

Not having sex? Not having sex? Steady, safe relationship?Steady, safe relationship? Only HIV+ partner(s)?Only HIV+ partner(s)? Negotiating condoms with partners?Negotiating condoms with partners? Disclosing HIV status to partner(s)? Disclosing HIV status to partner(s)? Avoiding alcohol or drugs + sex?Avoiding alcohol or drugs + sex? No real plans?No real plans? Anything else?Anything else?



Personal Risk Review, Behaviors

Any that were HIV negative?

Any whose HIV status you did not know?

Unprotected anal sex?

Unprotected vaginal sex?

Sex + drugs or alcohol?

Shared injection needles?

Over the past 3 months or so:Over the past 3 months or so:How many different sex partners How many different sex partners have you had? have you had? (3 months..)(3 months..)



Personal Risk Review, risk estimations

HIV negative partner(s)HIV negative partner(s)

Unprotected anal, HIV- / ? partnerUnprotected anal, HIV- / ? partner

Unprotected anal sexUnprotected anal sex

Partner(s) whose HIV status youPartner(s) whose HIV status youdo not knowdo not know

High on drugs - alcohol during sexHigh on drugs - alcohol during sex

Unprotected vaginal sexUnprotected vaginal sex

Sharing injection needlesSharing injection needles

Other risks:Other risks: ___________________ ___________________

Let’s talk about how you Let’s talk about how you personally view different personally view different possible risks…possible risks… For “low” For “low”

ratings:ratings:

What What makes makes

these low these low risk?risk?

How risky (for you or your partner) is: Low moderate high



Personal Risk Review, personal risks

Are you comfortable with these risks?Are you comfortable with these risks?

So… the things you consider So… the things you consider personally risky are..personally risky are.. Cite high / mod. risks

Of the behaviors you consider risky…Of the behaviors you consider risky…

……which do you actually do?which do you actually do?



Personal Risk Review, risk attitudes

What makes your risky behaviors What makes your risky behaviors more likely?more likely?

Moods or feelings?Moods or feelings?Alcohol or drugs?Alcohol or drugs?

Other things?Other things?

Partner(s)?Partner(s)?

Certain…Certain…



Moods & Risk Screen

How much do negative moods or How much do negative moods or feelings…feelings…

Disrupt your life?

Interfere with taking your meds?

Make you less sexually safe?

Keep you from having relationships or sex?

0 1 2 3 4none at all a little some a fair amount very much

Your moods in generalYour moods in general



Places & partners screen


How much do you find that some How much do you find that some places or times just make it difficult places or times just make it difficult to stay safe?to stay safe?

0 1 2 3 4not at all a little some a fair amount very often

How often do partners make it How often do partners make it difficult to stay safe?difficult to stay safe?



Condom hassle

How much is the hassle of How much is the hassle of using a condom an issue for using a condom an issue for you?you?

Thinking generally:Thinking generally:

How so?How so?



Recent Risk Analysis, Basic Skills


How about using female condoms?How about using female condoms?

How much do you avoid condoms How much do you avoid condoms because of the hassle of using because of the hassle of using them?them?

Click for Basic safety skills

How comfortable are you in putting How comfortable are you in putting on & using condoms?on & using condoms?

Or return Or return to skills to skills later..later..



Attitudes screen

Tired of safe sexTired of safe sex

Intimacy is more important than safetyIntimacy is more important than safety

HIV meds make safety less importantHIV meds make safety less important

Your partner is responsible for his/her Your partner is responsible for his/her own safetyown safety


How much do your attitudes How much do your attitudes toward sex affect whether you toward sex affect whether you use condoms?use condoms?



Alcohol or drug screen

How much does getting high make it How much does getting high make it difficult to stay safe?difficult to stay safe?


How much of the time are you high How much of the time are you high on alcohol or drugs during sex?on alcohol or drugs during sex?



Key concerns

Safe + pleasurable behaviors you Safe + pleasurable behaviors you might increase?might increase?

Most typical “risk triggers”?Most typical “risk triggers”?

Times you are able to “override” Times you are able to “override” your risk triggers?your risk triggers?

What are your key concerns about What are your key concerns about safety and intimacy?safety and intimacy?



Recent Risk Analysis

RiskyRisky(for yourself or your partner)(for yourself or your partner)

or or

You had difficulty staying You had difficulty staying safesafe

Let’s use that time as an example of Let’s use that time as an example of your risk pattern to see what more your risk pattern to see what more

we can learn.we can learn.

Think of recent sex episode that was...Think of recent sex episode that was...



What was the risk? What was the risk?

What were you doing / where were you?What were you doing / where were you?

Where did you meet your partner?Where did you meet your partner?

What was happening?What was happening?

Recent Risk Analysis, What & where..

Thinking about a recent time when Thinking about a recent time when it was difficult to be safeit was difficult to be safe



Recent Risk Analysis, What & where..

Were condoms / lube available?

What made it difficult to use a condom?

Where did you have sex?

What about the time or place made safety difficult?

Thinking about that risky time…Thinking about that risky time…



Who was your partner?

Recent Risk Analysis, Partner

Steady / primary?

Casual or anonymous?

Internet partner?

Particularly “hot”?

Coercive?

Trading sex for money or drugs?

“Barebacker” / risky sexual attitudes?

A recent risky time:A recent risky time:

How did your partner make safety difficult?How did your partner make safety difficult?



Recent Risk Analysis, Attitudes

What were your sexual attitudes? A recent risky time:A recent risky time:

How much did you feel…

Coping InterviewCoping Interview

**

Intimacy is more important than safety?Intimacy is more important than safety?

HIV meds make safety less important?HIV meds make safety less important?

Your partner is responsible for his/her Your partner is responsible for his/her own sexual safety?own sexual safety?

Tired of safe sex?Tired of safe sex?



His / her HIV status?His / her HIV status?

Safety, or what kind of sex to have?Safety, or what kind of sex to have?

Did you talk about…?:Did you talk about…?:

Recent Risk Analysis, Communication

How did you and your partner How did you and your partner talk about safety?talk about safety?

What did your partnerWhat did your partner say about HIV say about HIV or safety?or safety?

Thinking about recent risk…Thinking about recent risk…

Your HIV status?Your HIV status?



Recent Risk Analysis, Communication, 2

How much did How much did not not talking about talking about these issues lead to being risky?these issues lead to being risky?

What made talking about safety or risk difficult?




How were alcohol or drugs How were alcohol or drugs involved?involved?

Recent Risk Analysis, Alcohol & Drugs

Recent risky time:

Were you high? … … on what?on what?

Was your partner high? … … on what?on what?



Recent Risk Analysis, Alcohol & drugs, 2

How did being high make safety difficult How did being high make safety difficult that time?that time?

How did being high make sex better?How did being high make sex better?

… … more intense?more intense?… … more comfortable?more comfortable?

How did being high make sex How did being high make sex worseworse??

… … less communication?less communication?… … concern over risk?concern over risk?



Celebration?Celebration?

Love, intimacy?Love, intimacy?

Horniness?Horniness?

Anything else?Anything else?

Recent Risk Analysis, Positive Moods

What What positivepositive feelings do you feelings do you remember?remember?

Thinking back to your Thinking back to your moods and moods and feelingsfeelings during that recent time during that recent time



Stress or depression Loneliness or isolation Angry or frustrated at being HIV+ Anything else?

Recent Risk Analysis, Negative Moods

What What negativenegative feelings do you feelings do you remember?remember?



Recent Risk Analysis, Negative Moods

How did your mood or How did your mood or feelings make it difficult feelings make it difficult to be safe then?to be safe then?



What made it most difficult to be What made it most difficult to be safe then?safe then?

The place or time?

Your partner(s)?

Sexual attitudes?

What were the “active ingredients” for you?What were the “active ingredients” for you?

Recent Risk, Triggers

Let’s summarize that time, and Let’s summarize that time, and begin thinking about safety plansbegin thinking about safety plans

Communications?

Alcohol or drugs?

Moods-feelings?

Other “risk triggers”?



Recent Risk, Changes

We’ll review your “risk profile” – We’ll review your “risk profile” – your scores on the questions so your scores on the questions so far – that will help us figure this far – that will help us figure this out and develop a safety and out and develop a safety and intimacy plan.intimacy plan.

How typical is this risk How typical is this risk pattern?pattern?



Show risk profile

Advocate: show “Risk Profile” of Advocate: show “Risk Profile” of scores on sexual risk items.scores on sexual risk items.



Risk Profile

Here is your risk profileHere is your risk profile

This shows your scores on the This shows your scores on the areas we discussed todayareas we discussed today

Do the high & low scores seem to Do the high & low scores seem to fit your sexual patterns?fit your sexual patterns?

For changesFor changes To To maintainmaintain safety & intimacy safety & intimacy

Where do you feel you might plan?Where do you feel you might plan?



Safety Plan Intro

Moving toward a safety & intimacy plan

Here is an example…Here is an example…

Let’s use your concerns -- and Let’s use your concerns -- and strengths -- to write a safety plan.strengths -- to write a safety plan.



An example of a personal

Concerns Goals Action steps

What do you want to change….?

Unsafe sex with tricks when angry or sad

Personal goal(s)(s)

for each area?

Choose safer partners

Be aware of emotions

Specific steps to reach each goal?

Sexual planning

Moods & feelings module, therapy

Missed medication doses during sex

Talk to partners about HIV & meds

Take meds on time

Communication rehearsal & plan

Treatment skills

Feeling more intimate with sex partners

Talk to partners about HIV

Safe paths to intimacy

Communication skills

New relationships



Safety Planning

1.1. Concerns: Concerns: What do you want to What do you want to change?change?

2.2. Goals: Goals: How would you like it How would you like it to be different?to be different?

3.3. Action Steps: Action Steps: What can you do to What can you do to achieve your goal?achieve your goal?

Your own safety plan:Your own safety plan:Click for Click for Safety & Safety &

Treatment worksheetTreatment worksheet



Safety Planning, 2

What has worked in the past?What has worked in the past?

What is concrete and feasible -- What is concrete and feasible -- what can you actually do?what can you actually do?

What are the first steps?What are the first steps?

How will you know if you are How will you know if you are successful?successful?

What else should we include?What else should we include?

To help us with action steps…To help us with action steps…Click for Click for Safety & Treatment worksheetSafety & Treatment worksheet



Visit Summary

Visit Summary: Visit Summary: We have spoken about…We have spoken about…

Why safety is important

Your sexual values and concerns

What you consider risky or safe

“Triggers” that make safety difficult

Your personal safety plan.



Your safety plan Your safety plan

Some sexual safety skillsSome sexual safety skills

More focused concerns or goalsMore focused concerns or goals

Next Session

Next time we will discuss:Next time we will discuss:

Is _______ / _______ still the best day and time for your next visit?



Checking in

About today’s visitAbout today’s visit

Did we get a chance to discuss the topics that are important to you?

How could we have addressed your concerns better?

Remember: Call or e-mail if you have any questions or concerns.

How did it feel to talk with me about these topics?



Advocate’s Notes & Checklist

Safety Planning Worksheet Safety Planning Worksheet

Referral sheet (if used)Referral sheet (if used)

Next appointment hand cardNext appointment hand card

Advocate: Complete Advocate: Complete Counseling Notes FormCounseling Notes Form and and Visit LogVisit Log for file. for file.

Visit ChecklistVisit Checklist



Safety & Treatment Planning Worksheet

Action StepsPersonal GoalsAction Areas

Participant ID: _______ Advocate___________ Date ___________ Visit code _____

Fill in one or several general areas of concern / change targetsFill in one or several general areas of concern / change targets Note Note personalpersonal goals for each; what specifically should be goals for each; what specifically should be

different.different. Fill in actions that are Fill in actions that are specificspecific, , concreteconcrete, “, “do-abledo-able”.”.


TAP Planning worksheet, 4/24/03TAP Planning worksheet, 4/24/03

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