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Open. The University of Illinois at Chicago Howard Brown Health Center Treatment Advocacy Program Sexual Safety Visit 1 Planning for Sexuality & Intimacy. Module; Goals. Today we will discuss:. Your sexual values and goals

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Open

Open

The University of Illinois at Chicago

Howard Brown Health Center

Treatment Advocacy Program

Sexual Safety Visit 1

  • Planning for Sexuality & Intimacy

TAP: Sexual Safety 1. 12/9/03 1


Module goals

Module; Goals

Today we will discuss:

  • Your sexual values and goals

  • Issues that are most important for you in sexuality, intimacy and safety

  • Your concerns about sexuality, intimacy and safety

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

TAP: Sexual Safety 1. 12/9/03 2


Hiv information

HIV Information

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

  • HIV / AIDS?

  • HIV infection?

  • HIV treatments?

  • This program?

Click for

HIV information

TAP: Sexual Safety 1. 12/9/03 3


Continuing safety super infection

Continuing Safety: Super Infection

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

  • You can be infected with a whole new strain of HIV

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

  • It may be resistant to other drugs

  • Makes your HIV drugs less effective

  • Makes your treatment very difficult

TAP: Sexual Safety 1. 12/9/03 4


Continuing safety other stds

Continuing Safety: Other STDs

  • Contracting a new STD (like syphilis or gonorrhea)…

Sexual safety is still important:

  • Increases your viral load

  • Makes your HIV harder to control

  • Makes you more likely to infect others

  • Being HIV+ makes a new STD harder to treat

TAP: Sexual Safety 1. 12/9/03 5


Continuing safety

Continuing Safety

Sexual safety is still important:

  • STDs are common in infected men:

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

  • HIV infections are increasing among gay / bi men

  • New HIV infections doubled between 1998 and 2001

TAP: Sexual Safety 1. 12/9/03 6


Continuing safety drug resistant strains

Continuing Safety: Drug Resistant Strains

Sexual safety is still important:

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

  • Half of new infections are resistant to an HIV drug

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

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

TAP: Sexual Safety 1. 12/9/03 7


Safety bottom line

Safety: Bottom Line

  • Bottom Line:

  • Safety is still important

  • To protect your partners

  • For your own protection

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

TAP: Sexual Safety 1. 12/9/03 8


Sexuality and intimacy 1

Sexuality and Intimacy, 1

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

  • Let’s begin by talking about sexuality and intimacy

  • Dating & sex?

  • Feelings about yourself?

  • Feelings about your partners?

  • Steady relationships?

TAP: Sexual Safety 1. 12/9/03 9


Personal concerns

Personal concerns

What are your personal concerns about sex and safety?

  • How often do you think about safety?

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

  • What would you gain by being safer?

  • What would you lose by being safer?

TAP: Sexual Safety 1. 12/9/03 10


Sexuality and intimacy

Sexuality and Intimacy

How would you like your sex life to be different?

  • New or more partners?

  • Fewer partners?

  • More intimacy or closeness?

  • Keep partners safe?

  • Avoid new STDs?

  • Talk about HIV with partners?

  • Anything else?

TAP: Sexual Safety 1. 12/9/03 11


Sexuality and intimacy 2

Sexuality and Intimacy, 2

How satisfied are you with your relationships or dating?

  • What is going well?

  • What would you like to see different?

TAP: Sexual Safety 1. 12/9/03 12


Recent sexual patterns

Recent sexual patterns

We have discussed your sexual concerns & possible changes

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

  • This will help us plan for safety & intimacy.

Cite concerns / changes

TAP: Sexual Safety 1. 12/9/03 13


Coping with sexual safety

Coping With Sexual Safety

  • How are you handling sexual safety now?

  • Not having sex?

  • Steady, safe relationship?

  • Only HIV+ partner(s)?

  • Negotiating condoms with partners?

  • Disclosing HIV status to partner(s)?

  • Avoiding alcohol or drugs + sex?

  • No real plans?

  • Anything else?

TAP: Sexual Safety 1. 12/9/03 14


Personal risk review behaviors

Personal Risk Review, Behaviors

How many different sex partners have you had? (3 months..)

Over the past 3 months or so:

  • 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?

TAP: Sexual Safety 1. 12/9/03 15


Personal risk review risk estimations

Partner(s) whose HIV status you

do not know

High on drugs - alcohol during sex

Sharing injection needles

HIV negative partner(s)

Unprotected anal, HIV- / ? partner

Unprotected anal sex

Unprotected vaginal sex

Other risks: ___________________

Personal Risk Review, risk estimations

Let’s talk about how you personally view different possible risks…

How risky (for you or your partner) is:

Lowmoderatehigh

For “low” ratings:

What makes these low risk?

TAP: Sexual Safety 1. 12/9/03 16


Personal risk review personal risks

Personal Risk Review, personal risks

So… the things you consider personally risky are..

  • Are you comfortable with these risks?

Cite high / mod. risks

Of the behaviors you consider risky…

…which do you actually do?

TAP: Sexual Safety 1. 12/9/03 17


Personal risk review risk attitudes

Personal Risk Review, risk attitudes

  • What makes your risky behaviors more likely?

Certain…

  • Partner(s)?

  • Moods or feelings?

  • Alcohol or drugs?

  • Other things?

  • TAP: Sexual Safety 1. 12/9/03 18


    Moods risk screen

    Moods & Risk Screen

    Your moods in general

    • How much do negative moods or feelings…

    • Disrupt your life?

    • Interfere with taking your meds?

    • Make you less sexually safe?

    • Keep you from having relationships or sex?

    01234

    none at alla littlesomea fair amountvery much

    TAP: Sexual Safety 1. 12/9/03 19


    Places partners screen

    Places & partners screen

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

    01234

    none at alla littlesomea fair amountvery much

    How often do partners make it difficult to stay safe?

    01234

    not at alla littlesomea fair amountvery often

    TAP: Sexual Safety 1. 12/9/03 20


    Condom hassle

    Condom hassle

    Thinking generally:

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

    How so?

    TAP: Sexual Safety 1. 12/9/03 21


    Recent risk analysis basic skills

    Recent Risk Analysis, Basic Skills

    How comfortable are you in putting on & using condoms?

    How about using female condoms?

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

    01234

    none at alla littlesomea fair amountvery much

    Or return to skills later..

    Click for Basic safety skills

    TAP: Sexual Safety 1. 12/9/03 22


    Attitudes screen

    Attitudes screen

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

    • Tired of safe sex

    • Intimacy is more important than safety

    • HIV meds make safety less important

    • Your partner is responsible for his/her own safety

    01234

    none at alla littlesomea fair amountvery much

    TAP: Sexual Safety 1. 12/9/03 23


    Alcohol or drug screen

    Alcohol or drug screen

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

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

    01234

    none at alla littlesomea fair amountvery much

    TAP: Sexual Safety 1. 12/9/03 24


    Key concerns

    Key concerns

    What are your key concerns about safety and intimacy?

    • Safe + pleasurable behaviors you might increase?

    • Most typical “risk triggers”?

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

    TAP: Sexual Safety 1. 12/9/03 25


    Recent risk analysis

    Recent Risk Analysis

    Think of recent sex episode that was...

    • Risky

    • (for yourself or your partner)

    • or

    • You had difficulty staying safe

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

    TAP: Sexual Safety 1. 12/9/03 26


    Recent risk analysis what where

    Recent Risk Analysis, What & where..

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

    What was happening?

    • What was the risk?

    • What were you doing / where were you?

    • Where did you meet your partner?

    TAP: Sexual Safety 1. 12/9/03 27


    Recent risk analysis what where1

    Recent Risk Analysis, What & where..

    Thinking about that risky time…

    • 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?

    TAP: Sexual Safety 1. 12/9/03 28


    Recent risk analysis partner

    Recent Risk Analysis, Partner

    A recent risky time:

    Who was your partner?

    • Steady / primary?

    • Casual or anonymous?

    • Internet partner?

    • Particularly “hot”?

    • Coercive?

    • Trading sex for money or drugs?

    • “Barebacker” / risky sexual attitudes?

    How did your partner make safety difficult?

    TAP: Sexual Safety 1. 12/9/03 29


    Recent risk analysis attitudes

    *

    Coping Interview

    Recent Risk Analysis, Attitudes

    What were your sexual attitudes?

    A recent risky time:

    How much did you feel…

    • Tired of safe sex?

    • Intimacy is more important than safety?

    • HIV meds make safety less important?

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

    TAP: Sexual Safety 1. 12/9/03 30


    Recent risk analysis communication

    Recent Risk Analysis, Communication

    How did you and your partner talk about safety?

    Thinking about recent risk…

    • His / her HIV status?

    • Safety, or what kind of sex to have?

    Did you talk about…?:

    • Your HIV status?

    What did your partnersay about HIV or safety?

    TAP: Sexual Safety 1. 12/9/03 31


    Recent risk analysis communication 2

    Recent Risk Analysis, Communication, 2

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

    What made talking about safety or risk difficult?

    01234

    none at alla littlesomea fair amountvery much

    TAP: Sexual Safety 1. 12/9/03 32


    Recent risk analysis alcohol drugs

    Recent Risk Analysis, Alcohol & Drugs

    Recent risky time:

    How were alcohol or drugs involved?

    Were you high?

    … on what?

    Was your partner high?

    … on what?

    TAP: Sexual Safety 1. 12/9/03 33


    Recent risk analysis alcohol drugs 2

    Recent Risk Analysis, Alcohol & drugs, 2

    How did being high make sex better?

    How did being high make safety difficult that time?

    … more intense?

    … more comfortable?

    How did being high make sex worse?

    … less communication?

    … concern over risk?

    TAP: Sexual Safety 1. 12/9/03 34


    Recent risk analysis positive moods

    Recent Risk Analysis, Positive Moods

    • Celebration?

    • Love, intimacy?

    • Horniness?

    • Anything else?

    Thinking back to your moods and feelings during that recent time

    What positive feelings do you remember?

    TAP: Sexual Safety 1. 12/9/03 35


    Recent risk analysis negative moods

    Recent Risk Analysis, Negative Moods

    • Stress or depression

    • Loneliness or isolation

    • Angry or frustrated at being HIV+

    • Anything else?

    What negative feelings do you remember?

    TAP: Sexual Safety 1. 12/9/03 36


    Recent risk analysis negative moods1

    Recent Risk Analysis, Negative Moods

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

    TAP: Sexual Safety 1. 12/9/03 37


    Recent risk triggers

    Recent Risk, Triggers

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

    • What made it most difficult to be safe then?

    What were the “active ingredients” for you?

    • The place or time?

    • Your partner(s)?

    • Sexual attitudes?

    • Communications?

    • Alcohol or drugs?

    • Moods-feelings?

    • Other “risk triggers”?

    TAP: Sexual Safety 1. 12/9/03 38


    Recent risk changes

    Recent Risk, Changes

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

    How typical is this risk pattern?

    TAP: Sexual Safety 1. 12/9/03 39


    Show risk profile

    Show risk profile

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

    TAP: Sexual Safety 1. 12/9/03 40


    Risk profile

    Risk Profile

    • Here is your risk profile

    • This shows your scores on the areas we discussed today

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

    • Where do you feel you might plan?

    • For changes

    • To maintain safety & intimacy

    TAP: Sexual Safety 1. 12/9/03 41


    Safety plan intro

    Safety Plan Intro

    • Moving toward a safety & intimacy plan

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

    Here is an example…

    TAP: Sexual Safety 1. 12/9/03 42


    An example of a personal

    An example of a personal

    Concerns

    Goals

    Action steps

    Personalgoal(s)

    for each area?

    Choose safer partners

    Be aware of emotions

    Specific stepsto reach each goal?

    Sexual planning

    Moods & feelings module, therapy

    Whatdo you want to change….?

    Unsafe sex with tricks when angry or sad

    Talk to partners about HIV & meds

    Take meds on time

    Communication rehearsal & plan

    Treatment skills

    Missed medication doses during sex

    Talk to partners about HIV

    Safe paths to intimacy

    Communication skills

    New relationships

    Feeling more intimate with sex partners

    TAP: Sexual Safety 1. 12/9/03 43


    Safety planning

    Safety Planning

    Click for Safety & Treatment worksheet

    Your own safety plan:

    • Concerns: What do you want to change?

    • Goals: How would you like it to be different?

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

    TAP: Sexual Safety 1. 12/9/03 44


    Safety planning 2

    Safety Planning, 2

    Click for Safety & Treatment worksheet

    • To help us with action steps…

    • What has worked in the past?

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

    • What are the first steps?

    • How will you know if you are successful?

    • What else should we include?

    TAP: Sexual Safety 1. 12/9/03 45


    Visit summary

    Visit Summary

    • Visit Summary:

    • 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.

    TAP: Sexual Safety 1. 12/9/03 46


    Next session

    Next Session

    Next time we will discuss:

    • Your safety plan

    • Some sexual safety skills

    • More focused concerns or goals

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

    TAP: Sexual Safety 1. 12/9/03 47


    Checking in

    Checking in

    • About today’s visit

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

    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.

    TAP: Sexual Safety 1. 12/9/03 48


    Advocate s notes checklist

    Advocate’s Notes & Checklist

    Visit Checklist

    • Safety Planning Worksheet

    • Referral sheet (if used)

    • Next appointment hand card

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

    TAP: Sexual Safety 1. 12/9/03 49


    Safety treatment planning worksheet

    Safety & Treatment Planning Worksheet

    UIC / HBHC Treatment

    Advocacy Program

    Participant ID: _______ Advocate___________ Date ___________ Visit code _____

    Action Areas

    Personal Goals

    Action Steps

    • Fill in one or several general areas of concern / change targets

    • Note personal goals for each; what specifically should be different.

    • Fill in actions that are specific, concrete, “do-able”.

    TAP Planning worksheet, 4/24/03

    TAP: Sexual Safety 1. 12/9/03 50


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