The University of Illinois at Chicago Howard Brown Health Center Treatment Advocacy Program

1. The University of Illinois at Chicago Howard Brown Health Center Treatment Advocacy Program Basic Sexual Safety Skills

2. Risk basics What transmits HIV / STDs? • Exposure to blood, semen, or feces (rimming) What makes exposure more likely? • Unprotected Sex or sharing sex toys • Sharing injection needles (steroid or drug) • Using alcohol or drugs with sex

3. Click for skills modules: Male condom Female condom: For anal sex For women Dental dam Tattooing & piercing Injection drugs Other Focus modules: HIV Information Alcohol & drugs Moods HIV Communication

4. Male Condom Skills Goals:- prevent condoms from breaking / slipping - comfort & confidence in using condoms How do you make sure condoms are available? • When is it difficult have condoms & lube available? • How can you “set things up” to have them at hand? • How have your partners made condoms available?

5. Condom Choices How do you choose the right condom? • Do not store in hot area (e.g., glove compartment in summer..) • Get the correct size • LATEX ONLY • Lots of lubricant outside = safety

6. Basic Condom Steps, 1 Check the condom: • Expiration date, holes, rips...? • Latex condom? • Water-based lube? Use condom & penis models or illustrations. • Open the condom: • Open carefully to avoid ripping • Hold condom right side out: “rim of a hat”

7. Basic Condom Steps, 2 Put the condom on: • Drop of water-based lubricant inside the condom or on tip of penis • Squeeze air out of tip • Roll condom all the way down & squeeze out air bubbles • Apply lubricant liberally to penis [or anus / vagina]

8. Basic Condom Steps, 3 During sex: • Check to make sure the condom has not slipped off or broken • If the condom slips / breaks, replace it • Reapply lube (or water) as needed After sex: • Withdraw penis while still hard • Make sure ejaculate does not spill out • Dispose of condom in trash, not toilet • Never reuse a condom

9. Reality Condom for Anal Sex[not FDA approved] Before sex: • Remove carefully from package. • Add lubricant to outside of pouch. • Make sure inner ring is at bottom (closed end) of pouch Outer ring – add extra lubricant if wanted Inner ring at bottom Tip of pouch -- add extra lubricant if wanted • Hold pouch with open end hanging down. • Holding the outside, squeeze the inner ring.

10. Reality Condom for Anal Sex [b] Inserting the condom: • Spread lubricant evenly inside condom. • Insert into anal opening. • Push inner ring & pouch the rest of the way up the anal cavity with index finger. • Push the inner ring past the sphincter muscle [May be hard the 1st or 2nd attempt]

11. Reality Condom for Anal Sex [c] During Sex: • About 1 inch of condom will stay outside • Leave inner ring in to hold condom in place Make sure the outside ring of the condom stays outside the anus • Moving side-to-side or up & down is normal and will not reduce protection. • Do not use a male condom along with Reality.

12. Reality Condom for Anal Sex [d] Stop Having Sex if: • Penis begins to enter underneath or outside the pouch • If outer ring is pushed inside remove condom and add lubricant before putting it back inside. Do not use for fisting or water sports After Sex: • Squeeze & twist outer ring while pulling out to keep fluid inside pouch.

13. Female Condom Skills 1 [for use with women] What are some advantages of the female condom? • Female controlled STD/HIV protection • Can be inserted prior to sex [within 2 hours] • Male doesn't use a male condom (no restriction on penis) • Not latex -- people allergic to latex can use it

14. Female Condom Skills 2 Some disadvantages: • Have to be careful while using it • Takes practice to use comfortably • Might squeak • Effectiveness rating not as high as male condom How might you explain the female condom to your partner?

15. Female Condom Skills 3 Putting in the condom: 1. Rub the walls of the pouch together to evenly distribute lubricant, then squeeze a few drops of lubricant into the pouch. 2. Find a comfortable position: stand with one foot on a chair, or lay down with knees up. Squeeze the inner ring between thumb and middle finger, pushing down with the index finger.

16. Female Condom Skills 4 • Insert the inner ring as far as it will go. 4. Check that the pouch is not twisted.

17. Female Condom Skills 5 During Intercourse: 1. You must aim into the middle of the outer ring so your penis goes into the pouch. 2.Be aware of the location of the outer ring! • The condom or outer ring may move during intercourse. • Use lubricant to prevent your penis from pulling the condom out. • If the condom gets pushed into the vagina, stop and put in a new condom. 3. "Rough sex" and non-”missionary” positions increase the likelihood of the ring being pushed in.

18. Female Condom Skills 6 After intercourse: • Squeeze and twist the outer ring to keep the semen inside the pouch. • Gently pull the condom out of the vagina. • Throw it away in the trash can. Don't flush it!

19. Dental Dam Skills 1 What is a dental dam? • Piece of thin latex used for: • Oral sex with women • Oral – anal sex (“rimming”) with men or women • Homemade dental dams: • Use plastic wrap • Cut a rolled condom to the center and open it up

20. Dental Dam Skills 2 Dental Dam Basics: • Should cover the entire vulva or anus • Should be held at both edges • Be careful not to turn the dam inside out • Never re-use dams

21. Dental Dam Skills 3 How to use a dental dam: Step 1: Rinse powdery talc from the dental dam. Pat dry with a towel or let air dry Step 2: Place water-based lubricant on the side that faces the genitals or anus Step 3: Place barrier on the genitals or anus (Do not move barrier back and forth between the vagina and anus – may cause infection) Step 4:Throw away barrier after using (do not share or reuse dams).

22. Tattooing or piercing What form of body modification do you [plan to] engage in? • Permanent Piercing? • Tattooing? • Non - Permanent Piercing? • “Play”? • “Blood sports”? How have you established trust with the other person(s)?

23. Piercing Skills 2 Basic safety precautions: • Licensed shop only • Latex gloves • One-time or sterile needles or tools • No blood mixing or swallowing • Clean skin (with alcohol) • Sharps container

24. Injection Safety 1 Harm Reduction Steps: 1. Abstinence from steroid or drug use • Previous experience with treatment? 2. Abstinence from injecting • “Clean” street needles may be contaminated • Other ways of administering? 3. Do not share needles / syringes • Needle exchange use? • Avoid sharing ANY works: Cookers, cottons, etc. 4.Complete needle cleaning • Brief exposure to bleach not enough to kill HIV • Injecting bleach residue harmful.

25. Injection Safety: 3x3 Needle Cleaning Method 1. WATER(3 times) • Fill syringe with clean tap water • Shake the syringe • Empty the syringe in a drain 2. BLEACH (3 times) • Fill with clean, full strength bleach • Shake & leave bleach in for 30 seconds • Empty the syringe in a drain 3. WATER(3 times) • Fill with clean water (not water you used before) • Shake & empty