People Living With HIV/AIDS: A Positive Force for Prevention “Prevention in Context of Sero-Divergent Relationships” Neil Self, MSW (Candidate) Board of Directors, BCPWA Chair, Positive Prevention Standing Committee Good Day. I have been asked by San and Isobel to talk for a few minutes about “Prevention in the Context of Sero-Divergent Relationships” both from a Northern Perspective and from the perspective of an organization that currently has programs or services in the area of Positive Prevention.

BCPWA and Positive Prevention Largest HIV/AIDS Organization in Western Canada - > 4,300 members. Board of Directors are all HIV positive. Focuses on Tertiary prevention - efforts are directed toward people living with HIV/AIDS and are intended to reduce the negative or challenging effects of the illness and maximize quality of life. It's Complicated Campaign To give people a little context of BCPWA and the Positive Prevention Department. The picture presented is one of a series of posters that the Positive Prevention department developed and marketed in the “It’s Complicated Campaign”. A campaign that encouraged both positive and non-positive people to discuss their status.

Sero-Divergent Relationships Few supports & services. Prevention campaigns aimed at sero-divergent couples? Yet….Sex Now Survey (CBRC, 2002) found that half of positive gay men that were in a relationship were in sero-divergent relationships! Few supports and services – Yet we have evidence that partners of HIV positive individuals have higher levels of psychological distress – similar to the distress experienced by HIV positive individuals and that there is a need for couple focused interventions or services (Remien et al., 2003). Prevention Campaigns aimed at sero-divergent couples? – Little or none that I could find. Often sero-divergent couples’ relationships and safer-sex practices are “taken for granted”. Most of our efforts are focused on the single or individuals in single environments (i.e. gay men in sex environments) or specific groups (i.e. IDU or sex-workers). 25% or the sample population of positive gay men. No data on opposite-sex couples but findings could be extrapolated to straight positive people in relationships. “ What is one Research Question that needs to be answered in order to improve prevention approaches focused on sero-divergent couples?” – What supports and services do sero-divergent couples need to maintain a healthy and sero-divergent relationship? How can we support them in staying healthy and together? Responses from Groups?

BCPWA Response – SeroSupportive Workshop Designed, coordinated and implemented by a team of HIV positive individuals. Some specialized outside help – Pinnacle Pursuits (husband and wife team), Bodywork practitioners, HIV negative counsellor, Sex Positive facilitator. Initial Response – launching pad for other initiatives. Designed, coordinated and implemented by positive individuals – “What is the most effective way to engage peers in promoting or implementing positive prevention strategies?” – Including positive people in developing and implementing prevention strategies – “What works for them?”. Also include them in the evaluation of any interventions or projects applying the Empowerment Evaluation principles (Fetterman, 2005). Specialized Help – “What is one important role for health care providers or community support workers in helping PHA’s reduce risk behaviours and maintain sexual practices?” – Support PWA directed efforts and prevention strategies – provide outside expertise as required. We had assistance from BCPWA staff, bodywork practitioners, counsellors, prevention experts and a community based research technical assistant. Initial Response – Designed as a springboard for other potential services and to identify prevention challenges for sero-divergent couples. i.e. Support Groups, Social Groups, Community Forums on Health and Treatment (i.e. a forum on how couples can work collaboratively on adherence issues and management of side effects). Perhaps to enlist couples in the design of a prevention campaign directed at sero-divergent couples. Responses from Groups?

Needs Assessment – Significant Issues? N=36 (18 Couples) My Partner’s Health My Health Quality of Life Fear of Becoming HIV+/My Partner Becoming HIV+ Intimacy and Sexuality Conducted a needs assessment at an information session for couples interested in attending the SeroSupportive Workshop. 18 Couples from throughout B.C. No surprises on the top three responses when sero-divergent couples are asked about issues of importance to them. My Partner’s Health, My Health and Quality of Life (as a couple) were cited. Fear of Becoming HIV+ or My partner becoming HIV+ - Suggests that there is continual concern on the part of couples and that these “fears” need to be addressed either through prevention education and/or support services (i.e. support groups or counselling). Couples prevention needs on the workshop ranged from the basic (HIV 101) to the more advanced (harm reduction methods). Intimacy and Sexuality – Intimacy is a common theme among HIV sero-divergent couples. This issue is often tied to the issue of prevention in that we know that as many couples gain intimacy over time – the perception of risk decreases and unprotected sex increases (Remien et al. 1995). Sexuality is tied to prevention in more than the obvious ways as well; in that newer couples often site more pleasure seeking motivations for non-condom use rather than intimacy. Both of these issues were brought up by couples on the SeroSupportive Workshop and healthy discussion ensued. The picture is of a small group session where the issues were raised by individual participants.

Peer Based Programs – Providing Role Models and Inspiring Couples “Magic Moment” Younger couples were “inspired” by long time couples. Reciprocal – “reinvigorated our relationship” Retreat Team as Role Model. Magic Moments – Many couples experienced “breakthroughs” or what one couple referred to as “magic moments” – either around communications, understanding their partner’s emotional needs or in more practical terms – information that they did not know. The picture is of a couple who had been together for several years and had a magic moment during the communications wheel exercise. Younger Couples were inspired by long-time couples. Several couples were inspired or encouraged that other couples could not only maintain a healthy relationship but also stay sero-divergent as well. This type of prevention message is probably more effective and durable than any social marketing campaign we could produce. Likewise, long-time couples reported that both their relationships and their commitment to prevention was “reinvigorated” by attending the workshop. Their were two levels of role-modelling going one – one between the couples and another between the positive participants and the retreat team. Positive participants in the workshop were impressed that other positive people could produce the workshop. Two members of the 2005 SeroSupportive Workshop were invited onto the Retreat Team as advisors for the next year’s workshop. “ What is one message that must be communicated to people living with HIV with respect to reducing the number of infections?” – With respect to sero-divergent couples – one important message is that there is possible to have a healthy long-term sero-divergent relationship, and that supports are available or can be made available – by positive people themselves (if need be).

SeroSupportive Workshop Outcomes Delivered. Delivered Formal Prevention Session Established Informal Prevention Dialogue – Role Modelling. Consciousness Raising Community Building Informal Social Network Support Group Potential. Advisors on Future SeroSupportive Workshops (Leadership Building) No notes required. Just read outcomes.

SeroSupportive Workshop Poster Presentation Thursday, 17 August 12:30 – 2:00 Poster Exhibition Area Level 800 – South Building MTCC THP0664