UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 1 The University of Illinois at Chicago Howard Brown Health Center Treatment Advocacy Program Coping Follow-up Visits

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 2 TAP model check-in Health & Well Being Feelings & Moods Support & Disclosure Alcohol & Drug use …review the two main health areas.. Sexual Safety Treatment Adherence And coping areas that are important to them.. Welcome back to TAP… this visit we will: this visit we will:

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 3 HIV information Before we begin…what questions do you have about: HIV / AIDS? HIV infection? HIV treatments? This program? HIV Information

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 4 HIV Coping Check-in… How have things been with.. Sexuality & intimacy? Sexuality & intimacy? Medications & treatment? Medications & treatment? Areas where things are going.. Difficult? Difficult? Particularly well? Particularly well? Any issues since we met last?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 5 Safety: New STDs and health Review: Safety is still important. Not pass on HIV Not pass on HIV Avoid drug-resistant strain of HIV Avoid drug-resistant strain of HIV Keep from contracting a new STD (syphilis, gonorrhea…) Keep from contracting a new STD (syphilis, gonorrhea…)  Worsens your HIV  Being HIV+ makes STDs harder to treat HIV Information

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 6 Review: Adherence & medication effectivenessAdherence 2 dose/day regimen Effectiveness of HIV meds [% patients with < 200 copies HIV / ml blood ] Full Adherence: Over 80% effective 95% adherence missed doses per month About 65% effective About 50% effective About 25% Less than 10% effective 90% adherence missed doses per month 80% adherence missed doses per week 70% adherence missed doses per week < 70% adherence 5 or more misses / week Bottom Line: 95% of doses 95% of doses On time (+/- 2 hours) On time (+/- 2 hours) Adhering to treatment is also critical…

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 7 Adherence Information: Safety + Adherence = Health Remember the two basic HIV health formulas: Viral load Resistance T-cells Full Adherence = ++ HIV Information HIV InformationSafer sex = Avoid STD infections Not pass on HIV + Avoid HIV “Super- infection” +

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 8 Begin sexuality Let’s begin discussing sexuality and intimacy -- Are you dating, or have you had any sex partners since we spoke last? (male or female) Yes No

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 9 Not dating  How have you thought about intimacy?  Is this something you are lacking?  What goals and plans might you make for dating or intimacy? Is this a concern for you?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 10 Sexuality & intimacy How you are doing with relationships and dating now? How about sexual safety…? Successful safety strategies…? Successful safety strategies…? Concerns or issues? Concerns or issues? What is going well? What is going well? How satisfied are you? How satisfied are you? What would you change? What would you change?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 11 Coping with Sexual Safety Any changes in your comfort with safety or risk? How much are you focusing on this now? How much are you focusing on this now? How confident are you in your safety strategies? How confident are you in your safety strategies? Any risks to yourself or partner(s) that concern you? Any risks to yourself or partner(s) that concern you?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 12 Sexuality: Risks neverrarely; once or twiceonce a weekseveral timesabout perhaps once a monthor soa weekevery day Over the past 3 months or so… How often have you “slipped” on your safety guidelines and done something risky for yourself or your partner?  Coping Interview

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 13 Sexuality; Partners & risk Have you had unprotected anal or vaginal sex? Over the past 3 months or so… Any slip or UPA Any slip or UPA No slip or UPA No slip or UPA Click one to advance: If yes: with anyone who was not HIV+? If yes: with anyone who was not HIV+?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 14 Click an option Advocate; please go back and click one option

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 15 Where did you meet your partner? Where did you meet your partner? What was happening? Recent Risk Analysis, What & where.. Thinking about a recent time when you had unsafe sex or “slipped”… What was going on… What was going on…  What were you doing  where were you? Were condoms / lube available? Were condoms / lube available? What made it difficult to use a condom? What made it difficult to use a condom?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 16 Recent Risk Analysis, Place & condom.. What about the time or place made safety difficult? Coping Interview Coping Interview* How much was the hassle of using a condom an issue for you?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 17 Who was your partner? Recent Risk Analysis, Partner Steady / primary? HIV status? (+? --? Unknown?) Casual or anonymous? Internet partner? Particularly “hot”? Coercive? Trading sex for money or drugs? “Barebacker” / risky sexual Attitudes? A recent risky time:

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 18 Recent Risk Analysis, Partner, 2 How did your partner make safety difficult? Coping Interview Coping Interview* Did you tell your partner(s) you are HIV+? No Yes

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 19 Risk analysis: non-disclosure afraid would not get sex felt stigmatized time / place / mood did not feel right too high Would the same sex have happened? Why did you not disclose your status? How did that affect risk? How could you be safe without telling?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 20 your HIV status? your HIV status? 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: Recent Risk Analysis, Communication How did you and your partner talk about HIV…? What made talking about safety or risk difficult…?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 21 How were alcohol or drugs involved? Recent Risk Analysis, Alcohol & Drugs A recent risky time: How did being high make sex better? … more intense? … more comfortable? How did being high lead to risk? … less communication? … less concerned with risk? Were you high? … on what? Was your partner high? … on what?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 22 Celebration? Celebration? Love, intimacy? Love, intimacy? Horniness? Horniness? Anything else? Anything else? Recent Risk Analysis, Positive Moods What positive feelings do you remember? Thinking back to your moods and feelings …

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 23 Stress or depression Loneliness or isolation Angry or frustrated at being HIV+ Anything else? Recent Risk Analysis, Negative Moods What negative feelings do you remember?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 24 Recent Risk Analysis, Negative Moods How did mood or feelings affect whether you were safe or risky…? How important are moods and feelings to your risk generally? you are high during sex? you disclose your HIV+ status? Do moods or feelings affect whether...

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 25 What made it most difficult to be safe then?  the place or time…?  your partner(s)…?  disclosing HIV status…? What were the“active ingredients” for you? Recent Risk, Triggers Let’s summarize that time, and begin thinking about safety plans…  alcohol or drugs?  moods-feelings?  other “risk triggers”? Coping Interview Coping Interview*

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 26 Recent Risk, Changes What are your key concerns about safety and intimacy? What are your key concerns about safety and intimacy? Most typical “risk triggers”? Most typical “risk triggers”? Times you are able to “override” your risk triggers? Times you are able to “override” your risk triggers? How typical is this risk pattern?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 27 Sexuality or intimacy plans? Let’s keep your concerns about intimacy and sexuality in mind when we make plans at the end.

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 28 Begin adherence Let’s talk about treatment and adherence… Any medication changes since we last met? No Yes Not taking meds now Not taking meds now

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 29  Non-HIV meds?  Pharmacy & provider contact info.?  Any side effects?  Which pills at which times?  Food or other restrictions?  New HIV medications?  Number of doses each day?  Rewrite Medication Overview if needed Changes in Meds

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 30 Adherence Skills Check-in… How are you using it? Ways you have found it useful? Tracking missed doses? Barriers toward using it? Barriers toward using it? How has your pill box been working? How about your cue controls? What cues or reminders been effective? How should we change it?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 31 Adherence: Missed doses  Coping Interview Let’s review how you are doing… not at alla littlesomewhatfairly wellvery much In general, how difficult has it been to take meds consistently? Have you missed any medication dose since we met last? No Yes Click one

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 32 Overall adherence neveronce a monthseveral timesonce a weekseveral timesabout neveronce a monthseveral timesonce a weekseveral timesabout or soa monthor soa weekevery day In general, how often do you miss a dose? How many HIV doses did you miss during the last week? ______ How many doses did you take late (+ 2 hours) last week? ______  Coping Interview

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 33 Difficult Doses Let’s talk about doses that are difficult to remember or take…

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 34 Difficult doses: Adherence Difficulties.. Think of a time when you missed a dose… What was going on then? Can you tell me the story of what happened?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 35 Difficult doses: detail People who were with you…? Feelings or moods? Alcohol or drugs? Being with lover or sex partner? Anything else? How important was… Let’s keep these in mind as we develop some plans for adherence later…

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 36 Maintaining Adherence.. Commitment to health? Provider or clinic? Pill box, cues, dose planning? Family or friends? Lover or partner? Support group or counselor? Church or spiritual group? Tolerance to side effects? What else? What has HELPED you stay on your medications? How have these helped?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 37 Coping difficulties… Difficulty planning? Problems with HIV care? Side effects? Partners or lovers? Not talking to people about HIV? Depression or “treatment burnout”? Alcohol or drug use? What else? What has made it DIFFICULT to take your meds?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 38 Deal with adherence difficulties How have you dealt with these difficulties? Where would goals and plans help with these issues?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 39 Moods, intro Now let’s talk about some general coping areas… Beginning with Moods.

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 40 Moods & risk screen, 1 Over the past few weeks, how often have you felt sad, depressed, or angry… (Click response to advance..) less than 1 day1 or 2 daysseveral daysmost days less than 1 day1 or 2 daysseveral daysmost days a weeka weeka week  Coping Interview

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 41 Moods & risk screen, 2 How much do negative moods or feelings-- Disrupt your life? Disrupt your life? Interfere with taking your meds? Interfere with taking your meds? Make you less sexually safe? Make you less sexually safe? Keep you from having relationships or sex? Keep you from having relationships or sex? none at alla littlesomea fair amountvery much  Coping Interview

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 42 Moods, 1  Which moods?  When do you feel them?  How do they get in the way?  How have you dealt with them? When do moods interfere with your meds or make it difficult to be sexually safe? Should we discuss a referral or some program ideas after the session?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 43 Moods, 2  Keep your medication schedule even if you drop other activities.  Don’t have sex when depressed or angry.  Go to the clinic or call your advocate! What helps with negative moods?  What keeps you on track when you are depressed or angry?  When does that strategy not work well? Some possible strategies…

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 44 Moods, 3  Friend / neighbor?  Lover / partner?  Support group?  Provider or medical staff? Who can help during negative moods? How can you approach them? We will keep all these issues in mind when we address coping plans at the end…

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 45 Social Support & Disclosure Now let’s address support you get for treatment and safety, and talking about HIV with others.

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 46 Sources of support Who do you have to help you deal with HIV or HIV treatment?  Lover / partner  Friends / co-workers  Parents  Other family (sibs..)  Children  Support group  Counselor  Clergy / spiritual  Case manager  Health care  Anyone else:  Coping Interview

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 47 Practical & emotional support How much practical support do you get from others for HIV? (transportation, help with children, money…) nonenot enoughmoderatefair amounta lot nonenot enoughmoderatefair amounta lot How much emotional support do you get…? (talking about HIV, sharing personal concerns…)  Coping Interview

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 48 Social Support; Planning  …goals?  What are your concerns about practical or emotional support for HIV?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 49 Social Support; overall disclosure. Thinking of people you are close to… noneless than about half more than most or all halfhalf Let’s talk about HIV disclosure. How about sex partners? … how many have you told about your HIV status?  Coping Interview

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 50 Non-disclosure difficulties Has not talking about HIV -- or people not knowing you are infected… -- ever made it difficult to stay safe, or be comfortable during sex? -- ever made it difficult to take your meds?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 51 Alcohol & drug use intro. Now let’s talk about alcohol or drug use…

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 52 Alcohol & Drug Use screen …been high on alcohol? …taken any drug (including marijuana) ? …had trouble taking meds while high? …had unsafe sex while high? neverRarely1 to 3 timesAbout once2 to 4 timesAbout every (once or twice..)a montha weeka weekday All 0 click hereAny > 1 click here During the past 3 months how often have you…  Coping Interview

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 53 Alcohol & Drug: positive effects What are some positive things you get from alcohol or drugs? help with relaxation? help with relaxation? time out from thinking about HIV? time out from thinking about HIV? better sex? better sex? just enjoy being high? just enjoy being high? what else? what else? How do alcohol / drugs help with these?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 54 Alcohol & Drug: negative effects forget to take meds while high? forget to take meds while high? oversleep after drinking / using? oversleep after drinking / using? skip meds while on a binge? skip meds while on a binge? more sexually risky while high? more sexually risky while high? what else? what else? How about negative effects? Things you would want to change…? How can you get positive effects without the negative?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 55 Alcohol & drugs and meds. Certain drugs? With particular people? People you do not know well? People you do not know well? Sex partners? Sex partners? Others? Others? Certain places or times? Particular moods or feelings? When do alcohol / drugs make it hard to take your meds? Never How have you tried to keep with your meds at those times?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 56 Alcohol – drugs; medication skills  How can you keep meds available?  Cues & reminders that work while high?  Other strategies? Taking your meds when using alcohol or drugs…  Who can help you stay on meds while using?  How will you tell him / her? [Role play disclosure]  We can link to disclosure skills at the end… Disclosing HIV treatment…. Disclosing HIV treatment….  Take before getting high  Schedule use around HIV meds  decrease use to support HIV care

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 57 Alcohol-drugs and sex Certain drugs? Particular partners?  New or anonymous…?  Steady partner(s)?  Exchanging $ or drugs for sex? Certain places or times? Particular moods or feelings? When do alcohol / drugs make it hard to stay sexually safe? Never

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 58 Alcohol & drugs; Planning  Goals for alcohol-drugs?  …action plans? What are your biggest concerns about alcohol - drugs and…  staying on meds?  sexual safety or intimacy?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 59 Coping Profile: Overview Let’s use our discussion to focus on the areas most important to you. I would like to rate each topic we covered in terms of how much difficulty you face with it… Writing your Coping Profile… Advocate: review coping interview responses with client to generate the coping profile.

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 60 Coping Profile; Planning Major coping issues for key area(s)? Coping resources? Complete Coping Profile Coping Difficulty noneslight moderatehigh Adherence 0123 Relationships & intimacy 0123 Sexual risk 0123 Support & HIV 0123 communication Feelings & Moods0123 Alcohol or drugs0123 Using your other ratings…

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 61 Planning intro. Let’s use your coping profile to chose areas to work on, and develop goals & plans…

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 62 Coping planning worksheet 1. Adherence or safety concerns ? 2. Goals : Key changes? 3. Action steps : specific behaviors. Writing your coping action plan: What has worked in the past? What has worked in the past? What is concrete and feasible -- what can you actually do? What is concrete and feasible -- what can you actually do? What are the first steps? What are the first steps? How will you know if you are successful? How will you know if you are successful? What else should we include? What else should we include? Complete Action Planning Worksheet Action Planning Worksheet example Action Planning Worksheet example

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 63 Questions & further materials. What questions do you have about.. HIV or HIV treatment? Talking about HIV with other people? Your coping plans? Sexuality & intimacy?

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 64 Additional session? Do you want to schedule other session(s) to discuss disclosure, intimacy and safety, HIV treatment, or other issues? Additional visit schedule: day ____ / date _________ / time ______ Remember: Call or if you have any questions or concerns.

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 65 Next regular meeting Check in on your safety plan Check in on your safety plan Review your treatment and medications. Review your treatment and medications. We will meet next at your regular HIV care visit. Schedule next visit for:  Next regular HIV visit:  Other day: _____/_____ Date time

UIC / HBHC Treatment Advocacy Program Next  BackVisit MenuSchedule next visitProgram Menu TAP: Follow-up Visits 9/27/04 66 Advocate’s notes & checklist Advocate: Visit Checklist  Coping interview form  Action planning worksheet (to client & file)  Coping profile (to client & file)  Referral sheet (if used)  Next appointment hand card distributed Complete Counseling Notes Form and Visit Log for file.