1. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 1 The University of Illinois at Chicago Howard Brown Health Center Treatment Advocacy Program Sexual Safety Visit 1 Planning for Sexuality & Intimacy Open

2. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 2 Module; Goals Your sexual values and goals Your sexual values and goals Issues that are most important for you in sexuality, intimacy and safety Issues that are most important for you in sexuality, intimacy and safety Your concerns about sexuality, intimacy and safety Your concerns about sexuality, intimacy and safety Plans you might want to make for sexual safety and intimacy Plans you might want to make for sexual safety and intimacy Today we will discuss:

3. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 3 HIV Information Before we begin…what questions do you have about: Click for HIV information HIV / AIDS? HIV / AIDS? HIV infection? HIV infection? HIV treatments? HIV treatments? This program? This program?

4. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 4 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 difficult Makes your treatment very difficult Even though you are HIV+, sexual safety is still important: The new strain would be resistant to your current HIV drugs The new strain would be resistant to your current HIV drugs It may be resistant to other drugs It may be resistant to other drugs

5. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 5 Continuing Safety: Other STDs Contracting a new STD (like syphilis or gonorrhea) … Increases your viral load Increases your viral load Makes your HIV harder to control Makes your HIV harder to control Makes you more likely to infect others Makes you more likely to infect others Being HIV+ makes a new STD harder to treat Being HIV+ makes a new STD harder to treat Sexual safety is still important:

6. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 6 Continuing Safety STDs are common in infected men: Half of recent Chicago syphilis cases are in HIV+ MSM Half of recent Chicago syphilis cases are in HIV+ MSM HIV infections are increasing among gay / bi men HIV infections are increasing among gay / bi men New HIV infections doubled between 1998 and 2001 New HIV infections doubled between 1998 and 2001 Sexual safety is still important:

7. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 7 Continuing Safety: Drug Resistant Strains You can transmit drug resistant HIV to others by unsafe sex Half of new infections are resistant to an HIV drug Half of new infections are resistant to an HIV drug As much as 1/3 may be resistant to more than one 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 Infection with a drug resistant strain can be much more difficult to treat Sexual safety is still important:

8. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 8 Safety: Bottom Line Bottom Line: Safety is still important To protect your partners To protect your partners For your own protection For your own protection We are here to help infected men remain safe and develop intimacy

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

10. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 10 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 - - worry you? What risks -- to yourself or your partner - - 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?

11. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 11 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 to be different?

12. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 12 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 see different? What would you like to see different?

13. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 13 Recent sexual patterns Now let’s discuss what has been happening in the recent past. Now let’s discuss what has been happening in the recent past. This will help us plan for safety & intimacy. This will help us plan for safety & intimacy. We have discussed your sexual concerns & possible changes Cite concerns / changes

14. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 14 Coping With Sexual Safety How are you handling sexual 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?

15. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 15 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: How many different sex partners have you had? (3 months..)

16. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 16 Personal Risk Review, risk estimations HIV negative partner(s) Unprotected anal, HIV- / ? partner Unprotected anal sex Partner(s) whose HIV status you do not know High on drugs - alcohol during sex Unprotected vaginal sex Sharing injection needles Other risks: ___________________ Let’s talk about how you personally view different possible risks… For “low” ratings: What makes these low risk? How risky (for you or your partner) is : Lowmoderatehigh

17. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 17 Personal Risk Review, personal risks Are you comfortable with these risks? Are you comfortable with these risks? So… the things you consider personally risky are.. Cite high / mod. risks Of the behaviors you consider risky… …which do you actually do?

18. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 18 Personal Risk Review, risk attitudes What makes your risky behaviors more likely? Moods or feelings? Moods or feelings? Alcohol or drugs? Alcohol or drugs? Other things? Partner(s)? Partner(s)? Certain…

19. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 19 Moods & Risk Screen 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 Your moods in general

20. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 20 Places & partners screen 01234 none at alla littlesomea fair amountvery much How much do you find that some places or times just make it difficult to stay safe? 01234 not at alla littlesomea fair amountvery often How often do partners make it difficult to stay safe?

21. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 21 Condom hassle How much is the hassle of using a condom an issue for you? Thinking generally: How so?

22. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 22 Recent Risk Analysis, Basic Skills 01234 none at alla littlesomea fair amountvery much How about using female condoms? How much do you avoid condoms because of the hassle of using them? Click for Basic safety skills How comfortable are you in putting on & using condoms? Or return to skills later..

23. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 23 Attitudes screen Tired of safe sex Tired of safe sex 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 own safety Your partner is responsible for his/her own safety 01234 none at alla littlesomea fair amountvery much How much do your attitudes toward sex affect whether you use condoms?

24. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 24 Alcohol or drug screen How much does getting high make it difficult to stay safe? 01234 none at alla littlesomea fair amountvery much How much of the time are you high on alcohol or drugs during sex?

25. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 25 Key concerns Safe + pleasurable behaviors you might increase? Safe + pleasurable behaviors you might increase? 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? What are your key concerns about safety and intimacy?

26. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 26 Recent Risk Analysis 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. Think of recent sex episode that was...

27. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 27 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? Recent Risk Analysis, What & where.. Thinking about a recent time when it was difficult to be safe

28. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 28 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…

29. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 29 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: How did your partner make safety difficult?

30. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 30 Recent Risk Analysis, Attitudes What were your sexual attitudes? A recent risky time: How much did you feel… Coping Interview Coping 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 own sexual safety? Your partner is responsible for his/her own sexual safety? Tired of safe sex? Tired of safe sex?

31. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 31 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 safety? What did your partner say about HIV or safety? Thinking about recent risk… Your HIV status? Your HIV status?

32. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 32 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

33. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 33 How were alcohol or drugs involved? Recent Risk Analysis, Alcohol & Drugs Recent risky time: Were you high? … on what? Was your partner high? … on what?

34. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 34 Recent Risk Analysis, Alcohol & drugs, 2 How did being high make safety difficult that time? How did being high make sex better? … more intense? … more comfortable? How did being high make sex worse? … less communication? … concern over risk?

35. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 35 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 during that recent time

36. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 36 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?

37. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 37 Recent Risk Analysis, Negative Moods How did your mood or feelings make it difficult to be safe then?

38. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 38 What made it most difficult to be safe then? The place or time? Your partner(s)? Sexual attitudes? What were the “active ingredients” for you? Recent Risk, Triggers Let’s summarize that time, and begin thinking about safety plans Communications? Alcohol or drugs? Moods-feelings? Other “risk triggers”?

39. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 39 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?

40. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 40 Show risk profile Advocate: show “Risk Profile” of scores on sexual risk items.

41. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 41 Risk Profile Here is your risk profile This shows your scores on the areas we discussed today This shows your scores on the areas we discussed today Do the high & low scores seem to fit your sexual patterns? Do the high & low scores seem to fit your sexual patterns? For changes For changes To maintain safety & intimacy To maintain safety & intimacy Where do you feel you might plan? Where do you feel you might plan?

42. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 42 Safety Plan Intro Moving toward a safety & intimacy plan Here is an example… Let’s use your concerns -- and strengths -- to write a safety plan.

43. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 43 An example of a personal ConcernsGoalsAction steps What do you want to change….? Unsafe sex with tricks when angry or sad (s) Personal goal(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

44. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 44 Safety Planning 1.Concerns: What do you want to change? 2.Goals: How would you like it to be different? 3.Action Steps: What can you do to achieve your goal? Your own safety plan: Click for Safety & Treatment worksheet Click for Safety & Treatment worksheet

45. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 45 Safety Planning, 2 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? To help us with action steps… Click for Safety & Treatment worksheet Click for Safety & Treatment worksheet

46. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 46 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.

47. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 47 Your safety plan Your safety plan Some sexual safety skills Some sexual safety skills More focused concerns or goals More focused concerns or goals Next Session Next time we will discuss: Is _______ / _______ still the best day and time for your next visit?

48. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 48 Checking in About 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?

49. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 49 Advocate’s Notes & Checklist  Safety Planning Worksheet  Referral sheet (if used)  Next appointment hand card Advocate: Complete Counseling Notes Form and Visit Log for file. Visit Checklist

50. UIC / HBHC Treatment Advocacy Program Main Menu Basic Safety Skills TAP: Sexual Safety 1. 12/9/03 50 Safety & Treatment Planning Worksheet Action StepsPersonal GoalsAction Areas Participant ID: _______ Advocate___________ Date ___________ Visit code _____ Fill in one or several general areas of concern / change targets Fill in one or several general areas of concern / change targets Note personal goals for each; what specifically should be different. Note personal goals for each; what specifically should be different. Fill in actions that are specific, concrete, “do-able”. Fill in actions that are specific, concrete, “do-able”. UIC / HBHC Treatment Advocacy Program TAP Planning worksheet, 4/24/03