1. Setting up a Motivational Interviewing Clinic in an Urban GU Setting Dónal Traynor Senior Health Adviser East Sussex Healthcare NHS Trust

2. Rational for MI An unpublished audit in C&W identified 75% of patients being diagnosed with A1, A2 or A3 in a six months period, in 2009, were patients with a known pre-existing HIV diagnosis. Anecdotal evidence from clinicians in both HIV and GUM services suggested that some patients were unhappy with their sexual risk-taking behaviour and wanted help to address this. In changing sexual health landscape, it is vital to be able to measure HA activity and outcomes.

3. NICE Guidelines 2007 NICE [1] identified one of two target groups as MSM[1] Behaviours that increase the risk of STIs include: – misuse of alcohol and/or substances – early onset of sexual activity – unprotected sex and frequent change of and/or multiple sexual partners. What action should they take? – Have one to one structured discussions with individuals at high risk of STIs. The discussions should be structured on the basis of behaviour change theories. They should address factors that can help reduce risk-taking and improve self-efficacy and motivation. Ideally, each session should last at least 15–20 minutes. The number of sessions will depend on individual need (1).

4. Existing Research in the field A systematic review[2] of interventions intended to reduce the risk of acquiring sexually transmitted HIV in MSM identified two studies involving MI principles.[2] There is a paucity of evidence to show that MI is effective for particular client sub- groups e.g. Hep C co-infection, co-morbid recreational drug use.

5. Objectives and Method Aim 1: Aim of Clinic To offer an MI based intervention to MSM (both HIV positive and negative) who engage in high risk sexual activity (defined as unprotected anal intercourse and/or unprotected fisting), to reduce the frequency of patients’ risk taking, thereby reduce risk of acquisition and transmission of STIs.

6. Description of Clinic 4-5 individual 50 minute sessions of MI plus a Follow-up session. Delivered by either a health adviser or a clinical psychologist, trained in MI. To offer an MI based intervention to MSM (both HIV positive and negative) who engage in high risk sexual activity to reduce the frequency of patients’ risk-taking, thereby reduce risk of acquisition and transmission of STIs.

7. Aim 2 To gather data on patients’: sexual risk-taking behaviour serostatus co-morbid drug use Readiness for change

8. Aim 3 To investigate the level of need for the MI risk reduction clinic Comparison audit: total number of referrals to MI clinic was compared with the number of referrals to the general sexual health psychology clinic.

9. The Sexual Risk Inventory Tool (SRIT) On a scale of 0-10, 10 being the most important, how important is it to you to make changes to your sex life? Average response = 9

10. Sexual Risk Indicator Tool (SRIT) These questions are about your level of risk of getting, or passing on, sexually transmitted infections. How often have you had anal sex in the past 3 months? Number of times without condoms (unprotected, 'bareback') in past 3 months Number of times with condoms (protected) in past 3 months Anal sex where you have been the active partner/'top' Anal sex where you have been the passive partner/'bottom' Do you use sex toys/dildos, and do you share them in sex? Yes, sharedYes, me onlyNo sex toys Do you fist or are fisted, and do you wear gloves? Yes, without gloves Yes, with glovesNo fisting

11. Do you have sex with… (Please tick all that apply) A regular partner in a closed, monogamous relationship A regular partner in an open relationship A regular casual partner, sex buddy, fuck buddy. Casual/one off partners: bars, saunas, cruising, internet etc. Groups: sex parties, orgies, sex clubs, threesomes etc. Are there factors (such as drugs and/or alcohol) which make it more likely that you will engage in risky sex? Yes If yes, please specify

12. Not at all Somewhat Completely Please rate the four questions below… How happy are you with your sex life? 012345678910 How important is it to you to reduce your risk taking? 012345678910 How confident are you that you could reduce your risk taking? 012345678910 How ready are you to reduce your risk taking? 012345678910 Not at allSomewhatCompletely

13. Patient Demographics 1

14. Patient Demographics 2

15. Results Attendance data Total of 32 patients referred to clinic over 6 month pilotTotal of 32 patients referred to clinic over 6 month pilot 20 attended at least one session20 attended at least one session 12 completed SRIT12 completed SRIT

16. Results 2 Results of SRIT: Baseline Self-reported sexual risk taking over a 3 month period (n=12) Total no. of episodes of UPAI over 3 month period (n=12) 277 Of which active UPAI31% Of which passive UPAI69% Average no. of episodes of UPAI per patient over 3 month period 23 Total Patients reporting unprotected fisting50% Total Patients reporting group sex75%

17. Result 3/Acceptability to Referrers The MI Clinic averaged 30% more referrals per month, over a six-month period, than were received by the general sexual health psychology service.

18. A Case Study - Paul Referred by HIV Consultant. HIV+ since 1998. CD4 of 600+; VL < 40, HCV-. Serosorted for sex, usually UPRAI, Multiple regular sex partners. Has used crystal meth with all. Presenting concern: Drug use had begun to impact on his life as he was taking days off work after crystal use, feared he would lose job -> nice flat and expensive lifestyle. Also fear of acquiring HCV.

19. Paul 2 Importance of reducing risk 10/10 Confidence of reducing risk 4/10 Readiness to change 7/10. Had four sessions and left quite confident in being able to make and sustain change. Ongoing support offered by HA team.

20. Paul 3 Had a clear STI screen at 3/12 post MI 5/12 later he contacted us as he had relapsed, and had twice engaged in UPRAI as a result of crystal. Was diagnosed with A2 and was very upset. Completed another 4 MI sessions, less resistant to change the second time as he had enjoyed five months of drugs-free sex with condoms.

21. References 1.National Institute for Health and Clinical Excellence (2007) Prevention of sexually transmitted infections and under 18 conceptions. PH3. London: National Institute for Health and Clinical Excellence 2.Herbst, J. H, Sherba, R Thomas; Crepaz, N; DeLuca, J; Zohrabyan, L; Stall, R; Lyles, C; and the HIV/AIDS Prevention Research Synthesis Team. (2005). A Meta-Analytic Review of HIV Behavioral Interventions for Reducing Sexual Risk Behavior of Men Who Have Sex With Men. Journal of Acquired Immune Deficiency Syndromes. 39(2), pp 228-241 3.Margetts, A & Ratcliffe, D. Sexual Risk Indicator Tool. Unpublished.