Understanding Sexual Risk: What Nurses Need to Know

1. Understanding Sexual Risk: What Nurses Need to Know Gwendolyn D. Childs, PhD, RN NSNA Annual Conference April 3-7, 2013

2. Objectives • Differentiate between sexuality and sexual health. • Identify and discuss sexual risk factors. • Describe types of questions to ask regarding sexual health and sexual behavior • Discuss the incidence of sexually transmitted infections including HIV in the U.S.

3. Sexuality • Describes the expression of sexuality in terms of gender, appearance, behavior, personality, pleasure, sexual intercourse and reproduction • Involves an individual's physical, emotional, intellectual and social aspects • An individual's self-concept, shaped by their personality and expressed as sexual feelings, attitudes, beliefs and behaviors through a heterosexual, homosexual, bisexual or transsexual orientation Retrieved from http://www.nursingtimes.net/taking-a-sexual-history-the-role-of-the-nurse/206467.article

4. Sexual Health • The World Health Organization defines sexual health as a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. Retrieved from http://www.who.int/reproductivehealth/topics/gender_rights/sexual_health/en/

5. Sexuality vs Sexual Health • While sexuality refers to issues of gender, identity, self-esteem and self-expression (Masters et al, 1995), sexual functioning relates to whether the body is working normally or whether it is (or will be) impaired. Sexual health is an essential component of general health and includes the prevention of unplanned pregnancies and sexually transmitted diseases. Retrieved from http://www.nursingtimes.net/taking-a-sexual-history-the-role-of-the-nurse/206467.article

6. Sexual Health Topics • Sexually transmitted infections including HIV • STI and HIV prevention • Pregnancy prevention • Reproductive health • Sexual violence prevention • Healthy pregnancy

7. To facilitate effective communication about sexual health • Provide patients with current information regarding sexual health. • Be aware and respectful of their patients’ sexual values and lifestyles. • Acknowledge their patients’ feelings, attitudes, and norms that may be obstacles to individual sexual health and use this information to help patients establish realistic goals. Retrieved from http://www.arhp.org/publications-and-resources/clinical-fact-sheets/sexuality-and-sexual-health

8. To facilitate effective communication about sexual health • Assist patients with development of skills they may need to achieve personal goals for sexual health (e.g., communication, negotiation, and planning strategies). • Understand how values of the health care provider or the clinical setting may influence practices and take care to provide unbiased and comprehensive care. Retrieved from http://www.arhp.org/publications-and-resources/clinical-fact-sheets/sexuality-and-sexual-health

9. Providers must • Understand their own feelings about sexual matters • Be willing to speak truthfully at the risk of increasing their own vulnerability • Be able to listen and interpret patients’ sexual values, experiences, and concerns Retrieved from http://www.arhp.org/publications-and-resources/clinical-fact-sheets/sexuality-and-sexual-health

10. Providers must • Be willing to reply honestly and clearly to patients’ sexual concerns • Encourage enough trust from the patient to permit open communication about sex • Participate in continuing education activities focused on sexual health Retrieved from http://www.arhp.org/publications-and-resources/clinical-fact-sheets/sexuality-and-sexual-health

11. Taking a sexual history • Are you currently involved in a sexual relationship? • Do you have sex with men, women, or both? • Are you or your partner having any sexual difficulties at this time? • Are you satisfied with your current sexual relations? • Do you have any sexual concerns you would like to discuss? Retrieved from http://www.arhp.org/publications-and-resources/clinical-fact-sheets/sexuality-and-sexual-health

12. Other questions • Tell me about your sexual history— first sexual experiences, masturbation, how many partners you’ve had, any sexually transmitted infections or sexual problems you’ve had, and any past sexual abuse or trauma. • How often do you engage in sexual activity? Retrieved from http://www.arhp.org/publications-and-resources/clinical-fact-sheets/sexuality-and-sexual-health

13. Other questions • What kinds of sexual activities do you engage in? • Depending on the sexual orientation of the patient, ask about the specific forms of sex, including penis in mouth, vagina, or rectum; mouth on vulva. • If the patient is a lesbian, ask if she has ever had penetrative sex with a man, to assess risk of cervical cancer and sexually transmitted infections. • Do you have difficulty with desire, arousal, or orgasm? (If the woman is peri- or postmenopausal, begin by noting that many women experience vaginal dryness and changes in sexual desire around the time of menopause.) Retrieved from http://www.arhp.org/publications-and-resources/clinical-fact-sheets/sexuality-and-sexual-health

14. Being Sexually Healthy Retrieved from http://www.actforyouth.net/health_sexuality/sexual_health/

15. Beyond the Sexual Health History • Taking a sexual history is part of the admission or check-in process. Why should I be concerned about it beyond that point?

16. If your patient is sexually active, he/she is at risk.

17. What are Sexual Risk Factors? • Having unprotected sex • Sexual contact with multiple partners • History of sexually transmitted infections • Alcohol abuse • Use of recreational drugs • Injection drugs • Being an adolescent female Retrieved from http://www.mayoclinic.com/health/sexually-transmitted-diseases-stds/DS01123/DSECTION=risk-factors

18. Chlamydia—Rates by State, United States and Outlying Areas, 2011 NOTE: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 454.1 per 100,000 population. Retrieved from http://www.cdc.gov/std/stats11/slides.htm 2011-Fig 3. SR

19. Gonorrhea—Rates by State, United States and Outlying areas, 2011 NOTE: The total rate of gonorrhea for the United States and outlying area (Guam, Puerto Rico, and Virgin Islands) was 103.1 per 100,000 population. Retrieved from http://www.cdc.gov/std/stats11/slides.htm 2011-Fig 19. SR

20. Primary and Secondary Syphilis—Rates by State, United States and Outlying Areas, 2011 NOTE: The total rate of primary and secondary syphilis for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 4.5 per 100,000 population. Retrieved from http://www.cdc.gov/std/stats11/slides.htm 2011-Fig 40. SR

21. Retrieved from http://www.cdc.gov/hiv/topics/surveillance/resources/slides/general/index.htm

22. Retrieved from http://www.cdc.gov/hiv/topics/surveillance/resources/slides/general/index.htm

23. Retrieved from http://www.cdc.gov/hiv/topics/surveillance/resources/slides/general/index.htm

24. Retrieved from http://www.cdc.gov/hiv/topics/surveillance/resources/slides/general/index.htm

25. Every Nurse is an HIV Nurse!

26. Association of Nurses in AIDS Care (ANAC)

27. Association of Nurses in AIDS Care HISTORY The Association of Nurses in AIDS Care (ANAC) was founded in 1987 by a small group of nurses to assist other nurses in meeting the challenges of providing quality care to all persons living with and at risk for HIV infection. More than 25 years after that first meeting of about a dozen nurses, ANAC has grown to over 2,000 members and 41 local chapters. ANAC is a leading voice in all areas of HIV care, prevention, education, research, and policy.

28. ANAC – Our Mission MISSION STATEMENT To promote the individual and collective professional development of nurses involved in the delivery of health care to persons infected or affected by HIV and to promote the health and welfare of infected persons. This is accomplished through an effective network of AIDS care nurses who come together to exchange information, ideas and experiences. ANAC is THE professional organization for HIV/AIDS nurses.

29. ANAC – About Us • LEADERSHIP Includes local chapter officers, national committee chairs, editors and the national Board of Directors. ANAC has developed relationships with national AIDS service organizations, national nursing organizations and international nursing colleagues committed to HIV/AIDS care. • RESEARCH The Association is conducts critical research, such as needs assessments for the non-HIV specialist nurses, that lead to improved consumer care. • CERTIFICATION PROGRAM FOR HIV NURSES ANAC supported the development of a sister corporation, HIV/AIDS Nursing Certification Board (HANCB) which administers a semi-annual certification exam.

30. ANAC – Our Work • ANNUAL CONFERENCE Includes: plenary addresses, clinically focused sessions, research updates, noted experts, networking opportunities. • JOURNAL OF THE ASSOCIATION OF NURSES IN AIDS CARE (JANAC) Ahighly respected peer reviewed journal published bimonthly (with periodic special focused issues and supplements) by Elsevier publications. The only HIV/AIDS nursing journal published in the United States. • POSITION STATEMENTS On current clinical and policy issues related to HIV/AIDS prevention and care and to HIV/AIDS nursing practice. • AWARDS ANAC presents a number of awards annually to exceptionally qualified members nominated by their peers.

31. ANAC 2013 November 21-23, 2013 Atlanta, GA Westin Peachtree Plaza Student Diversity Mentorship Scholarship

32. Contact Information Gwendolyn D. Childs, PhD, RN University of Alabama at Birmingham School of Nursing gchilds@uab.edu