Sexual Health for Methamphetamine Users

1. Supporting Sexual Health for Methamphetamine Userswith Harm Reduction CounselingHeather LuskHepatitis C CoordinatorHawai`i Department of HealthLusk@lava.net

2. Sexual Health for Methamphetamine Users • Definition of sexual health • Overview of effects of meth • Framework for addressing sexual health • Theories for harm reduction counseling • Assessing sexual health and harm • Harm reduction techniques • Resources

3. Definition of Sexual Health Sexual health is a state of physical, emotional, mental and social well-being related 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. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled. –World Health Organization

4. Some Components of Sexual Health • Strong sense of self and sexual identity • Know likes and dislikes and be able to articulate them to others • Feel positive about sexual experiences before, during and after • Negotiation skills to feel good and be safe • Comfort in sexual expression • Self-esteem and self-efficacy are multidimensional – not just about sex life • Regular physical check-ups, screenings for HIV, STDs, viral hepatitis, breast, cervical and prostate cancer

5. Increase in: Energy Dopamine Respiration Heart rate Body temperature Dehydration Tooth decay/loss Constriction of blood vessels Blood clotting Blood pressure Erection Decrease in: Fatigue Appetite/thirst Digestion Elimination Natural neurotransmitters Pain sensations and pain threshold Erection Reaching orgasm Physical Effects of Meth

6. Increase in: Focused attention Confidence Sexual drive Sexual arousal Aggression Paranoia/anxiety Risk-taking Self focus Decrease in: Abstract thinking Seeing consequences Inhibitions Decision-making abilities Sense of time Awareness of others Psychological Effects of Meth

7. A Soapbox Moment about Hepatitis C and Sex • Transmission is through blood-to-blood contact (can live outside body up to 4 days) - meth can be a bloody drug • According to the 2002 NIH Consensus Statement on Hepatitis C: Seven US studies of long-term discordant partners found 1.5 - 3% seroprevalence of HCV. Other studies of MSM, sex workers, and those with history of STD found prevalence of 4-6% • Risk may be increased when trauma is present • Dehydration and decreased pain sensations may mean more openings in skin and membranes as entry for virus • Meth may lead to longer and/or rougher sex sessions – without lube, may create openings • “Booty bumping” may affect anal membranes

8. Sex, Meth and Culture • What are the cultural norms that may impact someone’s sexual health? • How does family, community, media, religion, spirituality impact sexual health? • What about racism, sexism, homophobia, transphobia? • How does the culture of meth impact sexuality? • How do societal sexual expectations affect sexual health? • What about 25 years of HIV?

9. Framework for Reducing Sex-Related Harm • Know your role • Be in touch with your own values/beliefs • Meet person where they’re at • Assess sexual health and potential for sexual harm • Explore options to support sexual health while reducing sex-related harm • Next steps

10. Theories and Models that Support Harm Reduction Counseling • Motivational Interviewing – identifying and resolving ambivalence towards change • Transtheoretical Model of Behavior Change (Stages of Change) – identifying readiness to change and matching services appropriately • Drug, Set and Setting – exploring the context surrounding drug use

11. Assess Sexual Health and Harm • Client/participant defined • Always balance harm with benefit • Increasing sexual health and well-being often minimizes harm • Acknowledge the impact of sexism, racism, classism, homophobia on sexuality • Identify what person gets out of experience (and reduce any shame) • Validation and respect for choices (don’t yuk someone else’s yum)

12. Risk/Harm and Strength/Asset Assessment • Explore reasons for using • Explore pros/cons of using • Explore method of meth administration • Explore patterns of use – especially relationship of use with sex • Explore interpersonal relationship dynamics • Identify previous success and attempts at reducing harm • Identify support network and needs

13. Exploring Sex and Meth • What is the difference between the sex with meth and without it? • What fantasies does meth give “permission” for? What purpose does it serve? • What is worst case scenario of having sex without meth? Best scenario? • How does meth affect sex both physically and psychologically? • How do you feel before, during and after sex?

14. Harm Reduction Strategies for Meth Users • Lube, lube lube! • Barrier use • Check for trauma, openings, abrasions • Viral hepatitis, STD and HIV checks • Method of meth administration • Communication and safe words • If douching, use only water

15. Harm Reduction StrategiesBeyond the Physical • Explore self and body image • Values clarification about sex • Enhance negotiation skills • Empowerment with decision making • Separate identity from behavior • Identify where self esteem is held • Explore sexual likes and dislikes • Sexual anatomy and physiology of pleasure • Explore and deconstruct sexual roles

16. Resources • Good Vibrations 1-800-289-8423 www.goodvibes.com • Motivational Interviewing: www.motivationalinterview.org • Society for Human Sexuality www.sexuality.org • www.tweaker.org and www.crystalneon.org • Please support the Hepatitis C Epidemic Control and Prevention Act (S 521 and HR 1290) http://www.hepcchallenge.org/resourcecenter1.htm