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1. opening The University of Illinois at Chicago Howard Brown Health Center Treatment Advocacy Program Sexual Safety Visit 2 • Safety Skills and • Focused Change Plans TAP: Sexual safety 2 12/9/03 1

2. Goals Our goals for this session: • Review your plans for safety & intimacy • Discuss specific safer sex skills • Focus on the topic you identified last time. TAP: Sexual safety 2 12/9/03 2

3. HIV Information • Before we begin…what questions do you have about: HIV / AIDS? HIV infection? HIV treatments? This program? Click for HIV Information overview TAP: Sexual safety 2 12/9/03 3

4. Review: Safety and Health Review: Why sexual safety is still important… What if you get a secondary infection to drug resistant HIV? • Transmitted by unsafe sex • Makes your HIV drugs less effective • Can be passed on to your partner TAP: Sexual safety 2 12/9/03 4

5. Review: Other STDs Why sexual safety is still important What if you get syphilis or gonorrhea? • Increases your viral load • Makes your HIV hard to control • Makes you more infectious TAP: Sexual safety 2 12/9/03 5

6. Review: Safety and Intimacy Why sexual safety is still important… How do safety & intimacy protect your partner? • Prevents new HIV infection • Fosters communication and caring TAP: Sexual safety 2 12/9/03 6

7. Review: Relationships & Sex Since our last session • How have things been going with relationships or sex? • Have your thoughts changed about sexuality or safety? • How about your safety / intimacy plans? • any chance to use them? • what went right / wrong? TAP: Sexual safety 2 12/9/03 7

8. Reviewing Module Choice Our next steps: • We’ll get back to: • Your safety plans • Your “focus” topic from last week • For now, let’s quickly review some safety basics TAP: Sexual safety 2 12/9/03 8

9. Male Condom Skills How do you make sure condoms are available? • When is it difficult have condoms & lube available? • How can you “set things up” to have them at hand? • How have your partners made condoms available? TAP: Sexual safety 2 12/9/03 9

10. Condom Choices • How do you choose the right condom? • Use extra strong condoms • Get the correct size • Use Latex Only • Use lots of lubricant outside TAP: Sexual safety 2 12/9/03 10

11. Skills Choice Menu • Would it be helpful to review some basic skills? • Putting on a condom • The female condom (RealityCondom) for Anal Sex • Using female condoms with women • Dental dams for rimming • Piercing • Injection drugs Basic sexual safety skills TAP: Sexual safety 2 12/9/03 11

12. Risk Model: Concerns and Risk Let’s talk about how personal concerns can lead to risk. Personal concern Personal concern or issue.. Risky behavior Risky choice based on that concern • Risk outcome • STD/ HIVexposure • Other negative outcome TAP: Sexual safety 2 12/9/03 12

13. Risk Model: Intimacy Example Here’s an example using the need for intimacy: Personal concern Personal concern or issue.. Risky behavior Risk outcome Desire for intimacy Sacrifice safety for “skin to skin” intimacy New STD or infect partner with HIV TAP: Sexual safety 2 12/9/03 13

14. Personal concerns Risky choicesor behaviors Outcomes Risk model: concerns, settings, outcomes Various concerns can set people up for risk or other “problem” outcomes… Sexual risk +: Depression, anxiety Stress or depression Use sex to change negative moods “Escape” during sex Hung over / over- using drugs Drugs or alcohol + sex Less true intimacy Difficulty disclosing HIV Poor sexual communication Barebacking / risky attitudes Risky partners, places, times Less control of sexuality TAP: Sexual safety 2 12/9/03 14

15. General concerns Risky choices Risk outcomes Risk Model; personal application • Let’s review your own concerns or behaviors to see where we should focus today… Key personal concern? (generally or from your worksheet last week..) Risky choices or behaviors it leads to? Possible results? TAP: Sexual safety 2 12/9/03 15

16. Risk Model Let’s choose one focus topic that fits best with your personal concerns about sexuality, intimacy and HIV… TAP: Sexual safety 2 12/9/03 16

17. Choice of Focus Module Click one: Basic safety skills • Male & female condoms, etc. • Negotiating sexual safety • Discussing intimacy & risk • Telling partners your HIV status Communication & HIV disclosure • Sex + drugs rewards & costs • Skills for controlling risk Alcohol & drugs Feelings & moods • Depression, anger, & risk Back to basic risk overview • Risky partners • Places & circumstances TAP: Sexual safety 2 12/9/03 17

18. Visit Summary • Visit Summary: • We have spoken about… • Your safety plans • Sexual safety skills • Your particular concern to focus on about safety TAP: Sexual safety 2 12/9/03 18

19. Checking in • How did it feel to talk with me about these topics? • Did we get a chance to discuss the topics that are important to you? • How could we have addressed your concerns better? TAP: Sexual safety 2 12/9/03 19

20. Additional Session? Do you want to schedule other session(s) to keep planning for intimacy and safety, or other issues in coping with HIV? Additional visit schedule: Day ____ / Date _________ / Time ______ TAP: Sexual safety 2 12/9/03 20

21. Schedule next visit for: • Next regular HIV visit: • Other day: _____/_____ Date time Next Regular Meeting At your next regular HIV care visit, we will… Check in on your safety plan Review your treatment coping and medication adherence TAP: Sexual safety 2 12/9/03 21

22. Advocate’s Notes & Checklist Visit Checklist • Safety Planning Worksheet • Referral sheet (if used) • Next appointment hand card • Remember: Call or e-mail if you have any questions or concerns Advocate: Complete Counseling Notes Form and Visit Log for file. TAP: Sexual safety 2 12/9/03 22