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Open. The University of Illinois at Chicago Howard Brown Health Center Treatment Advocacy Program Sexual Safety Visit 1 Planning for Sexuality & Intimacy. Module; Goals. Today we will discuss:. Your sexual values and goals

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

  2. Module; Goals Today we will discuss: • Your sexual values and goals • Issues that are most important for you in sexuality, intimacy and safety • Your concerns about sexuality, intimacy and safety • Plans you might want to make for sexual safety and intimacy TAP: Sexual Safety 1. 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 TAP: Sexual Safety 1. 12/9/03 3

  4. Continuing Safety: Super Infection Even though you are HIV+, sexual safety is still important: • You can be infected with a whole new strain of HIV • The new strain would be resistant to your current HIV drugs • It may be resistant to other drugs • Makes your HIV drugs less effective • Makes your treatment very difficult TAP: Sexual Safety 1. 12/9/03 4

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

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

  7. Continuing Safety: Drug Resistant Strains Sexual safety is still important: • You can transmit drug resistant HIV to others by unsafe sex • Half of new infections are resistant to an 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 TAP: Sexual Safety 1. 12/9/03 7

  8. Safety: Bottom Line • Bottom Line: • Safety is still important • To protect your partners • For your own protection We are here to help infected men remain safe and develop intimacy TAP: Sexual Safety 1. 12/9/03 8

  9. Sexuality and Intimacy, 1 How has being infected changed your relationship(s) or sex life? • Let’s begin by talking about sexuality and intimacy • Dating & sex? • Feelings about yourself? • Feelings about your partners? • Steady relationships? TAP: Sexual Safety 1. 12/9/03 9

  10. Personal concerns What are your personal concerns about sex and safety? • How often do you think about safety? • What risks -- to yourself or your partner -- worry you? • What would you gain by being safer? • What would you lose by being safer? TAP: Sexual Safety 1. 12/9/03 10

  11. Sexuality and Intimacy How would you like your sex life to be different? • New or more partners? • Fewer partners? • More intimacy or closeness? • Keep partners safe? • Avoid new STDs? • Talk about HIV with partners? • Anything else? TAP: Sexual Safety 1. 12/9/03 11

  12. Sexuality and Intimacy, 2 How satisfied are you with your relationships or dating? • What is going well? • What would you like to see different? TAP: Sexual Safety 1. 12/9/03 12

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

  14. Coping With Sexual Safety • How are you handling sexual safety now? • Not having sex? • Steady, safe relationship? • Only HIV+ partner(s)? • Negotiating condoms with partners? • Disclosing HIV status to partner(s)? • Avoiding alcohol or drugs + sex? • No real plans? • Anything else? TAP: Sexual Safety 1. 12/9/03 14

  15. Personal Risk Review, Behaviors How many different sex partners have you had? (3 months..) Over the past 3 months or so: • 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? TAP: Sexual Safety 1. 12/9/03 15

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

  17. Personal Risk Review, personal risks So… the things you consider personally risky are.. • Are you comfortable with these risks? Cite high / mod. risks Of the behaviors you consider risky… …which do you actually do? TAP: Sexual Safety 1. 12/9/03 17

  18. Personal Risk Review, risk attitudes • What makes your risky behaviors more likely? Certain… • Partner(s)? • Moods or feelings? • Alcohol or drugs? • Other things? TAP: Sexual Safety 1. 12/9/03 18

  19. Moods & Risk Screen Your moods in general • 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? 0 1 2 3 4 none at all a little some a fair amount very much TAP: Sexual Safety 1. 12/9/03 19

  20. Places & partners screen How much do you find that some places or times just make it difficult to stay safe? 0 1 2 3 4 none at all a little some a fair amount very much How often do partners make it difficult to stay safe? 0 1 2 3 4 not at all a little some a fair amount very often TAP: Sexual Safety 1. 12/9/03 20

  21. Condom hassle Thinking generally: How much is the hassle of using a condom an issue for you? How so? TAP: Sexual Safety 1. 12/9/03 21

  22. Recent Risk Analysis, Basic Skills How comfortable are you in putting on & using condoms? How about using female condoms? How much do you avoid condoms because of the hassle of using them? 0 1 2 3 4 none at all a little some a fair amount very much Or return to skills later.. Click for Basic safety skills TAP: Sexual Safety 1. 12/9/03 22

  23. Attitudes screen How much do your attitudes toward sex affect whether you use condoms? • Tired of safe sex • Intimacy is more important than safety • HIV meds make safety less important • Your partner is responsible for his/her own safety 0 1 2 3 4 none at all a little some a fair amount very much TAP: Sexual Safety 1. 12/9/03 23

  24. Alcohol or drug screen How much of the time are you high on alcohol or drugs during sex? How much does getting high make it difficult to stay safe? 0 1 2 3 4 none at all a little some a fair amount very much TAP: Sexual Safety 1. 12/9/03 24

  25. Key concerns What are your key concerns about safety and intimacy? • Safe + pleasurable behaviors you might increase? • Most typical “risk triggers”? • Times you are able to “override” your risk triggers? TAP: Sexual Safety 1. 12/9/03 25

  26. Recent Risk Analysis Think of recent sex episode that was... • 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. TAP: Sexual Safety 1. 12/9/03 26

  27. Recent Risk Analysis, What & where.. Thinking about a recent time when it was difficult to be safe What was happening? • What was the risk? • What were you doing / where were you? • Where did you meet your partner? TAP: Sexual Safety 1. 12/9/03 27

  28. Recent Risk Analysis, What & where.. Thinking about that risky time… • 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? TAP: Sexual Safety 1. 12/9/03 28

  29. Recent Risk Analysis, Partner A recent risky time: Who was your partner? • Steady / primary? • Casual or anonymous? • Internet partner? • Particularly “hot”? • Coercive? • Trading sex for money or drugs? • “Barebacker” / risky sexual attitudes? How did your partner make safety difficult? TAP: Sexual Safety 1. 12/9/03 29

  30. * Coping Interview Recent Risk Analysis, Attitudes What were your sexual attitudes? A recent risky time: How much did you feel… • Tired of safe sex? • Intimacy is more important than safety? • HIV meds make safety less important? • Your partner is responsible for his/her own sexual safety? TAP: Sexual Safety 1. 12/9/03 30

  31. Recent Risk Analysis, Communication How did you and your partner talk about safety? Thinking about recent risk… • His / her HIV status? • Safety, or what kind of sex to have? Did you talk about…?: • Your HIV status? What did your partnersay about HIV or safety? TAP: Sexual Safety 1. 12/9/03 31

  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? 0 1 2 3 4 none at all a little some a fair amount very much TAP: Sexual Safety 1. 12/9/03 32

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

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

  35. Recent Risk Analysis, Positive Moods • Celebration? • Love, intimacy? • Horniness? • Anything else? Thinking back to your moods and feelings during that recent time What positive feelings do you remember? TAP: Sexual Safety 1. 12/9/03 35

  36. Recent Risk Analysis, Negative Moods • Stress or depression • Loneliness or isolation • Angry or frustrated at being HIV+ • Anything else? What negative feelings do you remember? TAP: Sexual Safety 1. 12/9/03 36

  37. Recent Risk Analysis, Negative Moods How did your mood or feelings make it difficult to be safe then? TAP: Sexual Safety 1. 12/9/03 37

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

  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? TAP: Sexual Safety 1. 12/9/03 39

  40. Show risk profile • Advocate: show “Risk Profile” of scores on sexual risk items. TAP: Sexual Safety 1. 12/9/03 40

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

  42. Safety Plan Intro • Moving toward a safety & intimacy plan Let’s use your concerns -- and strengths -- to write a safety plan. Here is an example… TAP: Sexual Safety 1. 12/9/03 42

  43. An example of a personal Concerns Goals Action steps Personalgoal(s) for each area? Choose safer partners Be aware of emotions Specific stepsto reach each goal? Sexual planning Moods & feelings module, therapy Whatdo you want to change….? Unsafe sex with tricks when angry or sad Talk to partners about HIV & meds Take meds on time Communication rehearsal & plan Treatment skills Missed medication doses during sex Talk to partners about HIV Safe paths to intimacy Communication skills New relationships Feeling more intimate with sex partners TAP: Sexual Safety 1. 12/9/03 43

  44. Safety Planning Click for Safety & Treatment worksheet Your own safety plan: • Concerns: What do you want to change? • Goals: How would you like it to be different? • Action Steps: What can you do to achieve your goal? TAP: Sexual Safety 1. 12/9/03 44

  45. Safety Planning, 2 Click for Safety & Treatment worksheet • To help us with action steps… • What has worked in the past? • What is concrete and feasible -- what can you actually do? • What are the first steps? • How will you know if you are successful? • What else should we include? TAP: Sexual Safety 1. 12/9/03 45

  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. TAP: Sexual Safety 1. 12/9/03 46

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

  48. Checking in • About today’s visit 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? Remember: Call or e-mail if you have any questions or concerns. TAP: Sexual Safety 1. 12/9/03 48

  49. Advocate’s Notes & Checklist Visit Checklist • Safety Planning Worksheet • Referral sheet (if used) • Next appointment hand card Advocate: Complete Counseling Notes Form and Visit Log for file. TAP: Sexual Safety 1. 12/9/03 49

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

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