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The University of Illinois at Chicago Howard Brown Health Center Treatment Advocacy Program

The University of Illinois at Chicago Howard Brown Health Center Treatment Advocacy Program Coping Follow-up Visits. TAP model check-in. Health & Well Being. …review the two main health areas. Welcome back to TAP… this visit we will:. Feelings & Moods. Support & Disclosure.

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The University of Illinois at Chicago Howard Brown Health Center Treatment Advocacy Program

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  1. The University of Illinois at Chicago Howard Brown Health Center Treatment Advocacy Program • Coping Follow-up Visits TAP: Follow-up Visits 9/27/04 1

  2. TAP model check-in Health & Well Being …review the two main health areas.. Welcome back to TAP… this visit we will: Feelings & Moods Support & Disclosure • Sexual Safety • Treatment Adherence Alcohol & Drug use And coping areas that are important to them.. TAP: Follow-up Visits 9/27/04 2

  3. HIV information • Before we begin…what questions do you have about: HIV / AIDS? HIV infection? HIV treatments? This program? HIV Information TAP: Follow-up Visits 9/27/04 3

  4. HIV Coping Check-in… How have things been with.. • Medications & treatment? • Sexuality & intimacy? Any issues since we met last? Areas where things are going.. • Particularly well? • Difficult? TAP: Follow-up Visits 9/27/04 4

  5. Safety: New STDs and health HIV Information Review: Safety is still important. • Not pass on HIV • Avoid drug-resistant strain of HIV • Keep from contracting a new STD (syphilis, gonorrhea…) • Worsens your HIV • Being HIV+ makes STDs harder to treat TAP: Follow-up Visits 9/27/04 5

  6. Review: Adherence & medication effectiveness 90% adherence 2 - 3 missed doses per month About 65% effective 80% adherence 1 - 2 missed doses per week About 50% effective 70% adherence 3 - 4 missed doses per week About 25% < 70% adherence 5 or more misses / week Less than 10% effective Adhering to treatment is also critical… 95% adherence 0 - 2 missed doses per month Full Adherence: Over 80% effective Bottom Line: • 95% of doses • On time (+/- 2 hours) TAP: Follow-up Visits 9/27/04 6

  7. Adherence Information: Safety + Adherence = Health HIV Information • Remember the two basic HIV health formulas: Safer sex = Avoid HIV “Super-infection” Avoid STD infections + Not pass on HIV + Full Adherence = T-cells + + Viral load Resistance TAP: Follow-up Visits 9/27/04 7

  8. Begin sexuality Are you dating, or have you had any sex partners since we spoke last?(male or female) No Yes • Let’s begin discussing sexuality and intimacy -- TAP: Follow-up Visits 9/27/04 8

  9. Not dating • How have you thought about intimacy? • Is this something you are lacking? • What goals and plans might you make for dating or intimacy? Is this a concern for you? TAP: Follow-up Visits 9/27/04 9

  10. Sexuality & intimacy How you are doing with relationships and dating now? • What is going well? • How satisfied are you? • What would you change? How about sexual safety…? • Successful safety strategies…? • Concerns or issues? TAP: Follow-up Visits 9/27/04 10

  11. Coping with Sexual Safety Any changes in your comfort with safety or risk? • How much are you focusing on this now? • How confident are you in your safety strategies? • Any risks to yourself or partner(s) that concern you? TAP: Follow-up Visits 9/27/04 11

  12. Sexuality: Risks. • Coping Interview Over the past 3 months or so… How often have you “slipped” on your safety guidelines and done something risky for yourself or your partner? 0 1 2 3 4 5 never rarely; once or twice once a week several times about perhaps once a month or so a week every day TAP: Follow-up Visits 9/27/04 12

  13. Sexuality; Partners & risk Over the past 3 months or so… Have you had unprotected anal or vaginal sex? If yes: with anyone who was not HIV+? Click one to advance: Any slip or UPA No slip or UPA TAP: Follow-up Visits 9/27/04 13

  14. Click an option • Advocate; please go back and click one option TAP: Follow-up Visits 9/27/04 14

  15. Recent Risk Analysis, What & where.. Thinking about a recent time when you had unsafe sex or “slipped”… What was happening? • Where did you meet your partner? • What was going on… • What were you doing • where were you? • Were condoms / lube available? • What made it difficult to use a condom? TAP: Follow-up Visits 9/27/04 15

  16. * Recent Risk Analysis, Place & condom.. Coping Interview What about the time or place made safety difficult? How much was the hassle of using a condom an issue for you? TAP: Follow-up Visits 9/27/04 16

  17. Recent Risk Analysis, Partner Who was your partner? A recent risky time: • Steady / primary? • HIV status? (+? --? Unknown?) • Casual or anonymous? • Internet partner? • Particularly “hot”? • Coercive? • Trading sex for money or drugs? • “Barebacker” / risky sexual Attitudes? TAP: Follow-up Visits 9/27/04 17

  18. * Recent Risk Analysis, Partner, 2 Coping Interview Did you tell your partner(s) you are HIV+? No Yes How did your partner make safety difficult? TAP: Follow-up Visits 9/27/04 18

  19. Risk analysis: non-disclosure Why did you not disclose your status? • afraid would not get sex • felt stigmatized • time / place / mood did not feel right • too high How did that affect risk? Would the same sex have happened? How could you be safe without telling? TAP: Follow-up Visits 9/27/04 19

  20. Recent Risk Analysis, Communication How did you and your partner talk about HIV…? • your HIV status? • his / her HIV status? • safety, or what kind of sex to have? Did you talk about: What made talking about safety or risk difficult…? TAP: Follow-up Visits 9/27/04 20

  21. Recent Risk Analysis, Alcohol & Drugs How were alcohol or drugs involved? A recent risky time: Were you high? … on what? Was your partner high? … on what? How did being high make sex better? … more intense? … more comfortable? How did being high lead to risk? … less communication? … less concerned with risk? TAP: Follow-up Visits 9/27/04 21

  22. Recent Risk Analysis, Positive Moods • Celebration? • Love, intimacy? • Horniness? • Anything else? What positive feelings do you remember? Thinking back to yourmoods and feelings… TAP: Follow-up Visits 9/27/04 22

  23. 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: Follow-up Visits 9/27/04 23

  24. Recent Risk Analysis, Negative Moods How did mood or feelings affect whether you were safe or risky…? How important are moods and feelings to your risk generally? Do moods or feelings affect whether... you are high during sex? you disclose your HIV+ status? TAP: Follow-up Visits 9/27/04 24

  25. * Recent Risk, Triggers Coping Interview • What made it most difficult to be safe then? Let’s summarize that time, and begin thinking about safety plans… What were the“active ingredients” for you? • the place or time…? • your partner(s)…? • disclosing HIV status…? • alcohol or drugs? • moods-feelings? • other “risk triggers”? TAP: Follow-up Visits 9/27/04 25

  26. Recent Risk, Changes How typical is this risk pattern? • What are your key concerns about safety and intimacy? • Most typical “risk triggers”? • Times you are able to “override” your risk triggers? TAP: Follow-up Visits 9/27/04 26

  27. Sexuality or intimacy plans? • Let’s keep your concerns about intimacy and sexuality in mind when we make plans at the end. TAP: Follow-up Visits 9/27/04 27

  28. Begin adherence • Let’s talk about treatment and adherence… Any medication changes since we last met? Yes No Not taking meds now TAP: Follow-up Visits 9/27/04 28

  29. Changes in Meds • New HIV medications? • Non-HIV meds? • Pharmacy & provider contact info.? • Any side effects? • Number of doses each day? • Which pills at which times? • Food or other restrictions? • Rewrite Medication Overview if needed TAP: Follow-up Visits 9/27/04 29

  30. Adherence Skills Check-in… How are you using it? Ways you have found it useful? Tracking missed doses? Barriers toward using it? How has your pill box been working? How about your cue controls? What cues or reminders been effective? How should we change it? TAP: Follow-up Visits 9/27/04 30

  31. Adherence: Missed doses • Coping Interview In general, how difficult has it been to take meds consistently? 0 1 2 3 4 not at all a little somewhat fairly well very much Have you missed any medication dose since we met last? No Yes Click one Let’s review how you are doing… TAP: Follow-up Visits 9/27/04 31

  32. Overall adherence • Coping Interview In general, how often do you miss a dose? 0 1 2 3 4 5 never once a month several times once a week several times about or so a month or so a week every day How many HIV doses did you miss during the last week? ______ How many doses did you take late (+ 2 hours) last week? ______ TAP: Follow-up Visits 9/27/04 32

  33. Difficult Doses • Let’s talk about doses that are difficult to remember or take… TAP: Follow-up Visits 9/27/04 33

  34. Difficult doses: Adherence Difficulties.. Think of a time when you missed a dose… What was going on then? Can you tell me the story of what happened? TAP: Follow-up Visits 9/27/04 34

  35. Difficult doses: detail Let’s keep these in mind as we develop some plans for adherence later… How important was… People who were with you…? Feelings or moods? Alcohol or drugs? Being with lover or sex partner? Anything else? TAP: Follow-up Visits 9/27/04 35

  36. Maintaining Adherence.. What has HELPED you stay on your medications? Commitment to health? Provider or clinic? Pill box, cues, dose planning? Family or friends? Lover or partner? Support group or counselor? Church or spiritual group? Tolerance to side effects? What else? How have these helped? TAP: Follow-up Visits 9/27/04 36

  37. Coping difficulties… What has made it DIFFICULT to take your meds? • Difficulty planning? • Problems with HIV care? • Side effects? • Partners or lovers? • Not talking to people about HIV? • Depression or “treatment burnout”? • Alcohol or drug use? • What else? TAP: Follow-up Visits 9/27/04 37

  38. Deal with adherence difficulties • How have you dealt with these difficulties? Where would goals and plans help with these issues? TAP: Follow-up Visits 9/27/04 38

  39. Moods, intro • Now let’s talk about some general coping areas… • Beginning with Moods. TAP: Follow-up Visits 9/27/04 39

  40. Moods & risk screen, 1 • Coping Interview Over thepast few weeks, how often have you felt sad, depressed, or angry… (Click response to advance..) 0123 less than 1 day 1 or 2 days several days most days a week a week a week TAP: Follow-up Visits 9/27/04 40

  41. Moods & risk screen, 2 • Coping Interview • 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: Follow-up Visits 9/27/04 41

  42. Moods, 1 When do moods interfere with your meds or make it difficult to be sexually safe? • Which moods? • When do you feel them? • How do they get in the way? • How have you dealt with them? Should we discuss a referral or some program ideas after the session? TAP: Follow-up Visits 9/27/04 42

  43. Moods, 2 What helps with negative moods? • What keeps you on track when you are depressed or angry? • When does that strategy not work well? Some possible strategies… • Keep your medication schedule even if you drop other activities. • Don’t have sex when depressed or angry. • Go to the clinic or call your advocate! TAP: Follow-up Visits 9/27/04 43

  44. Moods, 3 Who can help during negative moods? • Friend / neighbor? • Lover / partner? • Support group? • Provider or medical staff? How can you approach them? We will keep all these issues in mind when we address coping plans at the end… TAP: Follow-up Visits 9/27/04 44

  45. Social Support & Disclosure • Now let’s address support you get for treatment and safety, and talking about HIV with others. TAP: Follow-up Visits 9/27/04 45

  46. Sources of support • Coping Interview • Lover / partner • Friends / co-workers • Parents • Other family (sibs..) • Children • Support group • Counselor • Clergy / spiritual • Case manager • Health care • Anyoneelse: • Who do you have to help you deal with HIV or HIV treatment? TAP: Follow-up Visits 9/27/04 46

  47. Practical & emotional support • Coping Interview • How much practicalsupport do you get from others for HIV? (transportation, help with children, money…) How much emotional support do you get…? (talking about HIV, sharing personal concerns…) 0 1 2 3 4 none not enough moderate fair amount a lot TAP: Follow-up Visits 9/27/04 47

  48. Social Support; Planning • …goals? • What are your concerns about practical or emotional support for HIV? TAP: Follow-up Visits 9/27/04 48

  49. Social Support; overall disclosure. • Coping Interview Let’s talk about HIV disclosure. Thinking of people you are close to…. … how many have you told about your HIV status? 0 1 2 3 4 none less than about half more than most or all half half How about sex partners? TAP: Follow-up Visits 9/27/04 49

  50. Non-disclosure difficulties Has not talking about HIV -- or people not knowing you are infected… -- ever made it difficult to take your meds? -- ever made it difficult to stay safe, or be comfortable during sex? TAP: Follow-up Visits 9/27/04 50

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