1. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 1 The University of Illinois at Chicago Howard Brown Health Center Treatment Advocacy Program Alcohol & drug use and sexual safety Opening slide

2. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 2 TAP: Alcohol - drug use & sex, goals Describe how alcohol / drugs may increase your sexual risk. Develop plans to lessen drugs + sex risk. Goals: Explore when you combine alcohol or drugs with sex.

3. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 3 Alcohol-drugs & sex; overview, 1. With certain partners? With certain partners? Certain places or times? Certain places or times? Certain moods or feelings? Certain moods or feelings? When are you most likely to be high during sex?

4. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 4 Alcohol-drugs & sex; overview, 2 Drugs that: Drugs that: Are there particular drugs you combine with sex? “Sex drugs” that make sex better? “Sex drugs” that make sex better?  your partner likes?  make safety difficult?  make you relaxed or confident?

5. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 5 Alcohol-drugs & sex; positives. More sexually intense? More sexually intense? Less sad, depressed, angry Less sad, depressed, angry “Forget about” HIV and risks? “Forget about” HIV and risks? Get your partner relaxed or “willing”? Get your partner relaxed or “willing”? How does being high make sex better?

6. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 6 Alcohol-drugs & sex; negatives. Concern about risk? Concern about risk? Less close to partner? Less close to partner? Hangover / concern about use? Hangover / concern about use? Other things Other things How does being high make sex worse?

7. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 7 Alcohol-drugs & sex; questionnaire intro. We will use these questions to begin developing change plans. We will use these questions to begin developing change plans. For these questions “getting high” means alcohol or other drugs For these questions “getting high” means alcohol or other drugs This section asks how alcohol or drugs affect you personally.

8. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 8 Questionnaire; Social facilitation How much does being high help you feel self-confident or make it easier to talk to people? Confidence 01234 01234 not at alla littlesomea fair very much amount amount Click one

9. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 9 Social facilitation; discussion Easier to relax? Easier to relax? More “in the moment”? More “in the moment”? Not thinking as much? Not thinking as much? How does being high help your self- confidence? What concerns do you have? Amount of alcohol or drugs? Amount of alcohol or drugs? Areas you might want to change? Areas you might want to change? Note for worksheet Particular times / places / people?

10. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 10 Questionnaire; sexual enhancement How much do you associate being high with particularly good or intense sex? Better sex 01234 01234 not at alla littlesomea fair very much amount amount Click one

11. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 11 Sexual enhancement; discussion Easier to have the sex you want? Easier to have the sex you want? Simple sensation? Simple sensation? More “in the moment”? More “in the moment”? Easier to keep erection / mood ? Easier to keep erection / mood ? Partner(s) more willing or relaxed? Partner(s) more willing or relaxed? How does being high help with sex? What concerns do you have? Other ways to enhance sex? Other ways to enhance sex? Areas you might want to change? Areas you might want to change? Note for worksheet

12. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 12 Questionnaire; Cognitive escape How much does being high help you to not think about HIV? Escape 01234 01234 not at alla littlesomea fair very much amount amount Click one

13. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 13 Escape; discussion When is it difficult to think about HIV or HIV status?  More anxious or self-conscious?  Worried about talking to partner?  Feel less desirable? How does thinking about HIV affect sex? How do alcohol or drugs help you not think about HIV? Certain moods or times? Certain moods or times? Certain sex partners? Certain sex partners?

14. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 14 Escape; concerns What are your concerns about getting high to not think about HIV? More risk? More risk? Amount of drug use? Amount of drug use? Less enjoyable sex? Less enjoyable sex? Areas you might want to change? Areas you might want to change?

15. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 15 Questionnaire; Risk How hard is it to follow your safer sex limits or use a condom when you are high? Risk 01234 01234 not at alla littlesomea fair very much amount amount Click one

16. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 16 Sexual risk; discussion Hard to talk about safety while high? Hard to talk about safety while high? Keeps you from thinking about HIV or your HIV status? Keeps you from thinking about HIV or your HIV status? Makes your partner less concerned? Makes your partner less concerned? Makes it difficult to get a condom on yourself or your partner? Makes it difficult to get a condom on yourself or your partner? How does being high interfere with safety? Areas you might want to change? Note for worksheet

17. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 17 Questionnaire; places How much do you tend to meet partners in bars or clubs? Places 01234 01234 not at alla littlesomea fair very much amount amount Click one

18. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 18 Risky Places; discussion Partners you meet there Partners you meet there Hard to talk about safety Hard to talk about safety Getting high and having unprotected sex is just expected Getting high and having unprotected sex is just expected Where do you tend to meet people (or have sex) ? Specific bars, clubs, baths? Specific bars, clubs, baths? How much is getting high a basic part of those places? How much is getting high a basic part of those places? What makes these places risky?

19. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 19 Places: Safety Strategies Avoid them altogether Avoid them altogether Get support from others Get support from others How can you stay safe in risky places? for alcohol / drug use for alcohol / drug use for sex for sex Have a safety plan Note for worksheet

20. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 20 Questionnaire; Partners How much is getting high a regular part of a relationship? Partners 01234 01234 not at alla littlesomea fair very much amount amount Click one

21. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 21 Partners; discussion Which partners do you get high with during sex? What concerns do you have? Use interfering with sex / intimacy? Use interfering with sex / intimacy? Other ways to enhance sex? Other ways to enhance sex? Areas you might want to change? Areas you might want to change? Note for worksheet How does this improve sex with them? How does this improve sex with them? How can you get those benefits without getting to high to be safe? How can you get those benefits without getting to high to be safe?

22. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 22 Questionnaire; Moods How much do you get high during sex to change moods, such as stress or sadness? Moods 01234 01234 not not at alla littlesomea fair very much amount Click one

23. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 23 Moods; discussion Positive moods? What moods do alcohol or drugs help you change? More sexual More sexual More “energized” More “energized” Negative moods? Less stress / worry / sadness Less stress / worry / sadness Feel better about yourself Feel better about yourself Less concerned about HIV Less concerned about HIV How does changing your moods make sex better for you?

24. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 24 Moods; changes Concerns about getting high to change moods? Use interfering with sex / intimacy? Use interfering with sex / intimacy? More negative moods after sex? More negative moods after sex? Areas you might want to change? Note for worksheet Other ways to enhance moods & sex? Other ways to enhance moods & sex? Dealing with moods directly? Dealing with moods directly?  Too uninhibited?  “Empty headed” during sex? Safety concerns? Safety concerns?

25. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 25 Summary of alcohol-drug motives Let’s summarize what we have been saying so far. When you think about being high and sexual risk, which of these factors seems really important…

26. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 26 Personal profile Risk Review, risk estimations … to be relaxed & self-confident … in particular places … to not think about HIV or stress … to enhance sex … certain moods and feelings … with certain partners Others?: ___________________ Getting high during sex… How Important: Lowmoderatehigh We will make safety plans for the important factors…

27. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 27 Control strategies; introduction Now let’s begin talking about control strategies for: Alcohol & drug use Alcohol & drug use Alcohol – drugs and risky sex Alcohol – drugs and risky sex

28. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 28 Alcohol-Drug Control; overview 1 Can you describe times you used too much? and times your use caused problems? and times your use caused problems? When have you wanted to change how you use alcohol or drugs? How would you see yourself changing? Use less – generally or in some situations? Use less – generally or in some situations? Use the same, less harm / keep control? Use the same, less harm / keep control? Only use when not having sex? Only use when not having sex? Other changes? Other changes?

29. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 29 Alcohol-Drug Control; overview 2 Strategies that have worked? Strategies that have worked? Strategies that have been difficult? Strategies that have been difficult? Times & places when it is easier to control use during sex? Times & places when it is easier to control use during sex? Areas where you could use some help? Areas where you could use some help? How have you tried to use less?

30. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 30 Alcohol-Drug Control Strategies, basics Alternate alcohol & non-alcohol drinks Some basic control strategies. What is a drink you can alternate? What is a drink you can alternate? How can you schedule it? How can you schedule it? How might you talk to others about it? How might you talk to others about it? Avoid combining different drugs / alcohol Don’t use before going out. What is your key drink or drug? What is your key drink or drug? How can you plan for not combining? How can you plan for not combining? Control strategies

31. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 31 Control strategies; Setting your limit How much does it take (or what drugs) get you beyond where you want to be? Control strategies… Have a plan or “limit” for using How much does it take to get you where you want to be?  as high as you want  still able to stay safe or keep control  What is the “right” number of drinks? ..the “right” drugs / amounts of drugs?

32. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 32 Alcohol-Drug Control Strategies, plan / limit Count drinks / drugs [lines, bumps, etc.] Count drinks / drugs [lines, bumps, etc.] Avoid (or count!) alcohol / drug “rounds” Avoid (or count!) alcohol / drug “rounds” Which drug / alcohol? Which drug / alcohol? How many? How many? How can you follow your plan? What would be a limit or plan for you? What would be a limit or plan for you? How could you talk to your partner(s) about your plan? How could you talk to your partner(s) about your plan?  Per hour?  For the evening? how will you keep track? how will you keep track? Other control steps that may work for you? Control strategies…

33. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 33 Alcohol – drug Control strategies, cont. Is this something you will be able to do? How would you feel trying these strategies? Social support from others? Social support from others? Change of places, partners, friends? Change of places, partners, friends? Your moods or feelings Your moods or feelings Skills for communication Skills for communication Your partners / places Your partners / places Moods? Moods? Feeling sheepish / embarrassed? Feeling sheepish / embarrassed? What would help? What would make these plans difficult? Control strategies

34. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 34 Alcohol-Drug Control Strategies; refusal skills What can you say to refuse (more) alcohol / drugs? Controlling social pressure toward use After you decide how much to use: What has worked for you in the past? What has worked for you in the past? What have you heard other people use? What have you heard other people use? When can you talk to your partner about use? When can you talk to your partner about use? How can you communicate your desires about drug use with sex? Let’s role play a “refusal” situation

35. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 35 Sexual control, intro. Now let’s talk about controlling sexual risk while you are high.

36. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 36 Alcohol-Drugs & Sex; sexual safety overview How have you controlled sexual risk while high? What risks have you tried to control? What risks have you tried to control? Times or places you stayed safe even though you were high? Times or places you stayed safe even though you were high? Times & places where being high makes it most difficult to be safe? Times & places where being high makes it most difficult to be safe? What would you see yourself changing? How confident are you that you can get high and still be safe? How confident are you that you can get high and still be safe? Difficulties or barriers? Difficulties or barriers?

37. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 37 Risk; change areas When have you been able to use condoms even though you were high? Particular places or times? Particular places or times? Particular partner(s)? Particular partner(s)? Particular drugs? Particular drugs? Your own attitudes or plans? Your own attitudes or plans? Talking with partner? Talking with partner? Condoms before getting high? Condoms before getting high? Which of these factors make it difficult to use condoms while high?

38. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 38 Some concrete strategies to reduce sexual risk while high Alcohol-Drugs & Sex; sexual safety skills Make a safety agreement. How will you talk to him about it? What would that plan look like? Non-penetrative sex? Non-penetrative sex? Condom on before getting high? Condom on before getting high?  Very important for poppers or crack cocaine..  Other drugs? (“K”?) Other plans / goals? Other plans / goals? Who can you form a “high but safe” plan with?

39. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 39 Sober in high risk situations, moods, etc. Sober in high risk situations, moods, etc. High only in non-sexual situation. High only in non-sexual situation. Alcohol-Drugs & Sex; “strategic abstinence” overview “Strategic abstinence” safety plan How can you enjoy getting high and be safe?  Certain partners for sex OR drugs?  Times / days you can separate them?  Not use “trigger drugs” with risky partners?  Other steps that may work for you? How can you separate drugs from sex? How can you separate drugs from sex?

40. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 40  What would be the barriers or difficulties? Alcohol-Drugs & Sex; “strategic abstinence” plan What would a strategic abstinence plan look like for you?  Which drugs should YOU avoid while with … New partners New partners  Which drugs can you take and still be safe? In really risky places (bathhouse) In really risky places (bathhouse) Talking to partners or friends? Talking to partners or friends? A written plan? A written plan? What else? What else? Your steady Your steady  What would help?

41. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 41 Alcohol - Drugs & Sex; Reducing Risk Would it help to talk to an alcohol / drug counselor or join a program? Would it help to talk to an alcohol / drug counselor or join a program? Have you ever sought help before? Have you ever sought help before? What would be your reservations or concerns about getting more focused help? What would be your reservations or concerns about getting more focused help? What might be a concrete plan for getting more help? What might be a concrete plan for getting more help? What other resources might you use to deal with alcohol & drugs?

42. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 42 Let’s write a safety plan Here is an example… Safety plan intro.

43. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 43 An example of a personal goal worksheet ConcernsPersonal goalsAction steps What do you want to change….? Heavy weekend alcohol & drug use Personal goal(s) for each area? -control alcohol - less cocaine.. Specific steps to reach each goal? -plan # drinks -no “rounds” -NA program Sex risk while using ‘X’… -100% condom use -fewer partners on “X” nights -talk to partner & carry condoms -plan for “X sex” Heavy use & sex risk when depressed When depressed: - Use less - Avoid risk - get depression treatment - abstinent when depressed

44. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 44 2. Goals: Your own safety plan: Alcohol - Drugs & Sex; Own safety plan 1. Concerns: Control strategies Control strategies Dealing with moods, partners Dealing with moods, partners What is your main concern or issue? Specific things you want to see different? Concrete actions to achieve your goal? 3. Action Steps: Click for Safety worksheet Click for Safety worksheet

45. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 45 To help us with action steps What has worked in the past? What has worked in the past? What is concrete and feasible -- what can you actually do? What is concrete and feasible -- what can you actually do? What are the first steps? What are the first steps? How will you know if you are successful? How will you know if you are successful? What else should we include? What else should we include? Alcohol - Drugs & Sex; Action steps

46. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 46 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?

47. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 47 Advocate’s notes & checklist Advocate: Visit Checklist  Coping interview form  Coping planning worksheet  Referral sheet (if used)  Next appointment hand card distributed Complete Counseling Notes Form and Visit Log for file.

48. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety & alcohol-drug use 12/9/03 48 Safety & Treatment Planning Worksheet Action StepsGoalsConcerns Fill in one or several general areas of concern / change targets Fill in one or several general areas of concern / change targets Note personal goals for each; what specifically should be different. Note personal goals for each; what specifically should be different. Fill in actions that are specific, concrete, “do-able”. Fill in actions that are specific, concrete, “do-able”. TAP Planning worksheet, UIC / HBHC Treatment Advocacy Program Participant ID: _______ Advocate___________ Date ___________ Visit code _____