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

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

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

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

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

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

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

8. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety 2 12/9/03 8 Reviewing Module Choice Well get back to: Your safety plans Your safety plans Your focus topic from last week Your focus topic from last week For now, lets quickly review some safety basics Our next steps:

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

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

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

12. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety 2 12/9/03 12 Risk Model: Concerns and Risk Lets talk about how personal concerns can lead to risk. Risk outcome STD/ HIV exposure STD/ HIV exposure Other negative outcome Other negative outcome Risky behavior Risky choice based on that concern Personal concern Personal concern or issue..

13. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety 2 12/9/03 13 Risk outcome Risky behavior Risk Model: Intimacy Example Personal concern Personal concern or issue.. Heres an example using the need for intimacy: Desire for intimacy New STD or infect partner with HIV Sacrifice safety for skin to skin intimacy

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

15. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety 2 12/9/03 15 Risk Model; personal application General concerns Risky choices Risk outcomes Lets 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? or behaviors it leads to? Possible results?

16. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety 2 12/9/03 16 Risk Model Lets choose one focus topic that fits best with your personal concerns about sexuality, intimacy and HIV…

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

18. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety 2 12/9/03 18 Visit Summary Visit Summary: We have spoken about… Your safety plans Your safety plans Sexual safety skills Sexual safety skills Your particular concern to focus on about safety Your particular concern to focus on about safety

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

20. Main Menu UIC / HBHC Treatment Advocacy Program TAP: Sexual safety 2 12/9/03 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 ______

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

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