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How To Have The Sexual Health Conversation

It is crucial for HIV prevention to become an ongoing topic of conversation with your patients.1

Talking to patients about their sexual health is often postponed due to urgent care issues, provider discomfort, or anticipated patient discomfort.1 However, routinely taking a sexual history is important for identifying patients at risk of acquiring HIV and other STIs.1

SAFE discussion method for conversations about sexual health and HIV transmission

Use the SAFE discussion method to help guide your conversations about sexual health:

  • START the sexual history conversation by stating that it is routine practice. Explain how information about your patients' sexual history will be confidential, and will enable you to provide appropriate sexual healthcare.1
  • ASSESS your patients' risk for acquiring STIs, including HIV. Though some patients may be at greater risk than others, it’s important to have this discussion with all of your patients.1
  • FIND OUT about your patients' sexual history in the past 6 months and current practices through a series of questions1,2:
    "Have you had sex with men, women, or both?"1
    • "How many men and/or women have you had sex with?"
    For men who have sex with men (MSM)1:
    • "Do you have insertive sex (you are the top), receptive sex (you are the bottom), or both?"*
    • "How many times did you have anal sex without a condom?"
    • "Have you used methamphetamine (such as crystal or speed)?"
    • "How many of your sex partners did not know their status or were HIV-positive?"
      • "With these HIV-positive male partners, how many times did you have anal sex without a condom?"
    For heterosexual men and women1:
    • "How many times did you have vaginal or anal sex when you (if a male patient) or your partner (if a female patient) did not use a condom?"
    • "How many of your sex partners did not know their status or were HIV-positive?"
      • "With these HIV-positive partners, how many times did you have vaginal or anal sex without a condom?"
    "Have you had sex under the influence of alcohol and/or recreational drugs?"1
    "Have you been screened for HIV, STIs, and/or hepatitis B and C? If so, what were the results?"1,2
    "Are you up to date on your hepatitis A and B and/or HPV vaccinations?"2
  • EDUCATE YOUR PATIENTS on the importance of condoms, as well as other components of a comprehensive HIV prevention approach including routine HIV and STI testing, and sexual history conversations. For HIV-positive patients, initiating and adhering to treatment helps prevent HIV transmission to negative partners. For HIV-negative patients at risk of HIV infection, consider additional prevention methods such as behavioral counseling, PrEP (pre-exposure prophylaxis), and PEP (post-exposure prophylaxis).1,3

Using the SAFE discussion method can help you gain a better understanding of your patients' risk status and sexual behaviors. By guiding your patients toward safer encounters that may reduce their risk of contracting or transmitting HIV, you can help end the epidemic.4

HPV=human papillomavirus; STI=sexually transmitted infection.

*Anal sex is the riskiest type of sex for contracting or transmitting HIV. Receptive anal sex (“bottoming") results in a higher risk of HIV infection than insertive anal sex (“topping”).5

References: 1. Centers for Disease Control and Prevention. Preexposure prophylaxis for the prevention of HIV infection in the United States—2014: a clinical practice guideline. http://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf. Published 2014. Accessed November 22, 2016. 2. Centers for Disease Control and Prevention. For your health: recommendations for a healthier you. http://www.cdc.gov/msmhealth/for-your-health.htm. Updated February 29, 2016. Accessed November 22, 2016. 3. Centers for Disease Control and Prevention. Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV—United States, 2016. http://www.cdc.gov/hiv/pdf/programresources/cdc-hiv-npep-guidelines.pdf. Published 2016. Accessed November 22, 2016. 4. Centers for Disease Control and Prevention. Today’s HIV/AIDS epidemic. http://www.cdc.gov/nchhstp/newsroom/docs/factsheets/todaysepidemic-508.pdf. Published August 2016. Accessed November 22, 2016. 5. AIDS.gov. Understanding risk activities. https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/understanding-risk-activities/. Updated December 23, 2015. Accessed November 22, 2016.

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