| Ask | Routinely obtain a sexual and substance use history for all patients to assess risk. Reinforce confidentiality; be tactful, clear, and nonjudgmental; check assumptions. - "To provide the best care, I ask all my patients about their sexual activity - so tell me about your sex life."
- "Tell me about your partners." (gender, number, new partners, partners with other partners)
- "What types of sex have you been having?" (vaginal, anal, oral)
- "How do you protect your partners and yourself during sex?"
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| Intervene | Provide patients with brief, tailored, behavioral interventions for risk reduction. - Discuss risk with patients:
- Unprotected sexual activity
- Anonymous partners
- Patient or partners with recent STI
- History of recreational or intravenous drug use (party drugs, methamphetamines)
- Exchange of sex for money or drugs
- Recent incarceration
- Assess patient's knowledge and misconceptions about STI transmission and assess attitudes and beliefs:
- "What are your concerns about giving or getting an STI?"
- Assess circumstances affecting behaviors (what, where, and with whom; triggers):
- "What makes it difficult to use condoms with your partners?"
- "How do you tell your partner about your HIV status/your STI infection?"
- Assess patient's readiness to change
- Negotiate a behavioral goal:
- "What is one thing you can do to reduce your risk of getting HIV or another STI?"
- Identify a first step toward the goal that is:
- Concrete
- Incremental
- Individualized
- Realistic
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