The webinar will assist the COE healthcare teams in understanding the current condition as it relates to sexual health in America. How they as team members can best ask screening questions to connect patients to preventive measures, treatment and resources.

Agenda:

1. Introduction
2. Learning Objectives/Key takeaways (slide 2)
   1. Greater than 20% of Americans have a treatable STI
   2. The five Ps of sexual history taking
   3. PrEP is a co-indicated for people with OUD
   4. U=U Undetectable HIV means untransmittable
3. Rationale for Incorporating Sexual Health into a COE (slide 3)
   1. 20%+ of Americans have a treatable STI
   2. COE is a care coordination service
   3. People with OUD have increased risk for infections diseases both due to possible sharing substance use paraphernalia and increased prevalence of STIs with sexual networks
   4. STI testing, prevention, and treatment are services that work best as co-located, integrative interventions rather than stand-alone
   5. Physical health COEs are ideal setting for incorporating sexual health services with MOUD and other care coordination
4. Possible Service Elements to Incorporate (slide 4)
   1. Sexual health testing
      1. Minimum model: sexual health history and HIV testing
      2. Standard model: sexual health history and HIV, syphilis, gonorrhea, chlamydia testing
      3. Enhanced model: sexual health history and HIV, syphilis, gonorrhea, chlamydia, Hep B, Hep C testing
   2. Sexual health prevention
      1. PrEP
      2. Condoms (internal and external) dental dams, gloves
   3. Sexual health treatment
      1. Monitor results
      2. Follow up treatment and/or referral
5. Sexual Health History Taking (Slide 5)
   1. “A sexual history should be taken as part of routine health care” – CDC
   2. Key clinical skill
      1. Physical health COEs are sometimes built out under the “physician extender” model where designated staff collect information that is incorporated into the complexity code that there physician bills-in this model sexual histories taken by designated and skilled staff are part of the physician’s visit notes and, thus, medical provider level skill is appropriate in these settings
6. Pronouns are not optional (Slide 6)
   1. As a Gen X person myself, it was difficult for me to adopt “they” and other pronouns instead of he/she.  Now- I use “they” as a pronoun.
   2. It is now a recognized part of respectful healthcare to state your pronouns and ask a patient their pronouns at the beginning of a sexual health history.
   3. These are not “preferred pronouns” but pronouns.  Doing so expresses respect for trans and gender non-conforming persons, of which there are many, esp. among younger persons. 
7. Starting the conversation (slide 7)
   1. May I ask you a few questions about your sexual health and sexual practices? I understand that these questions are personal, but they are important for your overall health.
   2. At this point in the visit I generally ask some questions regarding your sexual life. Will that be ok?
   3. I ask these questions to all my patients, regardless of age, gender, or marital status. These questions are as important as the questions about other areas of your physical and mental health. Like the rest of our visits, this information is kept in strict confidence unless you or someone else is being hurt or is in danger. Do you have any questions before we get started?
   4. Do you have any questions or concerns about your sexual health?
8. (Slide 8)
   1. You need to be a competent clinician who can talk about sex and sexual activity
   2. You need to use sexual terms that sound natural coming out of your mouth and/or be comfortable adopting the language of the person you are interviewing
   3. This is a skill that improves with practice. Get supervision or practice with co-workers until you can have a clear communication and stigma-free conversation about sexual practices that may be different than yours.
9. Stigma-free health histories include: (slide 9)
   1. LGBTQIA+ people
      1. If you aren’t sure what those letters means, please take a queer competency training before doing sexual health histories.
   2. Sex workers
      1. Please know that prostitute is a stigmatizing word.
      2. Sex work is real work-- not everyone who does sex work wants to stop
   3. BSDM/kink
      1. Kink-informed care is a growing area of clinical practice.
      2. About 20% of Americans endorse BDSM sexual activity.
   4. Multiple sex partners
      1. Never assume monogamy even if the person states it; it is statistically rare in American society. 
   5. Gender of partners
      1. Never assume monogamy even if the person states it; it is statistically rare in American society. 
10. The 5 Ps of what to ask: (slide 10)
    1. Partners
    2. Practices
    3. Protection of STIs
    4. Past history of STIs
    5. Pregnancy intention
11. Partners (slide 11)
    1. Are you currently having sex of any kind – so, oral, vaginal, or anal – with anyone?
       1. If no, have you ever had sex of any kind with another person?
    2. In recent months, how many sex partners have you had?
    3. What is/are the gender(s) of your sex partner(s)?
    4. Do you or your partner(s) currently have other sex partners?
12. Practices (slide 12)
    1. I need to ask some more specific questions about the kinds of sex you have had over the last 12 months to better understand if you are at risk for STIs. We have different tests that are used for the different body parts people use to have sex. Would that be OK?
    2. What kind of sexual contact do you have, or have you had? What parts of your body are involved when you have sex?
    3. Do you have genital sex (penis in the vagina)?
    4. Anal sex (penis in the anus)?
    5. Oral sex (mouth on penis, vagina, or anus)?
    6. Are you a top and/or bottom?
    7. Do you meet your partners online or through apps?
    8. Have you or any of your partners used drugs?
    1. Have you exchanged sex for your needs (money, housing, drugs, etc.)?
13. Protection of STIs (slide 13)
    1. Do you and your partner(s) discuss STI prevention?
    2. If you use prevention tools, what methods do you use? (For example, external or internal condoms – also known as male or female condoms – dental dams, etc.)
    3. How often do you use this/these method(s)? More prompting could include specifics about:
    4. Frequencies: sometimes, almost all the time, all the time.
    5. Times they do not use a method.
    6. If “sometimes,” in which situations, or with whom, do you use each method?
    7. Have you received HPV, hepatitis A, and/or hepatitis B shots?
    8. Are you aware of PrEP, a medicine that can prevent HIV? Have you ever used it or considered using it?
14. Past history of STIs (slide 14)
    1. Have you ever been tested for STIs and HIV? Would you like to be tested?
    2. Have you been diagnosed with an STI in the past? When? Did you get treatment?
    3. Have you had any symptoms that keep coming back?
    4. Has your current partner or any former partners ever been diagnosed or treated for an STI? Were you tested for the same STI(s)? Do you know your partner(s) HIV status?
15. Pregnancy intention (slide 15)
    1. Do you think you would like to have (more) children at some point?
    2. When do you think that might be?
    3. How important is it to you to prevent pregnancy (until then)?
    4. Are you or your partner using contraception or practicing any form of birth control? Would you like to talk about ways to prevent pregnancy? Do you need any information on birth control?
16. Last Points *a bonus P! (slide 16)
    1. Did you know PrEP is a medication that prevents you from getting HIV? It has fewer side effects than aspirin and you can pair it with your Suboxone. The medical provider would like to talk to you about PrEP today- alright. (opt-out language)
    2. What other things about your sexual health and sexual practices should we discuss to help ensure your good health?
    3. What other concerns or questions regarding your sexual health or sexual practices would you like to discuss?
17. PrEP prevents HIV (slide 17)
18. U=U Undetectable = Untransmittable (slide 18)
19. Citations (Slide 19)