Providing for Women's Well-Being: A Sexual Health Conversation Guide for Clinicians

Submitted on May 29, 2024
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The ability to have pleasurable, safe sexual experiences if one chooses to has been identified as a central aspect of health and wellbeing by the World Health Organization and other institutions worldwide. To make this assertion a reality, healthcare providers must be equipped to discuss pleasure and HIV prevention with women as part of their sexual and reproductive healthcare, and their overall wellness.

Through meaningful dialogue rooted in shared decision-making and respect, providers can normalize HIV and integrate prevention into efforts to support women's overall health – including their sexual health, pleasure, and bodily autonomy. Below is a series of considerations, talking points, and shareable infographics to help inspire and guide these crucial conversations. 

This resource is part of SHE/HER/THEY (Sexual Health Education/HIV Empowerment Resources/Treating HIV Equally), The Well Project's educational outreach initiative focused on improving engagement in care, health outcomes, and well-being for women living with and vulnerable to HIV while promoting language justice and holistic wellness through a non-stigmatizing lens.

Discussing Sex and Sexuality

When discussing sex and sexuality with patients:

  • Be mindful of personal bias: How comfortable do you feel talking about sex in general or discussing sexual health outside of STI testing?

    • Recognize that bias may appear in judgments about a woman's sexual expression, sexual identity, and her choices about sexual or reproductive health
  • Think outside the "five P's" (Partners, Practices, Past History of STIs, Protection from STIs, and Pregnancy Intention) to include Pleasure
    • Taking a detailed sexual history in a thoughtful, trauma-informed manner can be a crucial component of trust-building
    • Trauma-informed care should support self-advocacy 
  • Meet women where they are, while leaving room to expand the conversation
  • Recognize that women may have sex related to survival, housing, or money, and it may involve drug use. These conversations should focus on harm reduction and not on judgement.

It is important to use an approach that: 

  • Leverages open-ended questions without assigning guilt and shame and without making assumptions about the ways people have sex ​or with whom they have sex​​
  • Encourages dialogue, neutrality, and mutuality 
    • Mutuality is characterized by empathy, collaboration, and equality (i.e., acceptance of differences)
  • Uses people-first language

Starting the Conversation

Below is a list of sample questions to help guide conversations with your patients about sexual health, wellness, and HIV prevention, including PrEP (pre-exposure prophylaxis). These questions are designed to normalize HIV within women's healthcare.

Current Sexual Experience

  • Are you currently​ ​having sex?

    • (Have you had sex since the last time we talked? Have you had sex since the last time you had a checkup?)
  • There are numerous reasons people engage in sex including pleasure, intimacy, stress release, or for survival or housing​;​ what are some of the reasons you have sex?
  • What does sex look like in your life right now? What would your ideal sex life look like? What are the gaps between what sex looks like and your ideal sex life?
    • How can these gaps be addressed?
  • To best support your sexual health, we should conduct screenings that take place at the body parts people use to have sex. Would talking about body parts be OK?
  • What parts of your body are involved when you have sex?
  • What affects or interferes with your ability to enjoy sex? (Examples can include stress, tension with partner​(s)​, family, pain, etc.)

HIV Testing

  • Routine HIV testing is recommended for all individuals aged 13-64 years (and many suggest younger and older). Unless you tell me not to, I plan to include an HIV test in your screenings today.
  • Do you know the last time your partner(s) were tested for HIV?
  • Do you have fears or concerns about HIV testing?

HIV Prevention and PrEP

  • What types of HIV prevention methods do you use? Are you familiar with PrEP? What have you heard? ​​
  • Are you aware of the ways PrEP may benefit you?
  • PrEP is available via a daily oral pill or a bi-monthly injection. Is there an option you think would fit your life and schedule better? What might excite you about either of these methods? What ​​hes​​itations or questions would you have for either method?​
  • If PrEP is not right for you at this time, would you like to discuss it again in the future?
  • Do you have a current or recent history of injection drug use?
    • Did you know that PrEP may help to reduce HIV acquisition via intravenous drug use by as much as 74 percent?

Infographics: Integrating HIV Prevention into Women's Wellness

Save and share the individual images below in jpeg or pdf format, or download a pdf featuring the entire series of infographics.

Overview

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HIV Testing

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Reframing HIV Risk

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Normalizing HIV Testing and Prevention

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Sexual Pleasure and HIV Prevention

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Share These Resources

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The development of the above tools was supported by NASTAD through funding from the US Centers for Disease Control and Prevention (CDC).

The Well Project wishes to extend special acknowledgement to Carmen Logie, PhD (University of Toronto); Tonia Poteat, PhD, MPH, PA-C (Duke University); and Andrea Weddle, MSW (HIV Medicine Association), for expert consultation throughout the development of this resource.


Additional Resources from The Well Project

Program Materials

SHE/HER/THEY (Sexual Health Education/HIV Empowerment Resources/Treating HIV Equally

Black Women Living with and Vulnerable to HIV in the US: Leadership Exchange LIVE

Fall WRI Virtual 2021 Issue Brief: Interrogating the Intersection of HIV and Women's Sexual and Reproductive Health

Let's Talk About Sex: Facilitating Engagement About Sex and Pleasure Between Providers and Women Living with HIV

Sex, Pleasure, and PrEP: Leadership Exchange LIVE

Fact Sheets

PrEP for Women

Safer Sex

Older Women, Sex, and HIV

Sexual and Reproductive Health, Rights, Justice, Pleasure, and HIV

Gynecologic Care and HIV: What to Expect and Preparing for Appointments

References

HIV Prevention Guidelines (US Centers for Disease Control and Prevention)

Opening a Portal to Pleasure Based Sexual and Reproductive Health Around the Globe; A Qualitative Analysis and Best Practice Development Study (Sexual and Reproductive Health Matters)

GOALS Framework for Sexual History Taking in Primary Care (New York State Dept of Health AIDS Institute)

No Longer the Exception, but the Standard: Integrating Trauma-Informed Policy and Pre-exposure Prophylaxis Implementation for Women (Women's Health Issues)

Providing Primary Care for HIV in the Context of Trauma: Experiences of the Health Care Team (Women's Health Issues)

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