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Kristin Potterbusch, MPH

Director of HIV and Behavioral Health Integration, National Council for Behavioral Health

Have the Conversation: Raising Awareness about HIV in Behavioral Health Settings

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It’s 4:30 on Thursday afternoon. Your client, a young man who struggles with depression is here for his standing monthly appointment and starts telling you about last Friday night. He talks about how much fun he had, hooking up with a stranger at a bar while intoxicated. From what he is saying, it sounds like he plans to go out again tomorrow seeking a similar experience.

In this situation, would you consider referring your client for an HIV test? Are you prepared to ask your client about condom usage?

If your answer is no, that’s understandable. It can feel challenging to address client questions about sex, HIV and STDs and many providers feel uncomfortable initiating these conversations. Especially because the conversation doesn’t always present naturally, as it did in this scenario. In the behavioral health field, we need to start having conversations about sexual health with all our clients, regardless of demographics.

Did you know that we’ve seen a rise in HIV and STD rates for those 65 and older? This is partly linked to a knowledge gap about safer sex practices coupled with an increase in popularity of erectile dysfunction medications. So, when speaking with a client in the golden years – or any client – it is important to put aside assumptions of risk, and start the conversation.

So, how do you do it?

You can try asking some open-ended questions.

  • Who are you dating or spending time with romantically since we last met?
  • Do you have questions about sexual health?
  • When do you NOT use condoms?
  • Where do you typically get tested for HIV and STDs?

Alternatively, you can try providing demographic related facts.

But the truth is, there isn’t a magic formula for broaching sexual health with your patients. But, you know them, their struggles and their communication styles. Are they comfortable with direct information, or easily embarrassed about personal topics? Take what you know about them and use it in how you approach the conversation. No matter what, show them that you are a nonjudgmental and accepting professional who is concerned about all aspects of their health.

I’ve had a few clinicians tell me that fear of a patient disclosing uncomfortable information is a reason they don’t want to discuss the topic of sexual health. To those clinicians I say, you can refer those patients. You don’t have to be an expert on conducting an HIV test or screening. There is nothing wrong making a warm hand-off to another provider.

For behavioral and primary care clinicians, bringing up this topic might be new, but it is critically important to your patient’s health. In the coming months, we will provide additional blogs and resources on this topic and welcome your thoughts and input. In the meantime, you can always reach out to us with any questions at