STD Risk Reduction Counseling in the Family Planning Visit

Behaviors that put clients at risk for pregnancy may also put them at risk for STDs. When you talk to clients about birth control, you have a perfect opportunity to offer them information about STDs. You can include risk reduction counseling in your visits and help clients reduce their risk of getting an STD.

What is risk reduction counseling?

Risk reduction counseling is a dialogue between you, the provider, and your client. The goal is to help clients identify risky behaviors and explore ways they can reduce their chances of getting an STD. Risk reduction encourages clients to modify their behaviors to involve less risk, rather than asking them to stop the behavior completely.

Risk reduction counseling involves two key parts:

• The provider asks the client questions and provides support.
• The client decides what they can realistically do to decrease their chances of getting an STD.

How can you include risk reduction in your family planning visit? Since you are already talking to your clients about their sexual behavior, you may only need to add a few more steps to help clients reduce their risk of getting an STD.

Start by taking a detailed sexual history.

You may already be doing this as part of your family planning visit. Make sure to include all specific STD/ HIV risks in this sexual history. Find out about the client’s:

• Number of sexual partners in the past 6 months
• STD history
• Last test for any STD
• Types of sexual activity
• Previous or current risk reduction behaviors
• Alcohol and / or drug use

Ask the client how concerned they are about STDs.

Follow this question by asking about specific behaviors. Ask them, “What do you think puts you at risk for STDs?” Discuss any behaviors mentioned in the sexual history taking that may also put them at risk.

Next, ask the client, “What are you currently doing to reduce your risk?” Be sure to praise any steps that clients have taken to reduce their risk. You can then use this information to correct any misinformation and work on problem solving with the client.

Help your client come up with a behavior change plan.

Ask them, “What could you do to reduce your chances of getting an STD?” Help them come up with concrete steps they can take. These steps should be practical and realistic. Provide options for the client and have them decide what they want to do. Be sure to consider your client’s access to resources, support from family, friends and partners, and cultural values.

Some options for clients to think about include:

• Use male or female condoms every time you have sex.
• Use male or female condoms when you have sex with someone besides your main partner.
• Use extra lubricant to lower the chances of getting tears or small cuts. Have sex with only one person who is only having sex with you.
• Have fewer sexual partners.
• Get tested regularly for STDs.
• Talk to your partners about STDs and how you can protect yourselves.
• Don’t have sex when you use drugs and alcohol. That increases the chances you’ll do something risky.
• Use only clean needles for drug use.

Provide support and make referrals.

Discuss potential obstacles with clients and help them come up with ideas to deal with these. Make sure you have an updated referral list with information on resources for:

• Mental health
• Domestic violence
• Drug abuse
• Needle exchange
• Food and shelter

Close the session by reviewing the client’s plan to reduce their risks.

You can ask, “What are you going to do to decrease your chances of getting a STD? When are you going to do this?” This will help reinforce the client’s risk reduction plan. Let them know you’ll check in with them about their progress at the next visit or by phone.

Listen to your clients.

As in any counseling session, it is important to use a client-centered approach. Listen to the needs and feelings of your clients, and maintain an open and non-judgmental attitude. Don’t tell clients what to do, but give them information and resources. This will help you guide clients towards a more realistic behavior change for them.

STD risk reduction is ultimately in your clients’ hands. Their behavior change plans must be reasonable and practical for them. By talking to your clients about risk reduction, you can support and encourage them in their efforts to make healthy choices for themselves.

Want to Learn More?

• If you are interested in receiving training on STD counseling, check out CFHC’s training, Talking with Clients about STDs.
• For more information, visit the AIDS Health Project at UCSF.