ae606 3/19/96
Introduction to Stages of Change
Christine Mahoney, Project Aries, Seattle, WA (USA)
HIGHLIGHTS OF PRESENTATION
There are two things that are very important to consider when we talk
about safer sex:
1.   Language and diversity;
2.   Sexual rights.
It is important to acknowledge and validate our differences in the way
we talk about sex, and what kinds of sex we may prefer.
We need to respect the diversity of our community.  The Gayline
volunteer needs to be comfortable talking about sex, and talking about
sex needs to be normalized when these talks take place
with callers.  Women need to be able to use street language with their
male callers because when we talk about sex it is more common for men to
use "fucking" and less common for them to use "unprotected
anal intercourse."  We need, therefore, to speak the same language as
our callers.
It is important to acknowledge that we not only have constitutional
rights, but we have sexual rights as well.  Sexual rights include the
rights to:
initiate sex
say no to sex
stop sex
talk about sex
express your wishes
protect your safety
protect the safety of your partner
decide what is too risky
fee uncomfortable with certain acts
say no to acts that make you feel uncomfortable
be respected
possess feelings
negotiate
where to have sex and the frequency
ask for what you need or want
I'd like to discuss how people change and how this relates to
callers being and becoming sexually safer.  The model for the change
process is based on the work of psychologist James Prochaska who
found that a pattern exists as people move toward changing their
behaviour.  Prochaska identified five stages in this process including:
1.   precontemplation
2.   contemplation
3.   determination
4.   action
5.   maintenance.
People wanting to change behaviour pass through these five stages in
individual ways, varying in speed and efficiency.  There may be, as
well, stops and starts and delays in progress as people move toward
reaching goals.
Project Cares (Comprehensive AIDS and Reproductive Health Education
Study) incorporated Prochaska's stages into their work by modifying the
model into four stages:  Contemplation, determination, action and the
process goal of maintenance.
Project ARIES uses the stages of change model in their work with gay
and bisexual men who are wanting to be sexually safer.  A 14 week
telephone counselling  group is offered to men throughout the
US and western Canada which meets for 1.5 hours each week.  This program
is structured and divided into three sections:
1.  Contemplation:  Thinking and planning what changes will be
made; understanding feelings about making changes; this may include
setting specific goals, and thinking about how changes
can be fun or erotic (allowing men to retain or increase their sexual
satisfaction while also being safe);
2.  Action:  The time for men to make or maintain changes by
dealing with temptations, learning new skills, making mistakes, getting
feedback and receiving support;
3.  Maintenance:  How to continue staying safe over time, including
discussions of relationships, support networks and self-esteem issues.
I believe, even when resources are limited, that we can offer callers
the opportunity to call back and check in with respect to changes around
being sexually safer.  Since making changes is hard, ongoing
support is critical during the process of maintenance.
A simple way to look at how we change is to imagine a journey.
When we embark on a big trip we do some advance planning, i.e., maps
(accurate HIV information), guides (Gayline worker or counsellor),
talking with others who have already made the trip (support network).
The next part of the journey is departure from where you are now to
where you've chosen to go.  And the final part of the trip
is getting settled in the new destination and putting down some roots.
One impediment to positive change regarding sexual safety is
negative thinking, including denial (ignoring that unprotected sex is
risky), rationalization (making excuses) or pessimism ("bad attitude").
In dealing with a caller's negative thinking, respond to the negative
thinking as a barrier to sexual safety.  If, for example, your caller
was to say they have lost many friends to AIDS and you have not talked
about changes to become sexually safer, you would respond to the loss
and grief expressed but not to negative self-talk.