Sanctuary for Change Participant Workbook Sample

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Sanctuary for Change
Module 13: Communication and Risk Reduction
Checking in for Safe Sex and
Seeking A Healthy Relationship…
  • Self-Check: In your heart and soul, are you able to say "Yes" to all of these questions?
    Answer these questions based on your current or most recent sexual relationship.
  • Is this person kind and protective of me? Yes No
  • Do I feel safe with this person?
    Yes No
  • Do I feel like I can rely on this person no matter what? Yes No
  • Do I like and trust this person?
    Yes No
  • Is there a mutual commitment to the relationship? Yes No
  • Have I felt ready to have a sexual relationship with this person?
    Yes No
  • Has this person not been involved with multiple partners, sex work, or shared needles while using drugs in the last six months to a year? Yes No
  • Is this person not involved sexually with someone else and would like a monogamous relationship with me?
    Yes No
  • Have we both been tested (and treated) for Hepatitis C, STIs, and HIV+ screening? And if so, have we shared our results with each other? Yes No
  • Are we both committed to being retested every six months? Yes No
  • Have we abstained from sexual involvement (with anyone) for at least two weeks prior to being screened for HIV+? Yes No
  • Do we both commit to regular use of protective measures such as use of condom, dental dam, safe sexual practices, contraception, etc.? Yes No

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