Lee, also known as “Dr. Sex,” conducts custom condom consultations in sex clubs. “For us, our major success is repeat contacts. At our custom condom consultations we actually sit down and talk to a person about their sexual practices, what they do, what they don’t do. Then we ask, for the men, about penis size, rough sex, the types of condoms they like to use. Based on that, we carry an outreach kit that carries about 60 different condoms, and we sit there and we put together a prescription package tailored to their needs. And I’ll say field test them, then come back. They will tell me, based on my assessment of their condom needs, which ones I gave them that worked. Then they come back and get refills on their prescriptions. So that’s a way that I see that we’re being effective.”

“Part of the repeat contacts is developing a relationship. Communication, people come back and will talk to you about more personal and intimate things because they have established a trust level with you. And the fact that you gave them positive and good information to go out and have sex and improve what they’re doing or give them an opportunity to be safe. “

Tim’s outreach workers have the tough job of targeting sex industry workers where behavior change is a slow process. “How do you qualify incremental behavior change in a standardized assessment? We’ve not found anything that is a good HIV negative assessment tool that we can use to actually plot improvement over time in knowledge, attitudes and behaviors. In order to measure improvement and progress, the steps under a standardized assessment tool were too big. To move from level 1 to level 2 was impossible for a high-risk client. It would take them maybe years. But they could move from step 1A to B in a month, and then from B to C in a couple of weeks. We have the entire alphabet to go through before we get to level 2.

“For example, you’re on the street trying to do outreach to a prostitute and she basically says “fuck off.” OK, that’s your baseline. Then, an improvement is when she finally no longer says “fuck off” but “why are you guys out here hassling me when I’m trying to make money?” That’s an improvement. Her attitude has changed. And you can count that as a victory. Then that usually leads to “What are you guys doing down here all the time? What is all this about?” That’s an improvement because now she’s curious. And then we can lead that person further in terms of attitude, knowledge and behavior.”

In El Cajon, “The Story With No Names” is a small pamphlet (3” X 5”) that tells the story of one person and her experience with shooting up. These booklets are handed out to street-based IDUs as part of a safer injecting/hygiene kit. Sometimes the stories end hopefully: “So far now I have been clean for 3 years, except methadone, which saved my life. No lie.” Sometimes they end cautiously: “We buy new needles every chance we get. But sometimes it’s impossible to find them. So if we have to acquire someone’s used needles we make sure we clean it: three times water, three times bleach, three times water.”