The PLISSIT model is a 4-stage intervention model nurses use to assess a client's sexuality and healthcare needs related to sexuality. The stages include: Permission Giving to discuss sexuality issues, Limited Information where the nurse provides basic information about how a condition like HIV/AIDS affects sexuality, Specific Suggestions where the nurse offers suggestions to address specific sexual concerns, and Intensive Therapy where the nurse refers clients to specialists for more intensive therapy if needed. The model aims to help nurses have sensitive discussions about sexuality with clients in a non-judgmental way.

1. PLISSIT MODEL
A method for communication
PLISSIT is a four stage intervention model for the nurse to assess a client’s
sexuality and health care needs (Taylor & Davis, 2006).
Permission Giving
• Is provided for the client to discuss
sexuality or decline discussion in a
confidential and non-judgmental
setting (Taylor & Davis, 2006).
Examples:
• Many people diagnosed with
HIV/AIDS find that it affects their
relationships and their interest in
sex. Is it ok if we discuss this?
• How has your diagnosis impacted
your relationship(s)?
• Are you facing any body image
issues or complications in sexual
activities (Ortiz, 2007; Shell, 2007)?
Limited Information
• The nurse provides limited
information relevant to the client’s
sexual preferences to reveal how
HIV/AIDS will affect sexuality and
how treatment may affect sexual
function.
• Correct any misconceptions by
providing evidenced-based
information (Taylor & Davis, 2006).
Example:
• You have clarified that you want to
continue having sexual activity with
your partner(s). Open and honest
communication will help your
partner(s) understand your needs
and limitations (Ortiz, 2007).
Specific Suggestions
• Make specific suggestions to
manage sexual concerns the client
identifies (Taylor & Davis, 2006).
Example:
• There are many ways to adapt
sexual activities to reduce HIV
transmission risks and manage
disease and medication side
effects. Let’s review some
protective measures (refer to “Risk
Reduction Methods”). Some safe
`
A Nursing
Approach for
Addressing
Sexuality with the
Client who has
HIV/AIDSReferences
Canadian HIV/AIDS Legal Network. (2014). Criminal
law & HIV non-disclosure in Canada. Retrieved
from http://www.aidslaw.ca/site/wp-content/
uploads/2014/09/CriminalInfo2014_ENG.pdf
Lewis, S. L., Heitkemper, M. M., Dirksen, S. R.,
O’Brien, P. G., & Bucher, L. (2010). Medical-
surgical nursing: Assessment and management
of clinical problems. Toronto, ON: Elsevier
Canada.
National Guideline Clearinghouse (NGC). (2011).
Prevention with positives: Integrating HIV
prevention into HIV primary care. Agency for
Healthcare Research and Quality. Retrieved
from http://www.guideline.gov/content.aspx?id=
34207&search=sexuality+prevention+method
National Guideline Clearinghouse (NGC). (2013). HIV
prophylaxis for victims of sexual assault. Agency
for Healthcare Research and Quality. Retrieved
from http://www.guideline.gov/content.aspx?id=
48158&search=aids+and+sexuality
Ortiz, M. R. (2007). HIV, AIDS, and sexuality. Nursing
Clinics of North America, 42(4), 639-653.
doi:10.1016/j.cnur.2007.08.010
Rathus, S. A., Nevid, J. S., Fichner-Rathus, L.,
Herold, E. S., & McKay, A. (2013). Human
sexuality in a world of diversity. Toronto, ON:
Pearson Canada.
Shell, J. A. (2007). Including sexuality in your nursing
practice. Nursing Clinics of North America,
42(4), 685-696. doi:10.1016/j.cnur.2007.08.007
Taylor, B., & Davis, S. (2006). Using the extended
PLISSIT model to address sexual healthcare
needs. Nursing Standard, 21(11), 35-40.
doi:11.21.11.35.c6382
Research itself has contributed to the stigma that sexual activity
among males having sex with males is more dangerous than
females having sex with females or males having sex with
females, when, in reality, the risk associated with infectious
transmissions is based on how sexual activities are pursued
(Rathus, Nevid, Fichner-Rathus, Herold, & McKay, 2013).
This brochure aims to mitigate bias and stigma and looks at how
sexual activity can be safely pursued by individuals of any sexual
orientation whether HIV/AIDS is known to be present or not.
Rachel S. Hommersen
Collaborative Program between
McMaster University and Mohawk College
activities include dry kissing, hugging,
massage, or sharing fantasies (Lewis,
et. al., 2010; Ortiz, 2007).
Intensive Therapy
• The nurse must recognize when
intensive therapy is appropriate and
how to advocate for referral(s) to
available services (Taylor & Davis, 2006).
Example:
• Would you like me to make a referral
to our sex therapist who specializes
in HIV/AIDS (Shell, 2007)?
TopNews.in. (n.d.). Hands holding ribbon. Adapted from http://topnews.in/health/files/Disabled-HIV-virus.jpg
Purpose

2. Description of HIV/AIDS
According to Lewis, Heitkemper, Dirksen, O’Brien and Bucher (2010), human
immunodeficiency virus (HIV) is a retrovirus that causes infection of the immune
system leading to acquired immunodeficiency syndrome (AIDS). It can only be
transmitted under special circumstances “that allow contact with infected body
fluids, including blood, semen, vaginal secretions, and breast milk” (p. 299).
Impact on Sexuality
Broad Definition of Sexuality
• Human sexuality is the way in which humans experience and express
themselves as sexual beings regardless of sexual orientation. Many factors
play a role in how we express ourselves as sexual beings (Rathus et al., 2013).
Physical Sexuality
• Symptoms from HIV/AIDS and side-effects from treatment can cause
physical consequences such as:
o Painful intercourse
o Decrease in physical sensations related to neuropathies
o Autonomic neuropathic impotence
o Early menopause
o Increasing fatigue and generalized pain (Ortiz, 2007).
Body Image
• Individuals have their own unique body image perception and physical
changes may impact clients differently. Recognizable physical changes
may lead to feelings of disfigurement and negative body image. Noticeable
changes related to HIV/AIDS and treatment may include:
o General wasting (extreme weight loss)
o Kaposi’s sarcoma (lesions)
o Oral hairy leukoplakia (oral lesions)
o Lipodystrophy (fat accumulation on the back of the neck)
• Negative body image may hinder sexuality as clients can become more
self-conscious or feel inadequate, undesirable, and fear rejection from a
partner. Each one of these components can lead to performance anxiety
and loss of libido (Lewis et al., 2010; Ortiz, 2007).
Relationship Issues
• HIV/AIDS may add new stressors to relationships as a result of diagnosis
and disease progression:
o A partner may blame the client for bringing HIV/AIDS into the
relationship
o The client may have fears of transmitting HIV to a partner
o The client may not have communication skills to negotiate condom
use or may feel stigmatized in a long-term committed relationship
because of perceived loss of sexual freedom
o A client's loss of libido could cause a partner to feel undesirable or
believe that the client is cheating
o HIV may be sexually inhibiting, particularly in the area of
spontaneity (Ortiz, 2007).
Psychological and Emotional Factors
• Individuals diagnosed with HIV/AIDS may fear expressing and engaging in
sexual activities because of the stigma tied to their diagnosis and the fear of
transmitting it to a partner (National Guideline Clearinghouse [NGC], 2013).
• Having intimacy, the reward of a relationship, and mutual love with a partner
may be the most important needs for some individuals living with HIV/AIDS
(Canadian HIV/AIDS Legal Network, 2014).
• Disclosure can be the most difficult and stressful task one might face. As
per the Canadian criminal law, individuals with HIV must disclose their
status to potential sexual partners before engaging in sex or prosecution
may occur. The fear of criminalization can impact the individual’s sexuality
and affect libido causing depression and anxiety. It can also increase the
concern of reinfection or infecting a partner in discordant relationships, as
well as fear or desire for pregnancy (Canadian HIV/AIDS Legal Network, 2014).
Practicing Safer Sex
Examples of sexual contact
• Kissing, hugging, spooning
• Fondling (with or without digital penetration or fisting)
• Masturbation
• Sexual intercourse (penis penetrates vagina)
• Anal sex (penis penetrates anus)
• Oral-genital contact (fellatio, cunnilingus, analingus)
• Genital-to-genital contact without penetration
• Sexual aids – with or without penetration (Rathus et al., 2013).
Risk Reduction Methods
Regardless of a client’s sexual orientation, adapting the following methods will
reduce risk of transmission and enable individuals to continue engaging in any
of the examples of sexual contact mentioned above:
• Correct use of condoms, gloves, and dental dams for vaginal, anal or oral
sex, as well as for digital penetration, fisting, and when sharing sex toys
o use polyurethane based products if allergic to latex
• Use water-based lubricants during penetration to reduce barrier breakage
• Avoid substances that impair judgement and can lead to unsafe sex
• Avoid douching and hyperosmolar lubricants (irritates the mucosa)
• Partner serosorting for safer sex without condoms (still other STI risks)
• HIV/STI screening annually or when engaging sexually with new partner
• Antiretroviral therapy (ART) to reduce viral burden (NGC, 2011).
Safe Activities
• Outercourse, which is a restricting behaviour to prevent blood, semen, or
vaginal secretions from making contact with a partner's vagina, rectum,
mouth, or penis (Lewis, et al., 2010).
• Hugging, massage, sharing fantasies (Ortiz, 2007).
Accidental Exposure
• Despite every precaution taken, accidental exposure of HIV can occur.
• In such cases, the exposed individual needs to be assessed for
implementation of post-exposure prophylaxis (PEP) within 2 hours, thus
immediate medical attention must be sought (NGC, 2013).