The GOALS Approach includes 5 steps:
1. Give a preamble that emphasizes sexual health
Briefly introduce the sexual history in a way that de-emphasizes risk, normalizes sexuality as part of routine healthcare, and opens the door for the patient’s questions.
“I’d like to talk with you for a couple of minutes about your sexuality and sexual health. I talk to all of my patients about sexual health, because it’s such an important part of overall health. Some of my patients have questions or concerns about their sexual health, so I want to make sure I understand what your questions or concerns might be and provide whatever information or other help you might need.”
2. Offer opt-out HIV/STI testing and information
Tell the patient that you test everyone for HIV and STIs, normalizing both testing and HIV and STI concerns.
3. Ask an open-ended question
Start the sexual history with an open-ended question that helps you identify the aspects of sexual health that are most important to the patient, while allowing you to hear (and then mirror) the language that the patient uses to describe their own body, partner(s), and sexual behaviors.
“Tell me a little bit about your sex life”
4. Listen for relevant information and fill in the blanks
Ask more pointed questions to elicit information that might be needed for clinical decision-making (e.g., 3-site versus genital-only testing), but restrict these questions to specific, necessary information. For instance, if a patient has already disclosed that he is a gay man with more than 1 partner, there is no need to ask about the total number of partners or their HIV status to recommend STI/HIV testing and pre-exposure prophylaxis (PrEP) education.
“How do you protect yourself against HIV and STIs?”
“How do you prevent pregnancy (unless you are trying to have a child)?”
“Do you have any other sexual health concerns?”
5. Suggest a course of action
Consistent with opt-out testing, offer all patients HIV testing, 3-site STI testing, PrEP education, and contraceptive counseling, unless any of this testing is specifically contraindicated by the sexual history. Rather than focusing on any risk behaviors the patient may be engaging in, this step focuses specifically on the benefits of engaging in prevention behaviors, such as exerting greater control over one’s sex life and sexual health and decreasing anxiety about potential transmission.
