Table 2.

Themes and excerpts from control participants

Assumptions about clients w/severe mental illnesses	“Many people are not sexually active”—Reinforce earlier findings Promiscuous clients are the SMI individuals who could use HIV training
Discomfort with topic	“He was gay and quite flamboyant and I was uncomfortable ...”
Clinical Skill of case manager	“Seems like you are having sex with someone ... are you having protected sex?”
Perceived barriers to discussing safer sex and drug use behavior	Discomfort with gay clients, worry about upsetting persons who are psychotic or detoxing or known to have been victims of previous sexual abuse
Gender matching	Would only discuss topics related to safer sex with consumers of the same gender
Boundaries	Concern about consumer perception that this is a “come on.” Worry about how to respond when consumer asks about case manager's sexual behavior
Case managers appropriate to intervene?	Not case managers, but therapists, “clinicians,” psychiatrists should be the ones to discuss this topic
Leakage of intervention	Due to the presence of research assistants interviewing clients, are more aware of sexual issues. Did not get access to materials (condoms, pamphlets etc...)