Risk assessment specific to sexually transmitted and blood borne diseases is even more critical in the era of HIV infection. â–« Sexual and drug substance use risks should be determined during a routine health history with every new patient and updated regularly during periodic health care.The evidence and its interpretation are described thoroughly, as are counseling strategies for changing behavior. We believe that further discussion of counseling strategies, however, is prudent. In particular, we focus on two areas: the discomfort providers and patients experience when discussing sexual matters; and the complex process of changing behavior that starts with the provider's risk assessment, continues with a discussion about the patient's apparent risk and ends with the patient's decision to change or not change behavior.