The Phénix program

Program history

Phénix is an evidence-based intervention program, meaning that it is based on the scientific knowledge available at the time it was designed. It is the result of the commitment of a group of Québec researchers who studied various aspects of the lives of gay, bisexual, and other (cis or trans) men who have sex with men (gbMSM). Phénix was created for gbMSM who would like to improve their sexual well-being and reduce their risks of contracting an STBBI, but are not always able to achieve those goals as well as they would like. Unlike programs that could give the impression that risk reduction requires making compromises when it comes to sexual satisfaction and pleasure, Phénix specifically takes up the challenge of teaching participants how to better combine eroticism and risk reduction.

The first version of Phénix was developed in 2006 as part of a pilot project. Developed in accordance with the steps proposed for targeted intervention (Intervention Mapping; Bartholomew, Parcel and Kok, 2006), the group intervention aimed to encourage HIV-negative gbMSM to adopt risk reduction strategies without compromising sexual satisfaction. The intervention was implemented and evaluated in a community setting (Séro-Zéro, now RÉZO), and a clinical setting (CSSS Jeanne-Mance). Program validation results showed its pertinence in promoting sexual risk reduction and effectiveness in modifying some factors involved in exposure to risks, as well as a high degree of appreciation among participants. In 2010, Phénix was adapted to make it accessible to HIV-positive gbMSM; a workshop on disclosure or nondisclosure of HIV status was added. In 2012, the program was culturally adapted to gbMSM in Toronto, and then to gbMSM in Burkina Faso, Africa in 2013–2014.

During that time, the program was continuously offered by community organizations, mostly in the Montréal area. However, it was increasingly clear that the program needed updating. Phénix had to reflect new advances in risk reduction strategies (PrEP, undetectable viral load, combination prevention, etc.), since the first version was mostly centred around condom use. Also, many facilitators were no longer using the somewhat outdated audiovisual material.

In 2015–2016, the Phénix program was completely revised to update the contents, create new tools (including erotic skills videos), and standardize the contents to the realities of all gbMSM regardless of HIV status, and then to produce a version that could be offered as an individual program. Using a community-based research approach, a broad consultation was conducted: former participants attended focus groups, individuals who had delivered the program and other key informants were met one-on-one, and a day-long consultation with community-based organizations was organized. These consultations helped identify the strengths and weaknesses of the program, as well as stakeholders’ needs. Based on those findings, the program was updated with the help of an advisory committee composed of community workers and former participants. Two versions were produced: a group version with six 3-hour workshops; and an individual version of four 90-minute workshops plus an additional workshop created specifically for HIV-positive individuals. The individual version was designed to be offered in person or by videoconference.

In 2017–2018, the revised Phénix program was implemented in 10 sites (community, university and clinics) throughout Québec; most sites had offered the program more than once. Among the 25 individuals trained to deliver the program in their settings, 14 facilitated Phénix sessions. A total of 81 men completed the revised version of the Phénix program, either in groups (8 groups, totalling 47 participants) or individually (34 participants, including 31 who attended in person and 3 by videoconference). Through simultaneous data collection, implementation of the program in the various settings was evaluated, as were participants’ and facilitators’ appreciation of the program.

In 2019-2020, in light of the conclusions of the evaluation, the program was slighty modified; less-appreciated activities were revised, a few activities added, and the number of workshops increased to allow more time for discussion. A final version of the program, tools and Facilitator’s Kit were produced. The program was offered at no cost to organizations throughout Québec and Canada in all four formats: group and individual, in French and English.

Program description

The program was based on certain concepts that were used as guidelines to design the workshops. These concepts reflect the approach chosen for Phénix:

      • The concept of sexual well-being is central to the Phénix program. It refers to a positive subjective assessment to one’s current sex life. It includes feelings of physical and psychological well-being related one’s sex life, as well as feelings of content with oneself and others, and with life in general.

      • The term eroticism is used in a very broad sense, referring not only to stimulation of erogenous zones — genital and non-genital — but also to all sources likely to lead to sexual arousal. There are many sources of sexual stimulation: stimulation of the body using hands, the other person’s body, or objects; stimulation through fantasy, erotic memories, romantic gestures, etc.

      • In the Phénix program, risk reduction is conceived using a harm reduction approach, that is, a desire to reduce the negative consequences of a behaviour without necessarily eliminating it completely. This approach arose in response to the HIV epidemic among injection drug users, at a time when interventions mainly targeted abstinence. The harm reduction approach is now applied in many areas of intervention, such as STBBI prevention. According to this approach, there is no such thing as zero risk; as soon as there is sexual contact, there is a risk of contracting an STBBI. For these reasons, it’s better to be well informed about possible risks and strategies to reduce those risks. To succeed, Phénix proposes to implement diverse risk reduction strategies with assorted targets. Not all strategies are equally effective. Experts have shown that using more than one strategy helps reduce risks more significantly. This is known as combination prevention; it involves combining medical approaches (e.g., PrEP, PEP, testing) and behaviours (e.g., serosorting, condoms, withdrawal before ejaculation) at different moments during sex (before, during, after or daily). The idea is to combine the strategies that best suit a person’s needs, practices, and context of each sexual contact. The combination can change from partner to partner and can evolve over time.

Phénix workshops are divided into 4 parts:

      • Introduction and review of the previous workshop. Each workshop begins with a grounding exercise, which helps participants settle into the workshop and focus on the theme of the meeting. The previous workshop and the homework assignments and challenges are reviewed; then the current session contents are presented.

      • Activities linked to the weekly theme. Many themes are covered during the workshops: sexual preferences, sexuality-related risks, STBBIs, sexual consent, vulnerability to risk taking, risk reduction strategies, and others. Each workshop has a specific theme, and the activities are pathways to achieving the program objectives.

      • Erotic half-hour. What is distinctive about Phénix is the integration of an “erotic half-hour” at the end of each workshop, where various erotic skills can be discussed. Participants have an opportunity to reconsider their eroticism and sexuality during discussions supported by erotic educational videos or kinetic exercises (e.g., on the breath or sensual massage). The skills discussed are then practised at home, using erotic techniques to do alone or with a partner.

      • Presentation of homework and challenges, and closing remarks. Each week, participants are given a list of homework assignments and challenges. Most assignments are optional and are designed to help participants delve deeper into the topics raised during the workshops. When homework is mandatory, most of it involves exercises that will be done during the workshops, then finished at home if needed. Some of the challenges are erotic in nature and aim to put into practice the skills discussed; others are personal and interpersonal, and the goal is to practise skills that can be used in relationships (e.g., communication, seduction, self-confidence). The workshop ends by going around the table so each participant can talk about how they feel before leaving.

Group program

The Phénix group program begins with a 90-minute introductory session, designed to present the program to potential participants and act as an ice breaker. Participants who decide to continue will then start a program consisting of seven 3-hour workshops. The workshops take place in small groups of 6 to 8 participants and are led by two facilitators. During the workshops, participants are prompted to get to know themselves better, acquire new knowledge, better understand their risk-taking behaviours, and set objectives to improve their sexual well-being. There is a three-week break between the sixth and seventh workshops, so participants can put into practice the action plans they develop during the program.

Introductory workshop

The introductory workshop allows to introduce the program, to formulate expectations and motivations, and to establish rules between participants in order to foster a group dynamic. The half erotic half-hour focuses on breathing techniques.

Workshop 1: Sexuality

The first workshop is a gradual introduction to the subject. The focus is on sexuality as a whole, and what it means to participants. The activities are designed to encourage exploration and recognition of one’s own sexual preferences. The erotic half-hour focuses on sensuality and sensual massage techniques.

Workshop 2: Risk

The second workshop aims to encourage participants to think about the notion of risk and the acceptable levels of risk for them. An activity also aims to demystify certain notions surrounding sexually transmitted and blood-borne infections (STBBIs). The erotic half-hour focuses on pelvic tilt and masturbation techniques.

Workshop 3: Relationships

The third workshop focuses on relationships. Activities explore the challenges related to disclosing one’s HIV status, the importance of knowing one’s HIV status, issues related to HIV and the law, as well as sexual consent and communication. The erotic half-hour focuses on genital massage techniques, as well as condom use.

Workshop 4: Vulnerabilities

The fourth workshop aims to recognize the areas that make participants vulnerable to sexual risk taking. One activity among the following is chosen: 1) sexual well-being, 2) substance use in a sexual context, or 3) disclosing (or not) my HIV status (for participants living with HIV). The erotic half-hour focuses on oral sex and rimming techniques.

Workshop 5: The chain

The fifth workshop is designed to have each participant build their chain of risk, that is, to analyze a situation where they have put themselves at risk in the past, and then to discern their opportunities to do things differently in the future. One activity presents different risk reduction strategies to show participants the range of choices available. The erotic half-hour focuses on anal massage and anal penetration techniques.

Workshop 6: Action plan

The sixth workshop is designed to get participants to think about combinations of risk reduction strategies and erotic skills in their sexuality in different contexts. Action plan writing is central to this workshop. The erotic half-hour focuses on sex toys.

Workshop 7: Wrap-up

After a three-week break, the last workshop serves as a review of the implementation of the participants’ action plan, as well as a recap of their Phénix experience. The final erotic half-hour aims to demystify kinky sex.

Individual program

Phénix’s individual program begins with a 30-minute introductory workshop that can take place in person, online or by phone. The goal of this initial workshop is to present the program to the potential participant. If he decides to continue, the participant commits to the program, which includes six 90-minute workshops and a 30-minute wrap-up session. The 6 workshops can be held in person or online, while the wrap-up session can also be done over the phone, if so desired. During the workshops, the participant is prompted to get to know himself better, acquire new knowledge, better understand his risk-taking behaviours, and set objectives to improve his sexual well-being. There is a three-week break between the sixth and last sessions, so the participant can put into practice the action plan developed during the workshops.

Introductory workshop

The introductory workshop allows to introduce the program, to formulate expectations and motivations, and to establish terms of commitment with the participant.

Workshop 1: Sexuality

The first workshop is a gradual introduction to the subject. The focus is on sexuality as a whole, and what it means to the participant. The activities are designed to encourage exploration and recognition of one’s own sexual preferences. The erotic half-hour focuses on breathing and sensual massage techniques.

Workshop 2: Risk

The second workshop aims to encourage the participant to think about the notion of risk and the acceptable levels of risk for him. An activity also aims to demystify certain notions surrounding sexually transmitted and blood-borne infections (STBBIs). The erotic half-hour focuses on pelvic tilt and masturbation techniques.

Workshop 3: Relationships

The third workshop focuses on relationships. Activities explore the challenges related to disclosing one’s HIV status, the importance of knowing one’s HIV status, as well as sexual consent and communication. The erotic half-hour focuses on genital massage techniques, as well as condom use.

Workshop 4: Vulnerabilities

The fourth workshop aims to recognize the areas that make the participant vulnerable to sexual risk taking. One activity among the following is chosen: 1) sexual well-being, 2) substance use in a sexual context, or 3) disclosing (or not) my HIV status (for participants living with HIV). The erotic half-hour focuses on oral sex and rimming techniques.

Workshop 5: The chain

The fifth workshop aims at having the participant build his chain of risk, that is, to analyze a situation where he has put himself at risk in the past, and then to discern his opportunities to do things differently in the future. One activity presents different risk reduction strategies to show the participant the range of choices available. The erotic half-hour focuses on anal massage and anal penetration techniques.

Workshop 6: Action plan

The sixth workshop is designed to get the participant to think about combinations of risk reduction strategies and erotic skills in his sexuality in different contexts. Action plan writing is central to this workshop. The erotic half-hour focuses on sex toys and kinky sex.

Wrap-up workshop

After a three-week break, the last workshop serves as a review of the implementation of the participant’s action plan. A recap of his Phénix experience is also made.

Our partners

Several researchers and community organizations cooperated with the Phénix team to develop a theoretically sound, yet practically realistic program.

Research team

Scientific leadership :

Joanne Otis, Université du Québec à Montréal (UQAM)

Martin Blais, UQAM

Coordination and conception

Jessica Caruso, M.A

Marie Latendresse, M.A

Ludivine Veillette-Bourbeau, M.Sc.

Research officiers, Department of sexology,

Faculty of human sciences, Université du Québec à Montréal

Advisory committee

Sylvain Beaudry, ACCM

Patrice Bécotte, B.A. sexology

Pier-Luc Chouinard, Maison Plein Cœur

Nicolas Courcy, Centre Sida Amitié

Gabriel Daunais-Laurin, B.A. sexology

Gérald Julien, RÉZO

Maxime Lévesque, B.A. sexology

Alexander McKenzie, RÉZO

Gabrielle Pitre, Maison Plein Cœur

Guillaume Tremblay-Gallant, RÉZO

Joël Xavier, MAX Ottawa

Partner organizations that were implicated in the program evaluation

ACCM (Montréal)

Arche de l’Estrie (Sherbrooke)

BRAS Outaouais (Gatineau)

Le Dispensaire (St-Jérôme)

COCQ-SIDA (Montréal)

IRIS Estrie (Sherbrooke)

Maison Plein Cœur (Montréal)

RÉZO (Montréal)


The revision and dissemination of the Phénix program was financially supported by Canadian Institutes of Health Research (CIHR) and ministère de la Santé et des Services sociaux (MSSS).