HIV prevention in community-based substance abuse treatment: The NIDA CTN Safer Sex Skills Building Study for Women.

Data indicates that substance use may play a role in over 50% of HIV infections through high risk heterosexual contact, injection drug use, and in cases with combined risk. Drug-involved women are at especially high risk for heterosexual transmission of HIV, as primary male partners often use drugs and their own substance use may impair decision-making and decrease perception of risk. Brief, didactic interventions have been insufficient in reducing sexual risk behaviors. The CTN’s “Safer Sex for Women Study” (CTN-0019) offered an opportunity to test a multi-session, gender-specific, efficacious treatment against a single HIV education prevention session in a large effectiveness trial. Eligible participants reported at least one unprotected sexual occasion (USO) with a male partner in the 6 months prior to enrollment and were not pregnant or planning a pregnancy. Women were randomized to a 5-session Safer Sex Skills Building group (SSB) or a 1-session HIV Education group (HE). Participants were assessed at baseline and 3- and 6-months post treatment. Primary analysis revealed a significant time by intervention interaction whereby both interventions produced reductions in USO at 3-month follow-up, but SSB further reduced USO at 6-month follow-up while women in HE returned to baseline levels. Secondary analysis showed a significant treatment by time interaction for sex while intoxicated. Evidence-based HIV prevention should be integrated into substance abuse treatment programs; however, current policy limitations and practice demands make this challenging. Further, contextual factors, such as trauma history, are important to understanding sexual behaviors that increase HIV risk. Social workers are well positioned to advocate for best practices in clinical settings and for state and local policies that enhance quality of care. Thus, social workers can and should be key collaborators in the research conducted within the CTN to maximize the impact within community-based treatment settings.

Related protocols: CTN-0019