Men in methadone maintenance versus psychosocial outpatient treatment: Differences in sexual risk behaviors and intervention effectiveness from a multisite HIV prevention intervention trial.

The effectiveness of the Real Men Are Safe (REMAS) HIV prevention intervention was examined in this study, part of protocol CTN-0018, as a function of treatment program modality. REMAS is a five-session sexual risk reduction intervention for men involving didactically delivered informational material, role playing, peer group discussions, and self-assessment motivational exercises. REMAS was associated with significantly larger decreases in unprotected sexual occasions than an HIV education control condition in both methadone maintenance and psychosocial outpatient program participants. REMAS had superior effectiveness for reducing unprotected sexual occasions in the psychosocial outpatients compared to the methadone maintenance patients. At the six-month follow-up, the adjusted mean change for REMAS completers in the outpatient group was greater than for the methadone group.

Reasons for why REMAS appears to be especially effective for psychosocial outpatient programs are explored, including differences in patient variables, the effects of methadone as a treatment, and greater relevance of the REMAS intervention to patients in outpatient treatment. Modifications of the REMAS approach may be needed to further enhance effectiveness with methadone maintained patients.