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Abstract: African Americans who use substances experience a particular risk for HIV. Negative attitudes towards condoms are a strong predictor of risk and can serve as barriers to safe sex. They also vary by gender. In this secondary analysis of data from two NIDA Clinical Trials Network studies, CTN-0018 and CTN-0019, the relationship between gender, unprotected sex, and condom barriers among 203 African Americans in substance use treatment was examined. Results indicated that no gender differences were present in unprotected sex. Men reported more motivational barriers to condom use and were more likely to believe that condoms would impede sexual experience (the latter not statistically significant). For both genders, the perception that condoms might negatively impact sexual experience was associated with unprotected sex. Gender did not moderate the relationship between condom barriers and unprotected sex. Conclusions: These findings suggest the need for gender and race-specific prevention strategies that focus on motivation and address pleasure-based concerns regarding condoms. Substance use treatment facilities are well-positioned to support interventions to target these issues. Related protocols: CTN-0018, CTN-0019

Abstract:

HIV prevention for women with substance use disorders is a public health priority. To identify characteristics associated with sexual risk among women in outpatient substance abuse treatment, this study categorized 809 screened women who participated in CTN-0019 into 3 groups: sexually inactive, sexually active with consistent condom use, and sexually active with inconsistent condom use.

Multinomial logistic regression analyses were used to examine demographics, substance use and treatment characteristics, and regional HIV seroprevalence as predictors of sexual risk behavior.

Younger age and attending psychosocial treatment for primary cocaine use (versus attending methadone maintenance treatment for primary opioid use) were significantly associated with being at higher HIV risk.

Conclusions: Grounded in data from a large, geographically heterogeneous, national sample of substance using women in substance abuse treatment, this study identified demographic and clinical characteristics among women with differing levels of HIV risk. Analyses examined established predictors of HIV risk behavior of enduring importance, including: (younger) age; having multiple partners; primary stimulant use; alcohol use; and community HIV risk (as indicated by estimated IDU HIV seroprevalence). HIV prevention should be tailored to address HIV risk in younger women in psychosocial treatment.

Related protocols: CTN-0019

Abstract:

The aim of this research was to explore the association of abuse experiences (child sexual abuse and adult physical/sexual violence) to sexual relationship power among Black substance-abusing women. The study was a secondary analysis of baseline data collected from 124 Black women in 12 drug treatment programs across the United States who initially participated in an HIV risk reduction trial conducted within the NIDA Clinical Trials Network. The findings revealed that adult sexual abuse, but not childhood sexual or adult physical abuse, was associated with lower relationship control and decision-making dominance as measured by the Sexual Relationship Power Scale.

Conclusions: These findings suggest that a history of adult sexual abuse may disempower Black substance-abusing women from negotiating for safer sex. That argues for addressing a history of adult sexual abuse as a strategy for empowering women to advocate for their sexual health. Designing and implementing sexual risk reduction interventions that address adult sexual violence may enhance the relationship power of Black substance-abusing women and in turn may promote safer sex practices.

Related protocols: CTN-0019

Abstract:

Sexual risk behavior is now the primary vector of HIV transmission among substance users in the United States with gender as a crucial moderator of risk behavior. This study examined gender differences in factors (age, race/ethnicity, education) that predict main-partner unprotected sexual occasions (USO) using the unique platform of two parallel NIDA Clinical Trials Network gender-specific safer sex intervention trials. Baseline assessments of male (N=430) and female (N=377) participants included demographic characteristics; past 3-month sexual activity; and a diagnostic assessment for alcohol, cocaine/stimulant, and opioid use disorders. Using mixed effects generalized linear modeling of the main outcome USO, two-way interactions of gender with age, race/ethnicity, and education were evaluated and adjusted by alcohol, cocaine/stimulant, or opioid use disorder.

When adjusted for alcohol use disorder, the interaction of education and gender was significant. For men, a high school or greater education was significantly associated with more USO compared to men with less than high school. For women, greater than high school education was significantly associated with less USO compared to women with a high school education. None of the other interactions were significant when adjusted for cocaine/stimulant or opioid use disorder.

Conclusions: This study demonstrates gender differences in the relationship of education, alcohol use disorder, and main-partner USO in individuals in substance abuse treatment. This underscores the importance of considering demographic and substance use factors in HIV sexual risk behavior and in crafting prevention messages for this population.

Related protocols: CTN-0018, CTN-0019

Abstract:

Receptive anal sex has high human immunodeficiency virus (HIV) transmission risk, and heterosexual substance-abusing individuals report higher anal sex rates compared to their counterparts in the general population. This secondary analysis of two NIDA Clinical Trials Network studies (CTN-0018 and CTN-0019) evaluated the effectiveness of two gender-specific, evidence-based HIV prevention interventions (Real Men are Safe, or REMAS, for men; Safer Sex Skill Building, or SSSB, for women) against an HIV education (HIV-Ed) control condition on decreasing unprotected heterosexual anal sex (HAS) among substance abuse treatment-seeking men (n=171) and women (n=105). Two variables, engagement in any HAS and engagement in unprotected HAS, were assessed at baseline and three months post-intervention.

Compared to the control group, women in the gender-specific intervention did not differ on rates of any HAS at follow-up but significantly decreased their rates of unprotected HAS. Men in both the gender-specific and the control interventions reported less HAS and unprotected HAS at three-month follow-up compared to baseline, with no treatment condition effect.

Conclusions: Women and men showed different patterns when it came to unprotected HAS. For men, rates of unprotected HAS decreased overall in the sample, and patterns suggest the reduction may, at least partly, reflect their decreased rates of engaging in any HAS. On the other hand, SSSB women did show a decrease in unprotected HAS compared to controls despite no significant difference in overall HAS rates. For them, the results suggest the SSSB intervention did produce intentional action toward risk reduction. The mechanism of action for SSSB compared to REMAS in decreasing unprotected HAS is unclear. More attention to HAS in HIV-prevention interventions for heterosexual men and women in substance abuse treatment is warranted.

Related protocols: CTN-0018, CTN-0019

Abstract:

HIV transmission often occurs through heterosexual high-risk sex. Even in the era of HIV combination prevention, promoting condom use and understanding barriers to consistent condom use remain priorities, especially among substance-dependent individuals.

This secondary analysis used data from CTN-0018 and CTN-0019, two NIDA Clinical Trials Network studies that compared a five-session gender-specific risk reduction group (Real Men Are Safe for men, Safer Sex Skills Building for women) to a one-session HIV Education Group for men and women (N=729) in outpatient drug treatment. Condom barriers (Motivation, Partner-Related, Access/Availability, Sexual Experience) were assessed at baseline and 6-month follow-up.

Intervention condition was not associated with condom barriers across any of the four domains; however, individuals who attended at least three of the five SSSB/REMAS sessions or the single session of HIV Education were more likely to report fewer motivation and partner-related barriers. Among women, reductions in motivation and sexual experience barriers were associated with less sexual risk with primary partners. For both men and women, reductions in partner-related barriers were associated with fewer unprotected vaginal/anal sex acts with primary partners.

Conclusions: Condom barriers are important to gender-specific HIV prevention; given limited resources, brief interventions maximizing active components are needed.

Related protocols: CTN-0018, CTN-0019

Abstract:

In the U.S., women who use drugs are at heightened susceptibility to HIV/STD heterosexual transmission. Drug treatment is a critical juncture at which to provide HIV/STD risk assessment, testing, risk reduction interventions, and linkage to treatment, as needed. To effectively implement interventions in busy drug treatment programs, it is important to have a rapid and accurate measure of sexual risk. This study compared 2 dichotomous ratings of unprotected sex among women in substance abuse treatment who participated in NIDA Clinical Trials Network study CTN-0019, “Reducing HIV/STD Risk Behaviors: A Research Study for Women in Drug Abuse Treatment”: (1) any unprotected vaginal/anal sex occasions in the last 3 months, versus (2) unprotected vaginal/anal sex at last sexual occasion (LSO). The two measures were derived from the Sexual Experiences and Risk Behavior Assessment Schedule (SERBAS). Sexually active women from 12 methadone maintenance or psychosocial outpatient programs who had a main (n = 363) or other male partner(s) (n = 117) were assessed at baseline for unprotected sex in the last 3 months and at LSO. These 2 measures were compared for congruence.

Analyses found that participants who reported unprotected sex at LSO consistently reported at least 1 unprotected sex occasion in the last 3 months: 99.1% for main male partner sex and 93.8% for other male partner sex. Participants who reported using a condom at LSO, however, were less consistent in terms of their behavior over the past 3 months: only 30.3% also reported protected sex at all sex occasions in the last 3 months with main male partner, with 67.6% reporting the same for other male partner(s).

Conclusions: This study suggests that use of one question about condom protected sex at LSO is a good indicator of the presence of sexual risk behavior during the past 3 months. If participants report unprotected sex at LSO, they are likely to have had at least one other unprotected encounter in the prior 3 months. Those reporting condom use at LSO may or may not have consistently used condoms over the prior 3 months; follow-up questions with this group will be necessary to adequately gauge risk.

Related protocols: CTN-0019

Abstract:

This CTN ancillary investigation aimed to examine predictors and moderators of response to two HIV sexual risk interventions of different content and duration for individuals in substance abuse treatment programs. Participants were recruited from community drug treatment programs participating in the National Drug Abuse Treatment Clinical Trials Network (CTN). Data were pooled from two parallel randomized controlled CTN studies, CTN-0018 and CTN-0019 (“Reducing HIV/STD Risk Behaviors: A Research Study for Men/Women in Drug Abuse Treatment”), each examining the impact of a multi-session HIV education intervention, on the degree of reduction in unprotected sex from baseline to 3- and 6-month follow-ups. The findings were analyzed using a zero-inflated negative binomial (ZINB) model.

Severity of drug use, gender, and age were significant main effect predictors of number of unprotected sexual occasions (USOs) at follow-up in the non-zero portion of the ZINB model (men, younger participants, and those with greater severity of drug/alcohol abuse have more USOs). Monogamous relationship status and race/ethnicity were significant predictors of having at least one USO vs. none (monogamous individuals and African Americans were more likely to have at least one USO). Significant moderators of intervention effectiveness included recent sex under the influence of drugs/alcohol, duration of abuse of the primary drug, and Hispanic ethnicity.

Conclusions: These predictor findings and moderator findings point to ways in which patients may be selected for the different HIV sexual risk reduction interventions and suggest potential avenues for further development of the interventions for increasing their effectiveness within certain subgroups, with particular attention to cultural sensitivity.

Related protocols: CTN-0018, CTN-0019

Abstract:

Social workers are often on the front lines of the HIV/AIDS epidemic delivering prevention education and interventions, offering or linking individuals to HIV testing, and working to improve treatment access, retention, and adherence, especially among vulnerable populations. Individuals with substance use disorders face additional challenges to reducing sexual and drug risk behaviors, as well as barriers to testing, treatment, and antiretroviral therapy adherence.

This article presents current data on HIV transmission and research evidence on prevention and interventions with substance abusers, and highlights how individual social workers can take advantage of this knowledge in practice and through adoption and implementation with organizations. Research from the National Drug Abuse Treatment Clinical Trials Network (CTN) about rapid HIV testing and gender-specific HIV risk reduction interventions is described.

Related protocols: CTN-0018, CTN-0019, CTN-0032

Abstract:

For substance abuse treatment seekers engaging in high risk sexual behavior, their inconsistent condom use may be related to their condom use attitudes and skills. This study compared treatment-seeking male and female substance abusers in their reported barriers to condom use and condom use skills. Men and women (N = 1,105) enrolled in two multi-site HIV risk reduction studies in the National Drug Abuse Treatment Clinical Trials Network (CTN-0018 and CTN-0019) were administered the Condom Barriers Scale, Condom Use Skills, and an audio computer-assisted structured interview assessing sexual risk behavior. Men endorsed more barriers to condom use, especially on the Effects on Sexual Experience factor. For both men and women, stronger endorsement of barriers to condom use was associated with less use of condoms. However, the difference between condom users and non-users in endorsement of condom barriers in general is greater for men than women, especially for those who report having casual partners.

Conclusions: Results provide additional information about the treatment and prevention needs of treatment-seeking men and women. Understanding differences between men and women in their beliefs, knowledge, and skills related to condom use will allow clinicians to better tailor risk behavior interventions. These results also emphasize that it is important for clinicians to remember that both men and women engage in risky sexual behavior despite being actively involved in substance abuse treatment.

Related protocols: CTN-0018, CTN-0019

Abstract:

Heterosexual anal intercourse (HAI) is an understudied risk behavior among women and men in substance abuse treatment. In this ancillary investigation of data from two National Drug Abuse Treatment Clinical Trials Network (CTN) studies that evaluating gender-specific interventions for reducing HIV/STD risk behaviors for men/women in substance abuse treatment (protocols CTN-0018 and -0019), rates of HAI for women (n=441) and men (n=539) were identified for any, main, and casual partners. More men (32.8%) than women (27.1%) reported engaging in HAI in the previous 90 days. These rates are higher than those reported for both men (6-15,9%) and women (3.5-13%) ages 25-59 in the National Survey of Sexual Health and Behavior. Men were significantly more likely to report HAI with their casual partners (34.1%) than women (16.7%). In a logistic regression model generated to identify associations between HAI and variables previously shown to be related to high risk sexual behavior, being younger, bisexual, and white were significantly associated with HAI. For men, having more sex partners was also a significant correlate.

Conclusions: These data show that more substance abuse treatment-seeking women and men participate in HAI than in the general population and that condom use is low for both genders. Given that heterosexual transmission is a primary means of contracting HIV and the seroconversion risk is greatest for receptive AI, it is vital that any HIV prevention program include material on HAI.

Related protocols: CTN-0018, CTN-0019

Abstract:

Substance abusers are at risk for HIV and other STIs. Heterosexual anal intercourse (HAI) is riskier than vaginal intercourse, and more risky for women than for men. Previous analyses of data from protocols CTN-0018 and CTN-0019 (Reducing HIV/STD Risk Behaviors: A Research Study for Men (0018) and Women (0019) in Drug Abuse Treatment) found that more women and men in substance abuse treatment engaged in HAI than in general population samples. Additionally, more men engaged in HAI than women, and men were more likely to engage in HAI with their casual sex partners than women. Condom use for HAI was infrequent, and younger age, bisexual behavior, being white, and having more sex partners (men) were associated with engaging in HAI.

This study aimed to evaluate the effectiveness of the five session CTN gender-specific HIV prevention interventions, “Real Men Are Safe (REMAS)” (CTN-0018) and “Safer Sex Skill Building (SSSB)” for women (CTN-0019), vs. single session information only control, on decreasing heterosexual anal intercourse (HAI) and increasing condom use for HAI. Men and women enrolled in the two protocols who reported heterosexual activity at baseline, attended SSSB/REMAS or the control condition, and completed the 3-month follow-up were included in the analysis. Results of the study found that the percent of men, but not women, engaging in HAI decreased from baseline to 3 month follow-up, with the decrease for men similar for both REMAS and control condition participants. Although condom use for HAI remained infrequent, the percentage of both women and men reporting any use of condoms for HAI increased between baseline and follow-up. Women attending SSSB were more likely to change from no condom use to some condom use than women attending the control intervention. A similar non-significant trend was noticed for men attending REMAS as well.

Related protocols: CTN-0018, CTN-0019

Abstract:

High-risk sexual behavior is an important vector of the HIV/AIDS epidemic, particularly among female substance abusers. Effective interventions to reduce unprotected sexual occasions (USO) and increase condom skills in this population are needed. Literature suggests ethnicity may influence risk behavior and participant response to intervention. This poster describes a secondary analysis of a gender-specific controlled multi-site trial of a 5-session HIV/STD risk reduction intervention for women, Safer Sex Skills Building (SSB), compared to a 1-session Health Education (HE) control (National Drug Abuse Treatment Clinical Trials Network protocol CTN-0019). SSB was skills-oriented but not ethnically tailored. Based on literature, it was hypothesized that ethnicity would moderate the intervention effects of SSB, reducing USO and increasing condom use skills among Caucasians but not minorities. For the primary outcome (unprotected sexual occasions), results found a significant main effect of treatment, reflecting lower USO in the SSB group, but no ethnicity by treatment interaction. For male condom use skills, there was an interaction between ethnicity and time, reflecting significantly greater skills among minorities at the 6-month follow-up. For female condom use skills, there was an interaction between ethnicity and treatment, reflecting significantly higher skills among minorities in the SSB group.

Conclusions: Contrary to the original hypothesis, a skills-based HIV risk reduction intervention was equal to or more effective among minorities in reducing unprotected sexual occasions and increasing condom use skills.

Related protocols: CTN-0019

Abstract:

Heterosexual anal intercourse (HAI) is a higher risk behavior for HIV transmission than vaginal intercourse. The NIDA Clinical Trials Network Safe Sex for Men/Women protocols (CTN 0018/0019) provided a unique opportunity to examine this understudied high risk behavior in men and women in substance abuse treatment. Men (n=539) and women (n=422) enrolled in CTN 0018/0019 reporting engaging in heterosexual activities in the 90 days prior to baseline assessment were included. Rates of engaging in HAI were determined for any, main and casual partners. Gender differences were analyzed with contingency table analysis utilizing the 2 statistic. Based on prior research, the following variables have been thought to be related to high risk sexual behavior among substance abusers: age, psychiatric severity, lifetime history of sexual abuse, ethnicity, stimulant use, number of sexual partners. These variables were entered into separate logistic regression analyses for men and women in an effort to identify correlates associated with HAI. More men (32.8%) than women report engaging in HAI. These rates are higher than the prior 90 day rates reported for both men (6.0 to 15.9%) and women (3.5 to 13.0%) age 25-59 in the National Survey of Sexual Health and Behavior. Men (28.6%) and women (23.2%) reported similar rates of engaging in HAI with their main partners. Men were much more likely to report HAI with their casual partners (34.1%) than women (16.7%). In the logistic regression model for men, having more sex partners, being younger, and white were significantly associated with engagement in HAI. For women, stimulant use and younger age were the significant associations.

Conclusions: HAI is a behavior practiced by more men and women in substance abuse treatment than in the general population, and is a logical target of HIV prevention interventions.

Related protocols: CTN-0018, CTN-0019

Abstract:

Gender-based relationship power is frequently linked to women’s capacity to reduce sexual risk behaviors. This ancillary investigation of data drawn from the baseline assessment of the National Drug Abuse Treatment Clinical Trials Network’s protocol CTN-0019 (“Reducing HIV/STD Risk Behaviors: A Research Study for Women in Drug Abuse Treatment”) offers an exploration of predictors of relationship power among women in outpatient substance abuse treatment, as measured by the multidimensional and theoretically grounded Sexual Relationship Power Scale. Linear models were used to test nine predictors (age, race/ethnicity, education, time in treatment, economic dependence, substance use, sexual concurrency, partner abuse, and sex role orientation) of relationship power among 513 women participating in a multi-site HIV risk reduction intervention study. Significant predictors of relationship control included having a non-abusive male partner, only one male partner, and endorsing traditional masculine (or both masculine and feminine) sex role attributes. Predictors of decision-making dominance were interrelated, with substance use x partner abuse and age x sex role orientation interactions.

This study makes a unique contribution to research on sexual relationships and provides support for the continued examination of factors that impact women’s relationship power, as well as the interaction of those factors. Given the empirical evidence supporting the association between relationship power and sexual risk behavior, HIV risk reduction interventions must include components that target the unique context of women’s lives, and diverse experiences of power within heterosexual partnerships. Results of this investigation contribute to the understanding of factors which may influence relationship power and their potential role in HIV sexual risk reduction interventions.

Related protocols: CTN-0019