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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:

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:

The presentation reports on a study designed to revise the CDC recognized, evidence-based HIV prevention intervention, “Real Men Are Safe” (REMAS) to be more culturally relevant to African American and Hispanic men, and then conduct a pilot feasibility trial of the revised REMAS (REMAS-CA) in four CTN community treatment providers that have a high percentage of minority clients. Comparisons between the original REMAS manual and four culturally tailored interventions (Nia, d-up, Many Men Many Voice, and Cuidate) were made, focusing in particular on language/expressions of the target group; activities that enhance ethnic identity, consistency with the norms, knowledge, and cultural values of the target group; and understanding of the social context and living situations of the target group. Resultant changes to the original intervention are described, along with data and feedback from focus groups following pilot testing of the REMAS-CA.

Related protocols: CTN-0018

Abstract:

Many substance users enrolled in drug treatment programs continue to engage in high-risk sexual behaviors despite the threat of sexually transmitted infections (STIs). Little is known about the impact of drug abuse treatment on these behaviors. This ancillary investigation of data from CTN-0018 (“Reducing HIV/STD Risk Behaviors: Men”) examined the association of substance abuse treatment with sexual risk behaviors among participants in the multi-site trial. The authors hypothesized that decreased drug/alcohol problem severity would coincide with decreases in sex risk behaviors. Three-hundred and fifty-six men were assessed using the Addiction Severity Index (ASI) and the Sexual Behavior Interview (SBI). Interactions were found between drug/alcohol use severity and condom use with regular partners. Decreased severity of drug problems and decreased severity of alcohol problems were associated with increased condom use with regular sex partners, when controlling for number of treatment sessions attended. There were interactions between decreased number of sex partners and decreased severity of drug and alcohol problems, and between decreased sex under the influence and decreased severity of drug and alcohol problems, but these interactions disappeared when including treatment sessions attended. Condom use with casual sex partners and having at least one high risk partner did not interact with decreased drug/alcohol use severity.

Conclusions: Some sexual risk behaviors decreased in those whose drug/alcohol use severity also decreased independent of specialized treatment-based intervention sessions. Enrollment in drug treatment may serve as an effective method for reducing HIV risk behaviors among drug users. Further research is needed to pinpoint the effect of drug treatment independent of other factors.

Related protocols: CTN-0018

Abstract:

HIV continues to be a significant problem among substance users and their sexual partners in the United States. The National Drug Abuse Treatment Clinical Trials Network (CTN) offers a national platform for effectiveness trials of HIV interventions in community substance abuse treatment programs. This article presents the HIV-related activities of the CTN during its first 10 years. While emphasizing CTN HIV protocols, this article reviews the (1) HIV context for this work; (2) the collaborative process among providers, researchers, and National Institute on Drug Abuse CTN staff, on which CTN HIV work was based; (3) results of CTN HIV protocols and HIV secondary analyses in CTN non-HIV protocols; and (4) implications for future HIV intervention effectiveness research in community substance abuse treatment programs.

Conclusions: While the feasibility of engaging frontline providers in this research is highlighted, the limitations of small to medium effect sizes and weak adoption and sustainability in everyday practice are also discussed.

Related protocols: CTN-0010, CTN-0013, CTN-0015, CTN-0017, CTN-0018, CTN-0019, CTN-0032

Abstract:

HIV prevention interventions often promote monogamy to reduce sexual risk. However, there is little consensus about how to define monogamy. The goal of this study was to determine the extent to which recent monogamy and/or being in a committed relationship serve as markers for low sexual risk among men in substance abuse treatment. Participants were 360 men enrolled in the National Institute on Drug Abuse Clinical Trials Network “Real Men Are Safe” protocol (CTN-0018) who completed all assessments (baseline, 3 months, and 6 months). Self-reported behaviors included number of sexual partners, type of relationships, frequency of vaginal/anal intercourse, and percentage of condom use. Results: The rate of self-reported monogamy in the prior 90 days was stable across assessments (54.2%, 53.1%, 58.3%). However, at each assessment 7.5–10% of monogamous men identified their partner as a casual partner, and only 123 (34.2%) reported being monogamous at every assessment. Of these, 20 (5.6%) reported being monogamous with different partners across assessments. Men with both committed relationship and casual partners reported more condom use with their committed relationship partners than men with only a committed relationship partner.

Conclusion: Clinicians and researchers should consider individual relationship context and behavior and avoid assuming that recent monogamy or being in a committed relationship denotes low risk. Scientific Significance: This study provides evidence that, in male drug users, monogamy does not necessarily reflect low sexual risk. Rather, “monogamous” men actually encompass various combinations of partner types and levels of risk behavior that are unstable, even over brief time periods. Clinicians and researchers must take these variations into account.

Related protocols: CTN-0018

Abstract:

This poster reports on a study designed to revise the CDC recognized, evidence-based HIV prevention intervention, “Real Men Are Safe” (REMAS) to be more culturally relevant to African American and Hispanic men, and then conduct a pilot feasibility trial of the revised REMAS in four CTN community treatment providers that have a high percentage of minority clients. The Delphi Process was used to modify the intervention, with expert panel members reviewing and rating all the modules from REMAS and four other HIV prevention interventions tailored to minority men. Panel members also provided specific suggestions of ways to revise REMAS to make it more culturally sensitive. After round 1, the manual was revised and then rated again by the expert panel in round 2. Following round 2, the final version, REMAS-CA (“culturally adapted”) was completed and readied for pilot testing.

The Delphi Process was found to be a successful technique for the revision process, and though the quantitative ratings and qualitative suggestions were, for the most part, consistent with each other, the qualitative feedback was utilized more extensively in making revisions to REMAS (specific revisions are noted in the poster). The effectiveness of the REMAS-CA at decreasing high risk sexual behavior of African American and Hispanic men in substance abuse treatment is currently undergoing pilot testing.