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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:

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:

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

Abstract:

This 2.5 hour workshop, developed by the Research Utilization Committee (RUC), focuses on the outcomes and clinical utility of National Drug Abuse Treatment Clinical Trials Network protocols CTN-0018 and CTN-0019, which were designed to test gender-specific interventions to reduce HIV sexual risk behavior among clients in drug treatment programs.

Four Workshop Components:

Louise Haynes, MSW
Watch: Introduction to the Article (3 min.)
Read: Addressing Sexual Issues in Addictions Treatment (Counselor article)

Don Calsyn, PhD
Watch: The Real Men Are Safe (REMAS) Clinical Trial (40 min.)

Susan Tross, PhD
Watch: HIV/STD Safer Sex Skills Building (SSB) Groups for Women in Methadone Maintenance or Drug-Free Outpatient Treatment (50 min.)

Related protocols: CTN-0018, CTN-0019

Abstract:

The female condom is effective in reducing unprotected sexual acts; however it remains underutilized in the U.S. This study, part of the National Drug Abuse Treatment Clinical Trials Network protocol CTN-0019 (“Reducing HIV/STD Risk Behaviors: A Research Study for Women in Drug Abuse Treatment”), examined whether a 5-session HIV prevention intervention (Safer Sex Skills Building (SSB)), including presentation, discussion, and practice with female condoms, improved female condom skills and attitude among women in outpatient substance abuse treatment. Mixed-effects modeling was used to test the effect SSB on skills and attitude over 3- and 6-month post-treatment among 515 randomized women. SSB was significantly associated with increases in skills and attitude, and the female condom demonstration session was primarily responsible for skills improvement. Attitude was a partial mediator of the intervention effect in reducing unprotected sex.

Findings emphasize the utility of integrating female condom messages targeting proximal behavioral outcomes into HIV prevention. Female condoms should be visible and available in treatment programs and other places women frequent and discussion about female condoms should be integrated into group and individual counseling. This study supports the importance of brief, hands-on exercises for female condom skill instruction, as well as further research to enhance attitudinal change to reduce sexual risk.

Related protocols: CTN-0019

Abstract:

This presentation, developed for clinicians, provides an overview of protocols CTN-0018 and CTN-0019, “Reducing HIV/STD Risk Behaviors: A Research Study for Men/Women in Drug Abuse Treatment.” It describes in detail the interventions evaluation by the two protocols, “Real Men Are Safe (REMAS)” (men) and “Safer Sex Skills Building (SSSB)” (women), presenting the main findings from each study, as well as a demonstration of part of the women’s program.

Both programs were associated with greater sexual risk reduction in men and women, suggesting that substance abuse treatment programs can help reduce sexual risk among their patients by providing not only information but also hands-on practice skills.

Related protocols: CTN-0018, CTN-0019

Abstract:

Since drug-involved women are among the fastest growing groups with AIDS, sexual risk reduction intervention for them is a public health imperative. The objective of this study, part of protocol CTN-0019 (“Reducing HIV/STD Risk Behaviors: A Research Study for Women in Drug Abuse Treatment”), was to test the effectiveness of HIV/STD safer sex skills building (SSB) groups for women in community drug treatment. The study used a randomized trial of SSB versus standard HIV/STD Education (HE), with assessments at baseline, 3, and 6 months. Women were recruited from 12 methadone or psychosocial treatment programs in the National Drug Abuse Treatment Clinical Trials Network. Five hundred and fifteen women who had had at least one unprotected vaginal or anal sex occasion (USO) with a male partner in the past six months were randomized. In SSB, five 90-minute groups used problem solving and skills rehearsal to increase HIV/STD risk awareness, condom use, and partner negotiation skills. In HE, one 60-minute group covered HIV/STD disease, testing, treatment, and prevention information.

The main outcome measured was the number of USOs at follow-up. A significant difference in mean USOs was obtained between SSB and HE over time (F = 67.2, P < 0.0001). At 3 months, significant decrements were observed in both conditions. At 6 months, SSB maintained the decrease and HE returned to baseline (P < 0.0377). Women in SSB had 29% fewer USOs than those in HE. This study demonstrates that skills building interventions can produce ongoing sexual risk reduction in women in community drug treatment.

Related protocols: CTN-0019