Presentation on theme: "HIV/STD SAFER SEX SKILLS GROUPS FOR MEN IN METHADONE MAINTENANCE OR DRUG-FREE OUTPATIENT TREATMENT PROGRAMS (CTN 0018) Lead Investigator: Donald Calsyn,"— Presentation transcript:
HIV/STD SAFER SEX SKILLS GROUPS FOR MEN IN METHADONE MAINTENANCE OR DRUG-FREE OUTPATIENT TREATMENT PROGRAMS (CTN 0018) Lead Investigator: Donald Calsyn, Ph.D. Washington Node Co-lead Investigator: Susan Tross, Ph.D. Long Island Node Project Managers: Sara Berns, Ph.D./ Mary Hatch-Maillette, Ph.D. Supported by NIDA (1 U10DA , Dennis Donovan, PI)
Treatment Sites Seattle San Francisco Hartford Philadelphia (x2) Staten Is. Greensboro Norwalk Rancho Cucamonga Santa Fe Richmond Toledo Huntington Raleigh Red=Psychosocial Outpatient Black=Methadone Maintenance
Study Schema Advertise Study Availability Consent to Screen for Inclusion/Exclusion & Screening Assessment Obtain Informed Consent from Eligible Participants Conduct Baseline Assessment → Place in Waiting Cohort Randomly Assign Cohort to Intervention Standard HIV Education Gender Specific Intervention (one session) (five sessions) Conduct Post Intervention Assessment Conduct Three Month Follow Up Assessment Conduct Six Month Follow Up Assessment
Inclusion / Exclusion Criteria & Screening Measures Inclusion Criteria: 1. Adult males in treatment at a participating CTP 2. Self report engaging in unprotected vaginal or anal intercourse during the past 6 months. 3. Agreeable to random assignment. 4. Agreeable to completing assessment battery at baseline, 2 wk., 3 mo., & 6 mo. post intervention. Exclusion Criteria: 1. Observable, gross mental status impairment – including severe distractibility, incoherence or retardation 2. Observable psychotic symptoms or severe psychiatric distress 3. Having a primary partner planning to become pregnant. Screening Measures: 1. Demographic Form 2. Risk Behavior Survey 3. Mini Mental Status Exam < 25
Primary and Secondary Outcomes Primary Outcome Variable Number of unprotected vaginal & anal sex events Secondary Outcome Variables Attitude towards condoms Possessing condoms Intent to use condoms Percentage of sexual events in which drug use occurred Frequency of “outer course” Gender role beliefs Number of sexual partners
Measures Baseline: ASI-Lite, CIDI Sexual Behavior Interview (ACASI) Condom Barriers Scale Sexual Self-efficacy Condom Skills Demonstration Bem Sex Role Inventory Intervention Exposure Checklist
Measures Follow Up: ASI-Lite D&A (at 6 month only) RBS (injection only) Sexual Behavior Interview (ACASI) Condom Barriers Scale Sexual Self-efficacy Condom Skills Demonstration Bem Sex Role Inventory Intervention Exposure Checklist
HIV Education (Control Group) I. Group Introductions. Goals and Guidelines 5 Min II. HIV/AIDS Update10 Min III. HIV Risky Behaviors, injection practices 5 Min IV. HIV Risky Behaviors, sexual practices10 Min V. Healthy Options 10 Min VI. Condom demonstrations 10 Min VII. Overcoming Barriers to Condom Use10 Min
Techniques Utilized in the HIV Education Group Lecture Information on Flipcharts Condom Demonstrations
REMAS: Real Men are Safe 1. HIV/AIDS Update: Identifying Risks 2. HIV/AIDS Update: Planning Prevention 3. Sex without drugs. Can it happen? Is it pleasurable? 4. Beyond the pick up line, communicating about sex 5. Communicating about Safe Sex II. Workshop Summary
Techniques Utilized in the REMAS Group Lecture & Discussion Information on Flipcharts Condom Demonstrations & Practice Brainstorming & Discussion Self Assessment Exercises Role Plays
Information, Motivation, Behavioral Skills Model & Techniques Utilized in REMAS Information Lecture & Information on Flipcharts Condom Demonstrations Motivation Self Assessment Exercises Brainstorming & Discussion Behavioral Skills Role Plays Condom Practice Brainstorming
Role Play Example: Running into a friend of friend still using JESSICA: Paul, do you remember me? We met at your friend Dave’s place a few months ago. We had a wild time. Dave had gotten some great stuff. What you been doing? PAUL: I’m in treatment now. I haven’t done any [crack/coke/crystal] for over a month now. I am just starting to feel normal again. JESSICA: I was in treatment once. I missed the excitement though. I try not to do so much anymore, but I still like to get high. I am on my way over to Dave’s right now to party. Dave called and said he has some killer stuff. Want to join me? PAUL: No thanks. I’m sticking to my program. I can get way out of control on that stuff. JESSICA: I remember the last time I saw you at Dave’s. It looked like you and that woman you were with were having a great time. I could show you an even better time. I know I’ll get all sexed up once I get high. PAUL: I’m sure you could show me a good time, and I get very horny when I do [crack/coke/crystal] also. The sex use to be good, but after awhile, I had trouble getting off. Then I got paranoid. I’m committed to staying straight. I need to get going.
Role Play Example Continued: Running into a friend of friend still using JESSICA: Paul when was the last time you got laid? You don’t need to do any [crack/coke/crystal]. Just come for the sex. I’m getting all turned on just thinking about it. Come join me. PAUL: There is no way I can be around other people getting high and not use myself. It has been awhile since I have had sex, but that’s OK. I like being straight and am not willing to start using again just to have sex. JESSICA: Good for you. I’m not ready to stop using now. I’m off to get high. See you later. PAUL: I’m sure that down the road some sexual opportunities will come my way that do not include getting high. Who knows, maybe even we could get together if you decide to do recovery again.
Sex under the Influence is Common for Substance Abuse Treatment Patients Calsyn, Hatch-Maillette, Doyle, Cousins, & Woody Tuesday, Board 38 The majority of sexually active men in methadone maintenance (82.8%) and psychosocial outpatient treatment (65.3%) reported engaging in sex under the influence of drugs or alcohol in the 90 days prior to baseline assessment. Both MM and OPS patients were more likely to have a casual sexual partner at the last sexual event if they were under the influence. OPS patients under the influence compared to those not under the influence at last sexual event were more likely to engage in anal sex and insertive oral sex.
Sexual Activity of Substance Abuse Treatment Patients Hatch-Maillette, Calsyn, Doyle, Woods, Coyer, Sillo, Woody Tuesday, Board 33 Patients in psychosocial outpatient treatment reported significantly more frequent vaginal and insertive oral sex with their main partner, and with other female partners in the prior 90 days compared to methadone maintenance patients. Men who were stimulant users had more partners and their partners were riskier (χ2=4.6, p=.03), compared to primarily non- stimulant users.
Communication about condom use and reported condom use among participants enrolled in drug treatment Song, Calsyn, Doyle, Herr, & Sorensen Tuesday, Board 32 Positive attitudes about condoms, communication with female partners about sex and condom use, possessing condoms, and not being married were associated with greater condom use for vaginal and anal intercourse. Participants who perceived condoms as being more accessible were more likely to use condoms for vaginal and anal intercourse Participants in MM were more likely to communicate with their female partners about their sex life and condom use then those in OPS programs.
Screening, Baseline & Randomization Eligible No sex other Pregnancy Planned Randomized Other No Contact Left Tx MMSE < % condom use Withdrew
Sample Demographics Ineligible Randomized m (sd) m (sd) Age 42.5 (10.2)39.5 (10.4) Race n (%) n (%) White 179 (54.9) 342 (58) Af. Am. 89 (27.3)165 (28) Hisp. 43 (13.2) 66 (11.2) other 15 ( 4.6) 17 ( 2.9)
Sample Demographics: Randomized m (sd) Education 12.3 (1.9) Income $ ( ) Marital n (%) Never 278 (47.2) Married 112 (19) Div/Wid/Sep 199 (33.8)
Recruitment by Site Total n=594
Treatment Exposure REMASHIV-ED 51.56% 56.57%
Follow Up Rates
Male condom skill list Chose a latex condom Chose a water-based lubricant Expiration date on package is checked Package is opened carefully Condom checked for damage Determined direction in which condom rolls Condom rolled correctly downward Condom rolled to base of penis Air removed from condom Space left at tip of condom Lubricant added to inside tip of condom or penis Turned to the side and withdrew condom Took care to avoid spilling Tied off condom and disposed of in trash
Female condom skill list Expiration date on package is checked Package is opened carefully Condom checked for damage Condom unrolled and the two rings separated Condom rubbed gently to evenly spread the lubricant Inner ring squeezed between fingers Inner ring pushed into vaginal canal while squeezed Inner ring placed against cervix so that it is completely covered Outer ring covers outside of vagina End of condom is twisted and removed by pulling, with care taken not to spill its contents Condom disposed of in a trash can
Change in condom skills as a function of intervention attendance ♂ condoms ♀ condoms P time <.001 P time x attendance <.001
Condom use for most recent sexual event at post intervention as a function of intervention attendance Low risk High Risk
Lead Node Team Mary Hatch-MailletteQA & Regulatory Sara Berns Anthony Floyd Data Management Donna Bargoil Molly CarneyResearch Assistant Katie Weaver Viki Stanmour Brooke LearyStatistician Michael Dudley Suzanne Doyle TrainingWA Node Coordinator John Baer Brenda Stuvek
RRTC and Site PIs Yong SongGenise Lalos Paul Crits-ChristophJudy Harrer Stephen WeinsteinRoss Chaban Bob SterlingAllen Cohen Bill DalyMichael McCann Susan TrossLouise Haynes Julie MatthewsTherese Killeen Sam BallDiane Pallas Tad ClodfelterRon Jackson Jackie ButlerKristie Smith Charlotte Royer-MalvestutoJennifer Manuel Tamara Owens
Site Coordinators Esther Ricardo-Bulis Jenifer Skelding Sarh Pelta Parrish Harless Kerry Raively Gina Richardson Mark Hirschman Kimberly Pressley Bonita Sussman Al Woods Lisa Markiewicz Diane Pallas Allison Hartsock Lester Fleming Nicole Moodie
Research Assistants Rhodri Dierst-DaviesTracey Vann Ellen FritchSteve Rosebrook Carolyn LaurenzaTara Lee Diane LosardoScott Herr Brian SmithAaron Upton Sarah CousinsCharles Michael Beverly HolmesDennis Romero Brianne O’SullivanClark Reed Diana PachecoMelissa Clymer Patrick Worhunsky Denise McRae Barbara Hobbs
Therapist Supervisors Yong SongSusan Coyer Mark HirschmanAl Woods Henry BatesDeborah Service Evette WilsonLouise Haynes Joe GrossmanMichael DeBernardi Sarah SperrazzaCarol Davidson David HettichMelodie Keen Lester Quagliano
Therapists William Buehlman Max Mineo Luis Ramos Dennis Durant Jerome Wells Bernie Reardon Joel Hurdle Donald Bellemore Charles Holman Will Pescock Philip Pellegrino George Cantees Patrich Walsh Fred Clark Arthur Sagevick Jimmy McKeller Richard Dable Louis Battistone Frank Shimko Nick Nardone Jimmy Moutinho Ulysses Rogers Markel Pitt Andre Walker Quincy Stephens Art Panero Doug Stenchever Stefan Dobuszynski John Williams