1. Behavioral Intention and Partner Type on Condom Use Among Men in Drug Treatment Yong S. Song, PhD, University of California, San Francisco Donald Calsyn, PhD, University of Washington Suzanne Doyle, PhD, University of Washington Rhodri Dierst-Davies, MPH, Friends Research Institute TeChieh Chen, BA, University of Washington

2. Background Many substance users enrolled in treatment continue to engage in high-risk sexual behaviors HIV risk reduction interventions delivered in drug treatment programs are effective in reducing HIV risk behaviors among drug users

3. Background Positive attitudes and expectancies about condom use are associated with more consistent condom use Perceptions of HIV and STI risk are associated with actual condom use

4. Purpose Secondary outcome analysis from NIDA CTN 018, “Safer Sex Skills for Men” Explored the effects of the following on Condom Use: Behavioral Intentions to Use Condoms Sexual Partner Type

5. Method Participants: Men enrolled in a NIDA Clinical Trials Network (CTN18) gender specific HIV-prevention intervention 7 MMT & 7 outpatient psychosocial programs Interventions: Randomly assigned to either: HIV-Ed: Single-session standard HIV education intervention REMAS: Five-session gender-specific HIV prevention intervention Measurement: ACASI Assessments at baseline, 3- & 6-mos f/u

6. Sample Demographics: Randomized (N=590) HIV-ED REMAS m (sd) m (sd) Age 39.4 (10.4) 38.7 (10.6) Education 12.4 (2.0) 12.0 (1.7) Income (Mo.) 511.4 (1241.3) 530.8 (1114.3) Marital n (%) n (%) Never 137 (45.8) 142 (48.8) Married 57 (19.1) 55 (18.9) Div/Wid/Sep 105 (35.1) 94 (32.3)

7. Sample Demographics: Randomized HIV-ED REMAS Ethnicity n (%) n (%) Black 91 (30.4) 74 (25.4) White 173 (57.9) 169 (58.1) Hispanic 29 ( 9.7) 37 (12.7) Native Am. 2 (.7) 6 ( 2.1) Asian 3 (1.0) 2 (.7) Other 1 (.3) 3 ( 1.0)

8. Predicting Condom Use at Most Recent Sexual Event from Intention to Use Condoms with Regular Partners INTENTION RATING RECENT CONDOM USE NPHIZ OR (95% CI) Baseline RP 3-mos RP 3770.30781**15.01**3.69 (1.91, 7.14) Baseline RP 6-mos RP 2260.24868**11.73**3.12 (1.62, 5.99) 3-mos RP 6-mos RP 2310.36677**27.15**6.40 (3.18, 12.86) **p<.001RP=Regular partner

9. Predicting Condom Use at Most Recent Sexual Event from Intention to Use Condoms with Casual Partners INCREASE USE RATING RECENT CONDOM USE NPHIZ OR (95% CI) Baseline CP 3-mos CP 76-0.008690.010.96 (0.37, 2.47) Baseline CP 6-mos CP 750.183102.482.19 (0.83, 5.56) 3-mos CP 6-mos CP 590.30653*5.32*3.68 (1.22, 11.15) * p<.05CP = Casual Partner

10. Data Analytic Plan: Condom use by Regular vs. Casual Partner Primary Outcome (dependent) Variable: Condom Use with Regular or Casual partner (Binary variable) Approach: Repeated Measures Logistic Regression Model Independent variables used in models: Intervention Condition (HIV-Ed or REMAS) Time (Baseline, 3-mos, 6-mos) Treatment x Time Time-varying covariate used in the model: Frequency of vaginal and anal intercourse occasions with either regular or casual partners at baseline, 3-mos, and 6-mos follow-up points

11. Condom Use with Regular Partner (Female & Male) N=413 Model Results of Repeated Measures Logistic Regression Variable Parameter Standard z-value p Estimate Error Intercept -1.451 0.169 -8.55 <.0001 Covariate 0.007 0.002 3.42 0.0006 Treatment -0.029 0.225 -0.13 0.8949 Time 0.117 0.099 1.17 0.2413 Treatment X Time 0.179 0.146 1.22 0.2212

12. Condom Use with Regular Partner (Male & Female) N=413 Treatment x Time z= 1.22, p=0.22

13. Condom Use with Casual Partner (Female & Male) N=261 Model Results of Repeated Measures Logistic Regression Variable Parameter Standard z-value p Estimate Error Intercept -0.532 0.198 -2.74 0.0062 Covariate 0.012 0.003 3.65 0.0003 Treatment 0.112 0.252 0.44 0.6575 Time 1.842 0.503 3.66 0.0002 Time 2 -0.932 0.253 -3.68 0.0002 Treatment X Time -1.773 0.694 -2.56 0.0106 Treatment x Time 2 1.003 0.353 2.84 0.0045

14. Condom Use with Casual Partner (Female & Male) N=261 Treatment x Time z=-2.56, p=0.01 Treatment x Time 2 z= 2.84, p=0.004

15. Conclusions Behavioral intentions to use condoms at baseline were better predictors of condom use with regular partners than with casual sexual partners. However, behavioral intentions to use condom ratings at the follow up data points were stronger predictors of condom use than baseline ratings for both causal and regular sexual partners.

16. Conclusions Neither intervention appeared to affect actual condom use with regular partners. For casual partners, the single-session HIV-Ed intervention appeared to have a time limited effect on actual condom use. For the REMAS treatment condition there was in incremental increase in condom use with Casual Partners at both 3- and 6-months.

17. Limitations Reliability of self-report outcome data No Post-intervention data point for behavioral intentions to use condoms Other factors may account for the difference in condom use

18. Acknowledgements  NIDA U10DA015815 (James Sorensen, PI)  NIDA U10DA13714 (Dennis Donovan, PI)  We thank the CTN018 lead node team, and the 14 sites participating in this clinical trial  RRTC Teams  Site PIs  Site Coordinators  Research Assistants  Therapist & Therapist Supervisors