Transcript HIV/STD SAFER SEX SKILLS GROUPS FOR MEN IN METHADONE OUTPATIENT TREATMENT

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 U10DA13714-01, Dennis Donovan,
PI)
Treatment Sites
Red=Psychosocial Outpatient
Black=Methadone Maintenance
Seattle
Toledo
Norwalk
Hartford
Staten Is.
Philadelphia (x2)
Huntington
San Francisco
Rancho Cucamonga Santa Fe
Greensboro Raleigh
Richmond
Study Schema
Advertise Study Availability

Consent to Screen for Inclusion/Exclusion & Screening Assessment

Obtain Informed Consent from Eligible Participants
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Conduct Baseline Assessment → Place in Waiting Cohort

Randomly Assign Cohort to Intervention


Standard HIV Education
Gender Specific Intervention
(one session)
(five sessions)
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Conduct Post Intervention Assessment

Conduct Three Month Follow Up Assessment

Conduct Six Month Follow Up Assessment
Inclusion / Exclusion Criteria &
Screening Measures
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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.
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•
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.
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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
II. HIV/AIDS Update
III. HIV Risky Behaviors, injection practices
5 Min
10 Min
5 Min
IV. HIV Risky Behaviors, sexual practices
V. Healthy Options
10 Min
10 Min
VI. Condom demonstrations
10 Min
VII. Overcoming Barriers to Condom Use
10 Min
Techniques Utilized in the
HIV Education Group
Lecture
Information on Flipcharts
Condom Demonstrations
AIDS/HIV Body Fluids
Information Map
Body Fluid
HIV
Present Risk Behaviors
Blood
Yes
Sharing Works, Needle
Sticks, Tattoos, Piercing,
Pregnancy/birth
Semen
Yes
Vaginal, Anal & Oral Sex
Vaginal
Yes
Fluids
Breast Milk Yes
Vaginal & Oral Sex
Saliva
No
None, unless Blood in
Saliva
Tears,
Sweat
Urine,
Feces
No
None
No
None, unless Blood in
Urine or Feces
Breast Feeding
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Safe Sex Hierarchy
• Abstinence
• Romantic non-orgasmic activities
• Massage, bathing, dancing,
stripping
• “Outer-course” (“grinding,”
masturbation)
• Oral sex with protection
• Oral sex without protection
• Vaginal intercourse with a
condom
• Anal intercourse with a condom
• Vaginal intercourse without a
condom
• Anal intercourse without a
condom
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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
Assertive TALK Tools
•T
Tell my partner “I hear
you”.
•A
Assert what I want in a
positive way.
•L
List my reasons for wanting
to be safe.
•K
Know our alternatives and
my bottom line.
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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 nonstimulant 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
Baseline &
Randomization
Screening Assessment
(n=1002)
100%
condom
use
No Contact
other
Other
Withdrew
Pregnancy
Planned
Left Tx
No sex
Eligible
MMSE < 25
Randomized
Sample Demographics
Age
Ineligible
m (sd)
42.5 (10.2)
Race
n (%)
White
179 (54.9)
Af. Am. 89 (27.3)
Hisp.
43 (13.2)
other
15 ( 4.6)
Randomized
m (sd)
39.5 (10.4)
n (%)
342 (58)
165 (28)
66 (11.2)
17 ( 2.9)
Sample Demographics: Randomized
Education
Income
Marital
Never
Married
Div/Wid/Sep
m
(sd)
12.3
(1.9)
$519.79 (1178.49)
n
278
112
199
(%)
(47.2)
(19)
(33.8)
Total Randomized
70
60
50
40
30
20
10
0
Site
OV-C
OV-P
NC
SC
NE
SW
PA
LI
NC
NE
DV-T
DV-C
CZ
WA
Recruitment by Site
Total n=594
Percent Attending
Treatment Exposure
100
90
80
70
60
50
40
30
20
10
0
HIV-ED
REMAS
56.57%
51.56%
one
none one
two three four five
Sessions Attended
Percent Followed
Follow Up Rates
100
90
80
70
60
50
40
30
20
10
0
Post
3 Month
Intervention
6 Month
Follow Up Time Period
Male condom skill list
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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
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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
Condom Skill Score
Change in condom skills as a function of
intervention attendance
14
12
10
8
6
4
2
0
♂ condoms
HIV-ED
Ptime<.001
Ptime x attendance<.001
REMAS
♀ condoms
None
HIV-Ed
Attendance Group
REMAS
None
Baseline
Post intervention
Percent using condom
Condom use for most recent sexual event at post
intervention as a function of intervention attendance
100
90
80
70
60
50
40
30
20
10
0
Low risk
High Risk
Baseline
Post intervention
HIV-ED
REMAS
None
HIV-Ed
Attendance Group
REMAS
None
Lead Node Team
Mary Hatch-Maillette
Sara Berns
Data Management
Molly Carney
Katie Weaver
Brooke Leary
Michael Dudley
Training
John Baer
QA & Regulatory
Anthony Floyd
Donna Bargoil
Research Assistant
Viki Stanmour
Statistician
Suzanne Doyle
WA Node Coordinator
Brenda Stuvek
RRTC and Site PIs
Yong Song
Paul Crits-Christoph
Stephen Weinstein
Bob Sterling
Bill Daly
Susan Tross
Julie Matthews
Sam Ball
Tad Clodfelter
Jackie Butler
Charlotte Royer-Malvestuto
Tamara Owens
Genise Lalos
Judy Harrer
Ross Chaban
Allen Cohen
Michael McCann
Louise Haynes
Therese Killeen
Diane Pallas
Ron Jackson
Kristie Smith
Jennifer Manuel
Site Coordinators
Esther Ricardo-Bulis
Sarh Pelta
Kerry Raively
Mark Hirschman
Bonita Sussman
Lisa Markiewicz
Allison Hartsock
Nicole Moodie
Jenifer Skelding
Parrish Harless
Gina Richardson
Kimberly Pressley
Al Woods
Diane Pallas
Lester Fleming
Research Assistants
Rhodri Dierst-Davies
Tracey Vann
Ellen Fritch
Carolyn Laurenza
Diane Losardo
Brian Smith
Sarah Cousins
Beverly Holmes
Brianne O’Sullivan
Diana Pacheco
Patrick Worhunsky
Denise McRae
Barbara Hobbs
Steve Rosebrook
Tara Lee
Scott Herr
Aaron Upton
Charles Michael
Dennis Romero
Clark Reed
Melissa Clymer
Therapist Supervisors
Yong Song
Mark Hirschman
Henry Bates
Evette Wilson
Joe Grossman
Sarah Sperrazza
David Hettich
Lester Quagliano
Susan Coyer
Al Woods
Deborah Service
Louise Haynes
Michael DeBernardi
Carol Davidson
Melodie Keen
Therapists
William Buehlman
Luis Ramos
Jerome Wells
Joel Hurdle
Charles Holman
Philip Pellegrino
Patrich Walsh
Arthur Sagevick
Richard Dable
Frank Shimko
Jimmy Moutinho
Markel Pitt
Quincy Stephens
Doug Stenchever
John Williams
Max Mineo
Dennis Durant
Bernie Reardon
Donald Bellemore
Will Pescock
George Cantees
Fred Clark
Jimmy McKeller
Louis Battistone
Nick Nardone
Ulysses Rogers
Andre Walker
Art Panero
Stefan Dobuszynski