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Dr. Calsyn has no conflicts of interest to report for this workshop presentation

Dr. Calsyn has no conflicts of interest to report for this workshop presentation. Gender Specific Sexual Risk Reduction Interventions for Men and Women Workshop at the 2009 Clinical Practices Research Symposium June 3, 2009 Portland, Oregon. Donald Calsyn, Ph.D., Washington Node of the CTN,

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Dr. Calsyn has no conflicts of interest to report for this workshop presentation

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  1. Dr. Calsyn has no conflicts of interest to report for this workshop presentation

  2. Gender Specific Sexual Risk Reduction Interventions for Men and WomenWorkshop at the 2009 Clinical Practices Research SymposiumJune 3, 2009 Portland, Oregon Donald Calsyn, Ph.D., Washington Node of the CTN, Alcohol & Drug Abuse Inst., University of Washington

  3. Presentation Plan • Rationale for men’s and women’s protocols • Study design • “Real Men Are Safe” description • “Safer Sexual Skills Building” description • Differences between the two interventions • Main findings “Real Men Are Safe” • Main findings “Safer Sexual Skills Building” • “Real Men Are Safe” demonstration • “Safer Sexual Skills Building” demonstration

  4. Background HIV Risk Behavior • Engagement is substance abuse treatment is associated with reduction in HIV risk behaviors. • However, many men and women in treatment continue to engage in high risk sexual behavior while in treatment. HIV Prevention in SA Treatment • Most treatment programs provide a one hour HIV/AIDS prevention limited to providing information only. • Meta analyses indicate the more efficacious HIV prevention interventions utilize:  Separate sessions for ♂/♀,  Condom demonstrations,  Skills training exercises,  Peer group discussions,  A variety of techniques

  5. Background-Women • Heterosexual women are among the fastest growing subgroups of people with AIDS in the US • While female AIDS cases due to injection drug use have declined (32%), cases due to heterosexual transmission have increased (66%) • Partner risk factors in heterosexual transmission: partner that is an IDU (19.8%) • Race/Ethnicity of AIDS cases: Black (59.5%); White (20.2%); Latina (19.1%)

  6. Purpose • Assess the effectiveness of an HIV risk reduction intervention for women in substance abuse treatment in multiple community treatment programs that had been shown to be efficacious previously in a single site • Develop an HIV sexual risk reduction interventions for men to serves as a companion research protocol to the CTN approved protocol for women. • Incorporate into the interventions elements shown to be efficacious previously, and consistent with current theories on HIV risk reduction interventions. • Compare the effectiveness of the developed interventions (“Safer Sex Skills Building” and “Real Men Are Safe”) to a standard HIV prevention intervention typicallyprovided in substance abuse treatment settings.

  7. Treatment Sites Red=PsychosocialOutpatient Black=Methadone Maintenance . Seattle Norwalk (18) Hartford Staten Is. . Philadelphia (x2) Toledo . Huntington . . . Raleigh (19) San Francisco (18) High Point . Raleigh . . . La Puente (19) Santa Fe (18) Columbia Rancho Cucamonga (18)

  8. Inclusion / Exclusion Criteria & Screening Measures Inclusion Criteria: • 1.Adult men or women 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.RiskBehavior Survey • 3. Mini Mental Status Exam < 25

  9. 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 Sex under the influence of drugs or alcohol Number of sexual partners

  10. Study Design - RCT Baseline Assessment Eligibility Cohort Randomization Health/HIV Education(1 Session) Safer Sex Skills BuildingorReal Men Are Safe(5 Session) Post Treatment 3 Month FU 6 Month FU

  11. Real Men Are Safe Description Donald Calsyn, Ph.D. and the CTN0018 protocol team

  12. Intervention Source Materials for “Real Men Are Safe” • Time Out! For Men: A communication skills and sexuality workshop for men Bartholomew, N.G., & Simpson, D.D. (1996). • Approaches to HIV/AIDS education in drug treatment Bartholomew, N.G. & Simpson, D.D. (1992). Available at www.tcu.ibr Institute for Behavioral Research, Texas Christian Univ. • Project Light Intervention Manual The NIMH Multisite HIV Prevention Trial Group

  13. Anything Missing ?

  14. It Will Be Difficult to Separate Substance Use from Sexual Behavior Rawson et al., 2002, JSAT

  15. Sex under the influence of drugs or alcohol Sex Under the Influence 100 90 Baseline 80 3 Months 70 6 Months 60 Percent 50 40 30 20 10 0 Last 90 Days Last Sexual Event

  16. Temptation to Use Drugs or Alcohol to Meet Sexual Needs / Desires

  17. HIV Education (Control Group) I. Group Introductions. Goals and Guidelines 5 Min II. HIV/AIDS Update 10 Min III. HIV Risky Behaviors, injection practices 5 Min IV. HIV Risky Behaviors, sexual practices 10 Min V. Healthy Options 10 Min VI. Condom demonstrations 10 Min VII. Overcoming Barriers to Condom Use 10 Min

  18. Techniques Utilized in the HIV Education Group Lecture Information on Flipcharts Condom Demonstrations

  19. 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

  20. Techniques Utilized in the REMAS Group Lecture & Discussion Information on Flipcharts Condom Demonstrations& Practice Brainstorming & Discussion Self Assessment Exercises Role Plays

  21. REMAS: Real Men are SafeSession 1 HIV/AIDS Update: Identifying Risks I. Group Introductions. Goals and Guidelines10 Min II. Getting Started 10 Min III. HIV Risky Behaviors Exercise 15 MinIV. HIV/AIDS Update15 Min V. HIV Risky Behaviors, injection practices10 MinVI. HIV Risky Behaviors, sexual practices10 MinVII. Condom demonstration10 Min VIII. Revisit Risky Behaviors Exercise 10 Min

  22. HIV RISK BEHAVIOR CARDS

  23. REMAS: Real Men are SafeSession 2 HIV/AIDS Update: Planning Prevention I. Welcome, redo introductions 5 Min II. Healthy options10 Min III. Barriers to Condom Use20 Min IV. Condom Practice 25 Min V. Identifying Triggers 15 Min VI. Risk Reduction Problem Solving 15 Min

  24. 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

  25. 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

  26. REMAS: Real Men are SafeSession 3 Sex without drugs. Can it happen? Is it Pleasurable? I. Welcome, redo introductions 5 Min II. Personalizing Commitment to Sexual Safety 15 Min III. Experience with combining sex & drugs Enhancements/Impairments 35 Min IV. Enhancing sex without drugs 20 Min V. Coping with sexual impairment without drugs 15 Min

  27. REMAS: Real Men are SafeSession 4 Beyond the pick up line, talking about sex with partners I.Welcome, redo introductions 5 Min II. Challenging Stereotypes 20 Min III. Unwritten rules 10 Min IV. Responsibility in sexual relationships 20 Min V. Communication about Safe Sex I 35 Min

  28. REMAS: Real Men are SafeSession 5 Talking about sexII I. Welcome, redo introductions 5 Min II. Practice Talk with Coaching and Feedback 25 Min III. Turning Around What They Say 25 Min IV. Workshop Summary 25 Min V. Workshop Closure 10 Min

  29. Safer Sex Skills Building Description Susan Tross, Ph.D. and the CTN0019 protocol team

  30. Features of Effective HIV Preventive Interventions For Women Gender specific Comprehensive skills building > 4 sessions

  31. Skills Underlying Safer Sex Sense of self-efficacy about trying safer sex (Marin et al., 1998) Problem-solving skills Negotiation and refusal skills – in as much as male condoms are controlled by men Skills for using female condoms Eroticizing safer sex skills Partner abuse risk assessment and safety planning

  32. Theory Social Cognitive Learning Theory: Behavior is learned through the social processes of observation, modeling, skill rehearsal, and feedback, especially with one’s peer group Empowerment Theory: Individuals are empowered to action by the processes of: skill mastery; peer support; and ability to impact on one’s world

  33. Health Education Overview HIV Information STD Information HIV Testing and Counseling Living With HIV (Including HIV Treatment Information)

  34. Safer Sex Skill Building Overview HIV/STD education, testing & counseling HIV/STD risk assessment HIV/STD safer sex obstacle problem-solving Condom use skill-building Negotiation skill-building Assertiveness training Partner risk assessment and safety planning

  35. SSSB: Introduction and HIV/STD Education (Session 1) WORTH (Women On The Road To Health) Introduction Purpose Counselor and Participant roles and rules Warm-up: Why I Want to Take Care of Myself HIV Information STD Information HIV Testing and Counseling Living With HIV (Including HIV Treatment Information) Closing: Homework and WORTH Affirmation

  36. SSSB: Making it Real: HIV/STDs in Our Lives (Session 2) Check-in HIV in Our Lives HIV Risk Rationalizations Challenging Rationalizations: Story of Jesse & Mathilde Challenging Rationalizations: Our Own Triggers for HIV/STD Risk Behavior: People, Places, Things Identifying Our Supports For Taking Care Of Ourselves Closing: Homework and WORTH Affirmation

  37. SSSB: Making It Real, Tuning Up Our HIV/STD Safer Sex Skills (Session 3) Check-in Getting Smart about HIV/STD Risk: Stop Light Behaviors Condom Use Practice and Feedback – Male Condom Use Practice and Feedback – Female Eroticizing safer sex Self-Talk in Tough Risk Situations Problem-Solving the SODAS Way Closing: Homework and WORTH Affirmation

  38. SSSB: Making It Real, Making Safer Sex Happen(Session 4) Check-In Identifying Barriers to Safer Sex Safer Sex Negotiation and Refusal: The Basics Safer Sex Negotiation: Demonstration and Discussion Safer Sex Negotiation: Pairing Up Assessing Risk of Partner Abuse and Making Safety Plans Closing: Homework and WORTH Affirmation

  39. SSB: Keeping It Going (Session 5) Check-in Where We’ve Been Together: Review Getting Ready: Common Slip Situations (Especially Involving Drugs & Alcohol) Slip Plans: The SODAS Way Program Evaluation and Feedback Graduation

  40. The SODAS Model The letter S STOP. DEFINE THE PROBLEM AND THE GOAL The letter O OPTIONS AND OUTCOMES The letter D DECIDE The letter A ACTION The letter S SELF - PRAISE

  41. Partner Abuse and Safer Sex Knowing What Abuse Is Identifying Your Risk For Abuse Making A Safety Plan Safety Plan Worksheet

  42. Similarities & Differences between REMAS & Safer Sexual Skills Building Prepared originally by Carol Davidson, M.S.W. Evergreen Treatment Services Seattle, WA

  43. Similarities • Basic information about HIV & STDs • Condom demonstration & practice • Identifying triggers for unsafe sex • Eroticizing safe sex • Communication skills training related to sexual situations

  44. Differences REMAS • Larger focus on the interplay between sex & drugs • Focus on recognizing partner needs and the role played by society’s “gender roles” • Stress importance of accepting responsibility for one’s own behavior • Use of assertive communication skills & “I” statements in safe sex negotiations

  45. Differences SSSB • Large focus on increasing a sense of self worth and self efficacy • Problem solving skills training for risky sexual situations and relapse prevention • Identification and enhancement of positive social support systems • Communication skills which stress need to include physical risk assessment and personal safety plan • Communication skills training which includes both direct & indirect negotiation and refusal skills

  46. Findings from Men’s Protocol:Real Men Are Safe

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