According to the Centers for Disease Control and Prevention (CDC), women represent approximately 20% of new HIV infections each year, with about 84% of those occurring through heterosexual contact. Heterosexual anal sex (HAS) in the absence of condom use is one of the highest risk factors for HIV and other sexually transmitted infections, 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, led by the Pacific Northwest Node, 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.
Citation: Hatch-Maillette MA, et al. Heterosexual Anal Sex Among Men and Women in Substance Abuse Treatment: Secondary Analysis of Two Gender-Specific HIV-Prevention Trials. Journal of Sex Research 2016 (in press).
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