Posts Tagged ‘CTN-0018’

Sociocultural Factors Affect Condom Use Among Black Men With Substance Use Disorders

March 7, 2016

shutterstock_328029845Although HIV prevention during substance abuse treatment is ideal, existing HIV risk-reduction interventions are less effective among Black and other ethnic minority substance abusers.

Though a number of recent theories have highlighted the importance of increasing our understanding of the relationship of sociocultural factors to sexual decision-making as a step towards developing more HIV prevention interventions for ethnic minorities, few studies have examined sociocultural factors in the sexual decision-making process of Black substance abusing men.

The HIV prevention intervention Real Men Are Safe (REMAS) was evaluated in a multisite, randomized clinical trial in the NIDA Clinical Trials Network (protocol CTN-0018; the Pacific Northwest Node was the lead Node on this project).

This secondary analysis aimed to examine the relation of two specific sociocultural factors (masculinity and perceived barriers to condom use) to the self-reported sexual behaviors of Black substance abusing men with their main and casual female partners.

Analyses of the baseline data of 126 Black men entering substance abuse treatment revealed that the endorsement of both personal and social masculinity predicted more unprotected sexual occasions (USO) with casual partners. The perception that condoms decreased sexual pleasure also predicted higher USO rates with casual partners.  However, fewer partner barriers was not associated with USO among casual partners as expected. Neither the endorsement of social or personal masculinity or perceived condom barriers predicted USO with main partners.

Conclusions: These findings suggest that interventions that depict condom use as both pleasurable and congruent with Black male perceptions of masculinity may be more effective with Black substance abusing men than interventions focusing solely on health beliefs or education. Future research should continue to investigate the influence of other sociocultural factors, especially those that influence the sexual decision-making process, on sexual risk behaviors among Black men, as well as other groups.

Citation: Wilson J, et al. Do Masculinity and Perceived Condom Barriers Predict Heterosexual HIV Risk Behaviors Among Black Substance Abusing Men? Journal of Health Disparities Research and Practice 2014;7(6):54-71.

Women and Men Show Different Patterns Related to Unprotected Heterosexual Anal Sex

February 2, 2016

genderdiffAccording 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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HIV Prevention in Substance Abuse Treatment Webinar

April 16, 2013

This 90 minute webinar was presented on March 20, 2013 by Mary Hatch-Maillette of the Pacific Northwest Node and Aimee N. C. Campbell of the Greater New York Node as part of the Seattle STD/HIV Prevention Training Center webinar series, “Hard to Reach, Hard to Treat: Current Approaches to HIV Prevention and Care.”

Titled “HIV Prevention in Substance Abuse Treatment Settings,” this webinar includes an overview of current incidence of HIV/AIDS in the U.S.; descriptions of recent research examining prevention interventions of biological, behavioral, and structural focus; and a discussion of the challenges clinicians and counselors face when trying to talk openly and comfortable with their clients about sexual issues.

Aims, methods, and results from CTN-0018 and CTN-0019 (Reducing HIV/STD Risk Behaviors: A Research Study for Men/Women in Drug Abuse Treatment) are presented, with a focus on “real world implications.” The webinar ends with an overview of the pilot feasibility trial testing the efficacy of a culturally-adapted version of the CTN-0018 intervention for men (Real Men Are Safe – Culturally Adapted) to make it more relevant to African American and Hispanic men.

Find this and the rest of the “Hard to Reach, Hard to Retain” series at the Seattle STD/HIV Prevention Training Center web site: http://www.seattlestdhivptc.org/webinars.html.

Citation: Hatch-Maillette MA, Campbell ANC. HIV Prevention in Substance Abuse Treatment Settings. Seattle STD/HIV Prevention Training Center webinar, March 20, 2013.


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REMAS-CA Found Effective for Minority Men in Pilot Study

March 19, 2013

minoritymalesThe National Drug Abuse Treatment Clinical Trials Network (CTN) recently completed a randomized clinical trial evaluating the utility of Real Men Are Safe (REMAS), an HIV prevention intervention for men in substance abuse treatment (protocol CTN-0018) lead by Donald Calsyn, PhD, of the Pacific Northwest Node.

Analysis of the data with a focus on racial/ethnicity-related differences found a differential effect for white versus minority men and led to the development of a culturally adapted version of the intervention, REMAS-CA.

This ancillary/platform study, by Dr. Calsyn, Ann Kathleen Burlew, Mary Hatch-Maillette, and colleagues, compared minority attendees of REMAS-CA sessions with those who attended REMAS sessions in the original study, and found found that minority REMAS-CA participants were more likely to have attended 3 or more sessions than those in REMAS.

Additionally, REMAS-CA participants with casual partners significantly reduced the number of unprotected sexual occasions in the past 90 days; minority participants in the REMAS intervention did not.

Conclusions: REMAS-CA was effective across ethnic groups and appears to be more appealing to minorities than the original REMAS intervention. The finding that REMAS-CA was appealing across ethnic groups is especially important because many HIV risk reduction programs serve a diverse clientele and lack the resources to target an intervention solely to one ethnic group.

We miss you, Dr. Calsyn.

Citation: Calsyn DA, Burlew AK, Hatch-Maillette MA, et al. An HIV Prevention Intervention for Ethnically Diverse Men in Substance Abuse Treatment: Pilot Study Findings. Am J Public Health 2013 (in press).


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Differences Between Men and Women in Condom Use, Attitudes, & Skills.

February 25, 2013

This article by Pacific Northwest Node researchers Don Calsyn, Michelle Peavy, Betsy Wells, Mary Hatch-Maillette, as well as colleagues from the Greater New York and New England Consortium Nodes, recently published in American Journal on Addictions, reports on a study using data from two HIV risk reduction studies in the Clinical Trials Network (protocols CTN-0018 and -0019). The study compared treatment-seeking male and female substance abusers in their reported barriers to condom use and condom use skills.

The analysis revealed that men endorsed more barriers to condom use, especially in terms of their impact on sexual experience. For both men and women, stronger endorsement of barriers to condom use was associated with less use of condoms. However, the difference between condom users and non-users in endorsement of condom barriers in general is greater for men than women, especially for those who report having casual partners.

Conclusions: Results provide additional information about the treatment and prevention needs of treatment-seeking men and women. Understanding differences between men and women in their beliefs, knowledge, and skills related to condom use will allow clinicians to better tailor risk behavior interventions.

Citation: Calsyn DA, Peavy KM, Wells EA, et al. Differences Between Men and Women in Condom Use, Attitudes, and Skills in Substance Abuse Treatment Seekers. American Journal on Addictions 2013;22:150-157.


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Effect of Gender-Specific HIV Prevention Interventions on Heterosexual Anal Sex

August 8, 2012

Substance abusers are at risk for HIV and other STIs, with heterosexual anal intercourse (HAI) riskier than vaginal intercourse, and more risky for women than for men. This poster from the 2012 International AIDS Conference (Washington, DC, July 2012), by Pacific Northwest Node scientists Don Calsyn and Mary Hatch-Maillette, as well as colleagues Aimee Campbell, Christina Meade, and Susan Tross, reports on a study that aimed to evaluate the effectiveness of the five session CTN gender-specific HIV prevention interventions, Real Men Are Safe (REMAS) (CTN-0018) and Safer Sex Skill Building (SSSB) for women (CTN-0019), vs. single session information only control, on decreasing heterosexual anal intercourse (HAI) and increasing condom use for HAI.

Results of the study found that the percent of men, but not women, engaging in HAI decreased from baseline to 3 month follow-up, with the decrease for men similar for both REMAS and control condition participants. Although condom use for HAI remained infrequent, the percentage of both women and men reporting any use of condoms for HAI increased between baseline and follow-up. Women attending SSSB were more likely to change from no condom use to some condom use than women attending the control intervention. A similar non-significant trend was noticed for men attending REMAS as well.

Citation: Calsyn DA, Campbell ANC, Meade CS, Hatch-Maillette MA, Tross S. The Effect of Gender-Specific HIV Prevention Interventions on Heterosexual Anal Sex Among Men and Women in Substance Abuse Treatment. Poster presented at the International AIDS Society (IAS) Conference, Washington, DC, July 22-27, 2012.


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Revising Real Men Are Safe for an Ethnically Diverse Group of Men

April 10, 2012

Protocol CTN-0018, “Reducing HIV/STD Risk Behaviors: A Research Study for Men in Drug Abuse Treatment,” evaluated an HIV prevention intervention targeting men in substance abuse treatment called “Real Men Are Safe” (REMAS).  REMAS was found to be effective at reducing the number of unprotected sexual occasions for men in substance abuse treatment compared to an HIV education control intervention.

Using a modified Delphi process, Pacific Northwest Node researchers Don Calsyn, Mary Hatch-Maillette, Jerika Wilson, and colleagues compared modules from REMAS to similar-content modules from other CDC-approved, culturally tailored HIV prevention interventions.  Utilizing ratings and recommendations from an independent expert panel, REMAS was subsequently revised to be more culturally relevant to an ethnically diverse group of men.  This article in AIDS Education and Prevention describes the revisions made to REMAS in this CTN ancillary study, including an added focus on how culture, social norms, and upbringing affect a man’s sexual behavior and relationships.

Citation:  Calsyn DA, Burlew AK, Hatch-Maillette MA, Wilson J, Beadnesll B, Wright L.  Real Men Are Safe-Culturally Adapted: Utilizing the Delphi Process to Revise Real Men Are Safe for an Ethnically Diverse Group of Men in Substance Abuse Treatment.  AIDS Education and Prevention 2012;24(2):117-131.


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Addressing Sexual Issues in Addictions Treatment Workshop – Free CEUs!

January 31, 2012

This 2.5 hour workshop, Addressing Sexual Issues in Addictions Treatment, developed by the CTN Research Utilization Committee (RUC), focuses on the outcomes and clinical utility of National Drug Abuse Treatment Clinical Trials Network protocols CTN-0018 and CTN-0019, which were designed to test gender-specific interventions to reduce HIV sexual risk behavior among clients in drug treatment programs.  Counselors often have a difficult time discussing issues related to sex with their clients.  This workshop aims to provide information and skills that can help begin that dialogue.

The workshop, now available at the CTN Dissemination Library website, features an article from Counselor magazine and brief video from Louise Haynes, MSW, plus two longer video presentations from Pacific Northwest Node researcher Don Calsyn, PhD, and Susan Tross, PhD, the Lead Investigators of the safer sex studies in the CTN.

To qualify for free! continuing education credits (3 each from NAADAC and NBCC), users must read the article, view all three videos, and then pass a 12-item quiz (a passing score is 10/12 correct).  Get started here!


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Community Providers’ Impression of HIV Prevention Research in the CTN

January 17, 2012

This exploratory survey study, published in Journal of Drug Issues and co-written by Pacific Northwest Node researchers Bryan Hartzler, Mary Hatch-Maillette, and Don Calsyn, as well as Aimee Campbell, Gloria Miele and Susan Tross of the Greater New York Node, assessed staff attitudes as a function of direct research participation, treatment program type, and study performance within 7 methadone maintenance and 8 psychosocial outpatient substance abuse treatment programs participating in CTN-0018 and -0019 (HIV risk reduction in men and women, respectively).

Findings determined that effectiveness trials, such as the ones conducted in the CTN, offer a valuable opportunity to assess provider-level factors associated with adoption and implementation.  This study supports continued research on effective methodology for collaboration between investigators and providers to influence post-study implementation.

Citation:  Campbell ANC, Hartzler B, Hatch-Maillette MA, Calsyn DA, Miele GM, Tross S.  Community Providers’ Impression of HIV Prevention Intervention Research in NIDA’s Clinical Trials Network.  Journal of Drug Issues 2011;41(4):441-460.



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CTN-0018 and CTN-0019 Highlighted in NIDA Notes

August 12, 2011

An article in the new issue of NIDA Notes highlights the outcomes of CTN-0018,  and CTN-0019, both of which involved the Pacific Northwest Node (CTN-0018 was led by our node and researcher Don Calsyn, and Evergreen Treatment Services participated in both protocols).

In a large-scale test of gender-specific interventions, male participants in CTN-0018’s  Real Men Are Safe (REMAS) and female participants in CTN-0019’s Safer Sex Skills Building (SSB) workshops made greater reductions in high-risk sexual behavior for a longer period than comparison groups, who were provided a standardized single-session HIV educational intervention designed to mimic those provided in many substance abuse clinics. Moreover, at the 3-month followup, men who received the training were less likely than the comparison group to have been under the influence of drugs during their most recent sexual experience.

For detailed descriptions of the interventions and free manuals and implementation aids regarding REMAS, see ctndisseminationlibrary.org/display/397.htm; for SSB, see ctndisseminationlibrary.org/display/398.htm.

Citation:  Bonetta L. Intensive Interventions Reduce Risky Sexual Behaviors. NIDA Notes 2011;23(5):10-11.  Find it in the CTN Dissemination Library!