Posts Tagged ‘REMAS’

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:

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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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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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; for SSB, see

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

CPDD Poster from PN Node Researchers

June 27, 2011

CTN Pacific Northwest Node researchers Mary Hatch-Maillette, Don Calsyn, Blair Beadnell, and Lynette Wright, along with colleagues Ann Burlew and Jerika Wilson from the Ohio Valley Node, recently presented a poster at the College on Problems of Drug Dependence (CPDD) annual meeting in Hollywood, FL, June 18-23, 2011.

The poster, entitled “Culturally Tailoring the Real Men Are Safe HIV Prevention Intervention,” reported on the early stages of a study designed to revise the CDC recognized, evidence-based REMAS prevention intervention to make it more culturally relevant to African American and Hispanic men, and then conduct a pilot feasibility trials of the revised REMAS in four CTN CTPs.

The manual was revised using the “Delphi Process,” with expert panel members reviewing,  rating, and offering specific suggestions of improvements for all the modules in two separate rounds.  The panel members’ quantitative ratings and qualitative suggestions were, for the most part, consistent with each other, with the qualitative feedback being used more extensively in making revisions to REMAS. 

The Delphi Process was found to be a successful technique, and the effectiveness of the REMAS-CA (Culturally Adapted) is currently undergoing pilot testing.

Citation:  Hatch-Maillette MA, Calsyn DA, Burlew AK, Wilson J, Beadnell B, Wright L.  Culturally Tailoring the Real Men Are Safe HIV Prevention Intervention.  Poster presented at the College on Problems of Drug Dependence (CPDD) annual meeting, Hollywood, FL, June 18-23, 2011.  Find it in the CTN Dissemination Library!

Men in Methadone Maintenance versus Psychosocial Outpatient Treatment: Differences in Sexual Risk Behaviors and Intervention Effectiveness from a Multisite HIV Prevention Intervention Trial.

July 29, 2010

This new article in Journal of Addictive Diseases, written by Don Calsyn, Susan Doyle, and Mary Hatch-Maillette of the Alcohol & Drug Abuse Institute at the University of Washington, as well as other colleagues from the National Drug Abuse Treatment Clinical Trials Network (CTN), reports on the effectiveness of the Real Men Are Safe (REMAS) HIV prevention intervention (protocol CTN-0018) as a function of treatment program modality.

REMAS is a five-session sexual risk reduction intervention for men involving didactically delivered informational material, role playing, peer group discussions, and self-assessment motivational exercises (see REMAS manual).

REMAS was associated with significantly larger decreases in unprotected sexual occasions than an HIV education control condition in both methadone maintenance and psychosocial outpatient program participants, however it was especially effective with the latter group.  Potential reasons why are explored in this article, including differences in patient variables, the effects of methadone as a treatment, and greater relevance of the REMAS intervention to patients in outpatient treatment.

Modifications of the REMAS approach may be needed to further enhance effectiveness with methadone maintained patients.

Find the article in the CTN Dissemination Library:

Article citation: Calsyn DA, Campbell ANC, Crits-Christoph P, Doyle SR, Tross S, Hatch-Maillette MA, Mandler RN.  Men in methadone maintenance versus psychosocial outpatient treatment: Differences in sexual risk behaviors and intervention effectiveness from a multisite HIV prevention intervention trial.  Journal of Addictive Diseases 2010;29(3):370-382. [doi: 10.1080/10550887.2010.489451]

Reducing Sex Under the Influence of Drugs or Alcohol for Patients in Substance Abuse Treatment.

January 7, 2010

In a previous report (Calsyn et al, 2009), the effectiveness of the Real Men Are Safe (REMAS) intervention in reducing the number of occasions of unprotected sex among male patients in drug abuse treatment was demonstrated. A secondary aim of REMAS was to reduce the frequency with which men engage in sex while under the influence (SUI) of drugs or alcohol.

This new article in the journal Addiction, written by Pacific Northwest Node researchers Donald Calsyn, Mary Hatch-Maillette, and Suzanne Doyle, as well as other CTN colleagues, reports the outcomes of that secondary aim, finding that REMAS, an intensive skills-based HIV prevention intervention, was indeed associated with greater reduction in the frequency of SUI among men in substance abuse treatment compared to standard HIV education at the 3-month follow-up.

Read more about this article in the CTN Dissemination Library.

Citation: Calsyn DA, Crits-Christoph P, Hatch-Maillette MA, Doyle SR, Song YS, Coyer S, Pelta S. Reducing sex under the influence of drugs or alcohol for patients in substance abuse treatment. Addiction 2010;105(1):100-108. [doi: 10.1111/j.1360-0443.2009.02812.x]