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,
Alcohol & Drug Abuse Inst., University of Washington
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
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:
sessions for ♂/♀,
 Skills training exercises,
 A variety of techniques
 Separate
 Condom
demonstrations,
 Peer group discussions,
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%)
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 typically provided in substance abuse
treatment settings.
Treatment Sites
Red=Psychosocial Outpatient
Black=Methadone Maintenance
.
Seattle
Toledo.
Huntington.
.
San Francisco (18)
. .La Puente (19)
. Santa Fe (18)
Rancho Cucamonga (18)
Norwalk (18)
Hartford
Staten Is.
Philadelphia (x2)
.
High Point
.
.Raleigh (19)
Raleigh
Columbia
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. 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
Sex under the influence of drugs or alcohol
Number of sexual partners
Study Design - RCT
Baseline Assessment
Eligibility
Cohort Randomization
Health/HIV Education
(1 Session)
Safer Sex Skills Building or
Real Men Are Safe (5 Session)
Post Treatment
3 Month FU
6 Month FU
Real Men Are Safe
Description
Donald Calsyn, Ph.D. and the
CTN0018 protocol team
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
Anything Missing ?
It Will Be Difficult to Separate
Substance Use from Sexual Behavior
Percent
100
90
80
Men
Women
70
60
50
40
30
20
10
0
Alcohol
Opiate
Cocaine
Primary Drug of Abuse
Rawson et al., 2002, JSAT
Methamphetamine
Sex under the influence of drugs
or alcohol
Percent
Sex Under the Influence
100
90
80
70
60
50
40
30
20
10
0
Baseline
3 Months
6 Months
Last 90 Days
Last Sexual Event
Temptation to Use Drugs or Alcohol to Meet
Sexual Needs / Desires
Percent
Temptation to Use
100
90
80
70
60
50
40
30
20
10
0
To enhance sex
To increase likelihood
of sex occuring
Baseline
3 Month
Assessment Time Point
6 Month
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
7
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
14
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
REMAS: Real Men are Safe
Session 1
HIV/AIDS Update: Identifying Risks
I. Group Introductions. Goals and Guidelines
10 Min
II. Getting Started
III. HIV Risky Behaviors Exercise
IV. HIV/AIDS Update
10 Min
15 Min
15 Min
V. HIV Risky Behaviors, injection practices
VI. HIV Risky Behaviors, sexual practices
VII. Condom demonstration
10 Min
10 Min
10 Min
VIII. Revisit Risky Behaviors Exercise
10 Min
HIV RISK BEHAVIOR CARDS
Abstinence from
sex or drugs
Massage/ bodyto-body rubbing
Kissing
Solo or Parallel
Masturbation
Using vibrators
and sex toys
Shooting drugs
with
a new syringe
Mutual
masturbation
Grinding
Oral sex with a
barrier
Vaginal sex with a
condom
Anal sex with a
condom
Cleaning
injection
equipment with
bleach
Shooting up
second/sharing
works/needles
Oral sex with a
condom
Vaginal sex
Anal sex without
without a condom
a condom
REMAS: Real Men are Safe
Session 2
HIV/AIDS Update: Planning Prevention
I. Welcome, redo introductions
5 Min
II. Healthy options
10 Min
III. Barriers to Condom Use
20 Min
IV. Condom Practice
25 Min
V. Identifying Triggers
15 Min
VI. Risk Reduction Problem Solving
15 Min
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
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
REMAS: Real Men are Safe
Session 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
REMAS: Real Men are Safe
Session 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
REMAS: Real Men are Safe
Session 5
Talking about sex II
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
Safer Sex Skills Building
Description
Susan Tross, Ph.D. and the
CTN0019 protocol team
Features of Effective HIV Preventive
Interventions For Women
• Gender specific
• Comprehensive skills building
• > 4 sessions
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
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
Health Education Overview
• HIV Information
• STD Information
• HIV Testing and Counseling
• Living With HIV (Including HIV
Treatment Information)
Safer Sex Skill Building Overview
• HIV/STD education, testing & counseling
• HIV/STD risk assessment
• HIV/STD safer sex obstacle problemsolving
• Condom use skill-building
• Negotiation skill-building
• Assertiveness training
• Partner risk assessment and safety planning
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
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
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
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
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
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
Partner Abuse and Safer Sex
• Knowing What Abuse Is
• Identifying Your Risk For Abuse
• Making A Safety Plan
– Safety Plan Worksheet
Similarities & Differences
between REMAS & Safer
Sexual Skills Building
Prepared originally by
Carol Davidson, M.S.W.
Evergreen Treatment Services Seattle, WA
Similarities
• Basic information about HIV &
STDs
• Condom demonstration & practice
• Identifying triggers for unsafe sex
• Eroticizing safe sex
• Communication skills training
related to sexual situations
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
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
Findings from Men’s Protocol:
Real Men Are Safe
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.
Pacific Northwest Node
• Co-lead Investigator: Susan Tross, Ph.D.
Long Island Node
• Project Managers: Sara Berns, Ph.D./
Mary Hatch-Maillette, Ph.D.
• Lead Statistician: Suzanne Doyle, Ph.D.
• Supported by NIDA (1 U10DA13714-01, Dennis Donovan,
PI)
Participant Data Flowchart
Assessed for eligibility
(n=993)
Excluded (n=403, 41%)
Not sexually active (n=155)
100% condom use (n=112)
Other Inclusion/exclusion (n=96)
Other (n=71)
Randomized (n=590)
Real Men Are Safe (n=291)
Baseline Assessment (n=282)
Received any REMAS (n=230, 79%)
Completed REMAS (n=140, 51%)
Did not receive REMAS (n=96)
3 or 6 month follow-up
(n=209, 74%)
Missing 3 or 6 month fu
(n=73, 26%)
HIV Education (n=299)
Baseline Assessment (n=291)
Completed HIV Ed (n=164, 57%)
Did not receive HIV Ed (n=135)
3 or 6 month follow-up
(n=213, 73%)
Missing 3 or 6 month fu
(n=78, 27%)
Baseline Socio-demographic
Characteristics*
REMAS (N=291) HIV Ed (N=299)
n(%) or M(SD)
Total (N=590)
Age
<=40
>40
131 (52.4%)
119 (47.6%)
148 (55.9%)
117 (44.2%)
279 (54.2%)
236 (45.8%)
White
Black
Hispanic
Mixed/Other
Monogamous (% Yes)
Methadone (% Yes)
142 (56.8%)
58 (23.2%)
26 (10.4%)
24 (9.6%)
139 (55.6%)
121 (48.4%)
156 (58.9%)
67 (25.3%)
20 (7.6%)
22 (8.3%)
137 (51.7%)
134 (50.6%)
298 (57.9%)
125 (24.3%)
46 (8.9%)
46 (8.9%)
276 (53.6%)
255 (49.5%)
66 (26.4%)
90 (36.0%)
94(37.6%)
18.8 (27.8)
79 (29.2%)
103 (39.0%)
82 (31.1%)
19.9 (33.4)
145 (28.2%)
193 (37.6%)
176 (34.2%)
19.3 (30.8)
Race
Education
<12
=12
>12
USO
*No significant differences between REMAS and HIV Ed on any characteristic
Model Based Mean Predicted Values for
Primary Outcome Variable (ITT)
Unprotected Sexual Acts
Number of unprotected sexual events at baseline, 3 & 6 months
as a function of time and intervention group (n=422)
30
25
ES=0.098
ES=0.167
20
15
10
5
0
Baseline
3 Month
Assessment Time Point
HIV ED
REMAS
6 Month
Model Based Mean Predicted Values for
Primary Outcome Variable
Number of unprotected sexual events at baseline, 3 & 6 months
as a function of intervention group and completion status
(n=417)
Unprotected Sexual Acts
30
Completed
Not Completed
25
ES=0.213
ES=0.337
ES-0.017
20
ES=0.037
15
10
5
0
Baseline
HIV ED
3 Month
REMAS
6 Month
Baseline
Assessment Time Point
3 Month
6 Month
Change in Percentage of Men Engaging in
Sex under the Influence during Last Sexual
Event as a Function of Intervention Condition
Percents
Intervention x Time, t=2.18, p=0.03
50
45
40
35
30
25
20
15
10
5
0
*
Baseline
HIV ED
3 Month
Assessment Time Point
REMAS
6 Month
*p=.0065
Percentage of Men Engaging in Sex under
the Influence during Last Sexual Event as a
Function of Partner Risk
Percents
Partner Risk, t=3.50, p<.001
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
Regular
Baseline
3 Month
Assessment Time Point
Casual
6 Month
Percentage of Men Engaging in Sex under
the Influence during Last Sexual Event as a
Function of Treatment Modality
Percents
Treatment Modality, t=3.36, p=0.001
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
Methadone
Outpt. Psy-Soc
Baseline
3 Month
Assessment Time Point
6 Month
Sexual Satisfaction as a Function of Sex
under the Influence, Baseline to 3 Months
Sexual Satisfaction
9
8
*
7
6
SUI Both
SUI 3 Mo. Only
SUI Base Only
SUI Neither
5
Baseline
3 months
Assessment Time Point
Sexual Satisfaction as a Function of Sex
under the Influence, Baseline to 6 Months
Sexual Satisfaction
9
8
*
7
6
SUI Both
SUI 6 Mo. Only
SUI Base Only
SUI Neither
5
Baseline
6 Months
Assessment Time Point
Findings from Women’s
Protocol
From Susan Tross, Ph.D., and
the CTN 0019 Protocol Team
HIV/STD SAFER SEX SKILLS GROUPS FOR
WOMEN IN METHADONE MAINTENANCE
OR DRUG-FREE OUTPATIENT
TREATMENT PROGRAMS (CTN 0019)
• Lead Investigator: Susan Tross, Ph.D.
Long Island Node
• Co-lead Investigator: Donald Calsyn, Ph.D.
Pacific Northwest Node
• Project Managers: Aimee Campbell, Ph.D.
• Lead Statistician:, Ph.D.
• Supported by NIDA (1 U10DA-01, Edward Nunes, PI)
Participant Data Flowchart
Assessed for eligibility
(n=824)
Excluded (n=309, 38%)
Not meeting inclusion criteria (n=220)
Refused to participate (n=17)
Other reason (n=72)
Randomized (n=515)
Safer Sex Skills Build (n=250)
Baseline Assessment (n=247)
Received any SSB (n=154, 62%)
Completed SSB (n=108, 44%)
Did not receive SSB (n=96)
3 month follow-up
(n=155, 62%)
6 month follow-up
(n=155, 62%)
Missing 3, 6 month fu (n=73, 29%)
Health Education (n=265)
Baseline Assessment (n=262)
Completed HE (n=165, 63%)
Did not receive HE (n=100)
3 month follow-up
(n=186, 70%)
6 month follow-up
(n=177, 67%)
Missing 3, 6 month fu
(n=58, 22%)
Baseline Socio-demographic
Characteristics*
SSB (N=250)
HE (N=265)
n(%) or M(SD)
Total (N=515)
<=40
>40
131 (52.4%)
119 (47.6%)
148 (55.9%)
117 (44.2%)
279 (54.2%)
236 (45.8%)
White
Black
Hispanic
Mixed/Other
Monogamous (% Yes)
Methadone (% Yes)
142 (56.8%)
58 (23.2%)
26 (10.4%)
24 (9.6%)
139 (55.6%)
121 (48.4%)
156 (58.9%)
67 (25.3%)
20 (7.6%)
22 (8.3%)
137 (51.7%)
134 (50.6%)
298 (57.9%)
125 (24.3%)
46 (8.9%)
46 (8.9%)
276 (53.6%)
255 (49.5%)
66 (26.4%)
90 (36.0%)
94(37.6%)
18.8 (27.8)
79 (29.2%)
103 (39.0%)
82 (31.1%)
19.9 (33.4)
145 (28.2%)
193 (37.6%)
176 (34.2%)
19.3 (30.8)
Age
Race
Education
<12
=12
>12
USO
*No significant differences between SSB and HE on any characteristic
Observed (Baseline) and Predicted
Means (3- and 6-Months) For USO
Unprotected sexual occasions
30
25
20
15
10
5
0
Baseline (obsrvd)
3 months (pred)
6 months (pred)
HE
19.96
17.33
24.14
SSB
18.6
15.08
13.96
Tim e
HE
SSB
Effect Sizes
• 3-Month Follow-Up:
– SSB and HE both had similar effects (no
significant difference)
• 6-Month Follow-Up:
– USO decreased by 28% in the SSB condition,
as compared to the HE condition – reflecting
an effect size of .42
Observed (Baseline) and Predicted Means
(3- and 6-Months) For USO - Completers
30
Unprotected sexual occasions
25
20
15
10
5
0
Baseline (obsrvd)
3 months (pred)
6 months (pred)
HE
21.35
16.07
26.38
SSB
14.34
13.37
10.52
Tim e
HE
SSB
Observed (Baseline) and Predicted Means (3and 6-Months) For USO - Non-Completers
Unprotected sexual occasions
25
20
15
10
5
0
Baseline (obsrvd)
3 months (pred)
6 months (pred)
HE
17.67
19.59
19.35
SSB
21.82
17.15
18.04
Tim e
HE
SSB
Predictors of Unprotected Sexual
Occasions: Hanner, Tross, Campbell, Cohen and Nunes
• Lower Age (<40) (p<.0001)
• Monogamy X Perceived HIV Partner
Status: Among those perceiving their
partners to be HIV negative, monogamous
> non-monogamous women (p<.0001)
• Sex-with-drug occasions (p<.0001)
• No methadone versus psychosocial
treatment differences
number of times using
drug with sex
Number of Drug or Alcohol With
Sex Occasions
30
20
10
0
baseline(observed)
3-month (predicted)
6-month (predicted)*
HE
26.92
11.24
14.85
SSE
23.66
8.65
6.52
Tim e
HE
SSE
*p<.03
Analysis of USO: Summary
• There was a significant difference in effect of
SSB treatment over time (p<.0001), as
compared to HE – at 6-month follow-up. This
was enhanced by treatment completion.
• Further, as expected, Monogamy status was a
significant predictor of USO (p < .0001), such
that:
• Monogamous women exhibited
significantly more (33% more) USO than
non-monogamous women.
Real World Implications
‘When extrapolated to high-risk populations
. . . Modest changes have the potential to
improve public health’
Copenhaver et al., 2006
Real World Implications
• ‘Increase the comprehensiveness of
HIV-prevention interventions’
• ‘Advance female-controlled methods’
• ‘Change social and cultural norms
regarding sexual behavior’
• ‘Combine substance abuse treatment
with HIV prevention intervention’
Logan, Cole and Leukefeld, 2002
Real Men Are Safe
Demonstration
Flipcharts for “Sex & Drugs”
brainstorming exercise
Ways Drugs Makes it
Easier to Obtain a
Sexual Partner
• Relaxes/disinhibits me so I can
talk to potential partners (opiates,
sedatives, alcohol)
• Disinhibits my partner to be more
open to sexual advances (all)
• Increases sexual desire of my
partners (stimulants – women
primarily with amphetamine)
• Partners are willing to have sex if
I get them drugs (all, opiates and
stimulants especially)
20
Ways Drugs Improve
the Sexual Experience
• Delays orgasm, increases staying
power (opiates, sedatives, alcohol,
stimulants)
• Increases sexual desire (stimulants,
alcohol in low doses, cannabis)
• Increases sexual sensation,
intensifies the orgasm (stimulants,
cannabis)
• Disinhibition in self and partner,
increased willingness to be sexually
adventurous (all)
• Firmer erections (stimulants,
especially amphetamines)
21
Ways Drugs Make It
Harder to Obtain a
Sexual Partner
• Non-drug users are less
interested in users, limits the field
(all)
• Say stupid things to potential sex
partners (all, especially sedatives
and alcohol)
• Speak too slow, too fast,
(stimulants and alcohol initially)
or slur words (alcohol, sedatives,
opiates)
• Don’t have any money left for
dating (all)
• Become self conscious about
potential sexual dysfunction so
do not even start (all)
22
Ways Drugs Impair the
Sexual Experience
• Delays orgasm, makes it very
difficult to ejaculate (opiates,
sedatives, alcohol, stimulants)
• Decreases sexual desire (opiates,
sedatives)
• Erectile dysfunction. Difficulty
obtaining or maintaining erections
(all)
• You or your partner, passes out or
falls asleep before you get to the
sex (opiates, alcohol, sedatives)
• You or your partner tweaks before
you get to sex (cocaine,
amphetamines)
23
Ways to Obtain a Sexual
Partner without Drugs
• Attend clean & sober social functions
such as dances & picnics.
• Go to non-alcohol club.
• Take a class (local college,
community center).
• Identify current or past activities that
you have enjoyed and then join clubs
or groups in order to do these things
with other people (hiking, card
playing, bicycling, book reading,
volunteer activities.
• Attend church social activities
24
Ways to Improve the
Sexual Experience
without Drugs
•
Engage in pre-sex relaxing/stress reducing activities
(relaxing mood music, breathing exercises, watch a movie
video together, go for a walk, provide each other body
rubs).
•
Use body oils to heighten sensation.
•
Ask your partner to touch/kiss/lick you in ways you find
pleasing.
•
Allow yourself to be directed by her as she tells you
where and how she likes to be touched.
•
Heighten sexual tension by stopping & starting sexual
activity. Allow your self to get close to orgasm and then
stop/slow down, and then start up again.
•
Shower/bathe together.
•
Try different types of condoms, be a manikin for your
partner as she puts on the condom.
•
Experiment with the female condom.
•
Experiment with various positions.
•
Strip for each other.
•
Undress each other.
•
Vary the place or time of day that sex occurs.
25
Safer Sexual Skills Building
Demonstration
.
Putting SODAS into Action
•
•
•
•
S: What's the problem? What’s the goal?
O: What are your options?
D: What would you decide?
A: What will you do – to act on your
decision?
• S: Once we decide and act, we deserve a
pat on the back for taking care of
ourselves!
Example Using SODAS (S)
• Latricia just met this guy James at this party. She kind
of knew James before. Latricia and James go back to
James's house. Latricia is feeling a little uncomfortable,
but she is horny, and James is coming on to her, and he
is looking real good. She wants to have sex with him, but
she will only have safer sex, because she doesn't want to
get anything.
• S: What is Latricia’s problem and goal?
– She wants to have sex with him, but she will only have safer sex
and she is feeling unsure of herself and uncomfortable with
James.
Example Using SODAS (O)
What are Latricia’s Options?
1)
She can negotiate with him to use a condom
2)
She can slip the condom on when she gives him “head”
3)
She can have an alternative to intercourse that is safer, like giving him a hand job
4)
She can refuse to have any sex: directly (saying no) or indirectly (make an excuse)
What are the consequences or Outcomes of each Option?
1)
She is feeling unsure of herself and she might not be able to hold up her "bottom
line" of having safer sex and using a condom (he might be able to talk her out of it).
2)
This might work best. She can avoid having to ask him directly. He may find this
sexy, and he won't be able to talk her out of it.
3)
She can avoid having to ask him directly. He may find this sexy. She may not be as
sexually satisfied as she had hoped.
4)
This would protect her, but her goal of having sex would not be achieved.
Example Using SODAS (D, A, S)
What did Latricia’s Decide?
1) She chooses #2 “Slip the condom on when she
gives him head.”
2) She also has an alternative to intercourse, giving
him a “hand job” if he strongly objects to a condom.
Latricia Acts on her decision.
Latricia gives herself Self Praise,
“You go girl”
Special Thanks!
590
Men who participated in the CTN 0018 study
515
Women who participated in the CTN 0019 study
24
Regional Research Training Center Staff and CTP Principal
Investigators
16
Site Coordinators
22
Research Assistants
70
Clinicians and Clinical Supervisors
32
Data Managers and Quality Assurance Monitors
Questions
National Drug Abuse Treatment
Clinical Trials Network ∙ Dissemination Library
Find it in the
CTN Dissemination Library!
http://ctndisseminationlibrary.org