Increased exposure to an HIV risk reduction protocol associated
with a reduction in drug abuse severity
Louise F. Haynes1; Rickey E. Carter1; Amy E. Herrin1; Donald A. Calsyn2
1Medical University of South Carolina, Southern Consortium Node;
2University of Washington, Washington Node,
NIDA Clinical Trials Network
Introduction and Hypotheses
References
Acknowledgements
Results
Methods
Previously, we reported that men in substance abuse (SA)treatment randomized to a five-session HIV preventionintervention reduced their sexual risk more than menrandomized to a single-session intervention. For the purposeof this research, the association of the number of HIVprevention sessions attended with reductions in risky sexualbehavior (RSB) and ASI composite scores was examined forthose participants randomized to the five-session intervention.Specifically, the following hypothesis was tested:
Hypothesis: Participants who reduce their drug use will bemore likely to reduce risky sexual behavior and that thenumber of HIV prevention sessions attended would enhancethe effect.
Participants
Of the 291 men randomized into the Real Men Are Safe(REMAS) intervention, this analysis focuses on the n=89 whohad both baseline and three-month follow-up assessmentsand who reported having more than one sexual partner duringthe period six months prior to and throughout the study.
Measures
SA measures were the alcohol (ALC) and drug (DRG)composite scores from the ASI-Lite. Risky sexual behavior(RSB) was defined as the number of vaginal and analintercourse acts without a condom, and the outcome for thisanalysis was the change in RSB at three month follow-uprelative to baseline. A participant was considered to haveimproved if there was a reduction in RSB at the three monthfollow-up.
Statistical Considerations
Binary indicator variables were created to indicateimprovement in RSB, ALC and DRG. Improvement wasdefined as a decrease in scores at three-month follow-upcompared to baseline. Logistic regression was used to modelthe log odds of improvement in each measure as a function ofthe number of sessions attended. To assess if reductions inDRG mediated the effect of the number of sessions attendedon RSB improvement, a multiple logistic model wasconsidered.
Table 1 presents the sample description of the N=89participants included in this analysis. The majority(80%) reported engaging in risky sexual behavior atbaseline. A total of 20 (22%) of the included subjectsfailed to attend any REMAS sessions, 35% attendedall five sessions, and the remaining 43% attended oneto four sessions. Table 2 presents the baseline drugand alcohol use profiles of the sample at baseline.
Figure 1 illustrates the baseline and three-monthmean number of RSB events and ASI-Lite compositescores. Figure 2 dichotomizes each of these variablesto represent the percentage of subjects that improvedover the course of follow-up by the number ofsessions attended.
Conclusions
These data suggest that an overall reduction in RSB and DRG wasassociated with increased exposure to the REMAS intervention.
A limitation of this analysis is that it only examines correlations amongpatients who self-selected the amounts of their REMAS exposure, so anysuggestion of causality would be speculative. Another limitation is thepossible confounding. Men who attended more sessions would have beenexposed to additional substance abuse treatment. This could cause the ASIimprovements.
Further research is needed to examine if reductions in RSB are linked toreductions in incident cases of HIV and other STDs and to betterunderstand the potential confounding effects of a participants willingness toremain in treatment since those who attended more sessions may havebeen more highly motivated to change than those who did not attend asmany sessions.
This study is funded by the following grants from the National Institutes of Health: DA013727, DA013714. Theconsortium performing this study was a part of the Clinical Trials Network (CTN) established by the National Institute onDrug Abuse (NIDA).
1.Calsyn, Donald A.; Hatch-Maillette, Mary; Doyle, Suzanne R; Berns, Sara; Crits-Cristoph, Paul; Song,Yong S; Harrer, Judith M; Lalos, Genise. “Efficacy of a Gender Specific HIV Prevention of Men inSubstance Abuse Treatment.” Poster presented at the XVI International AIDS Society (IAS) Conference,Toronto, Canada, August 13-18, 2006.
2.Calsyn Donald A et al. “Primary Results from CTN Safer Sex Skills Groups for Men”. Symposium XVII atThe College of Problems of Drug Dependence (CPDD) Conference, Quebec City, Quebec, Canada, June15-21, 2007.
Figure 1: Mean (SD) number of RSB events andASI-Lite composite scores (n=89).
The SD for RSB is 60.94 at baseline and 39.4 at three-monthfollow-up.
Figure 2: Percent of subjects that improved by number of sessions attended (n=89)
*Note: Improvement is defined as a decrease in the number of RSB events or a decrease in the ASI-DRG andASI-ALC scores at three-month follow-up compared to baseline
Table 1: Sample description (n=89)
{a} Risky Sexual Behavior is defined as the number of vaginal and analintercourse acts without a condom
Table 2: ASI-Lite Drug and Alcohol Use at Baseline
The odds for an improvement in RSB (i.e.,reduction in RSB events) at follow-upsignificantly increased as the number ofsessions attended increased (p=0.032). Inaddition, the odds for a reduction in theDRG composite score similarly increasedwith session attendance (p=0.049), yet thisassociation did not mediate the effect ofthe number of sessions on RSB. Thenumber of REMAS sessions was not foundto be associated with a reduction in ALCcomposite scores (p=0.66).