1. Sexual practices in methadone maintenance and outpatient psychosocial drug treatment programs
Hatch-Maillette, M.1, Calsyn, D.A1,2, Doyle, S.1, Woods, A.3, Coyer, S.4, Sillo, G.5,6, Woody, G.7
1UW Alcohol & Drug Abuse Institute, Seattle, WA., 2UW School of Medicine, Seattle, WA., 3Compass Recovery Services, Toledo, OH., 4Prestera Center, Huntington, WV., 5UCLA Integrated Substance Abuse Programs, Los Angeles, CA., 6Matrix Institute, Rancho Cucamonga, CA., 7University of Pennsylvania, Philadelphia, PA.
Introduction
Sexual risk reduction has been one focus of many studies on HIV prevention efforts with substance abusers.
Past work has looked at sexual behavior from the perspective of gender or type of risky sex act.
Past work on HIV risk has often been done with sub-samples of:
Men who have sex with men
Sex trade workers
Injection drug users
Drug users not engaged in treatment
Specific geographic areas
Details about the sexual activity of a geographically diverse group of men--in both methadone maintenance and outpatient psychosocial drug treatment programs--is missing.
Results, cont.
Sexual Activity in Past 90 Days
OPS participants reported significantly more sexual encounters than MM participants in several areas:
Results, cont.
Proportion of Condom Use
MM participants used condoms more often, though both groups reported infrequent use overall
Method, cont.
Procedure
ACASI methodology was used to administer the Sexual Behavior Inventory (SBI), a structured, self-report questionnaire on sexual risk behaviors in the past 90 days. The SBI covers:
Number & type of sexual partners
Frequency & type of sexual behaviors
Condom use
Communication about sexual matters
Sex under the influence of drugs & alcohol
Detailed description of most recent sexual event
Data reported here are based on SBI results at Baseline of men who reported only heterosexual encounters in the past 90 days
Results
Demographics
Although MM were significantly older, less educated, and earned less each month, Cohen’s effect sizes were small to medium and were not suspected of impacting the outcome variables.
Proportion of High Risk Partners
“High risk” defined as >1 partner, OR 1 partner for <6 mo, OR HIV+ partner
Significantly more OPS participants (62%) had high risk partners than MM (51%) (X2=6.32, p<.05), but not more partners overall (M=2.6 both groups)
Conclusion
Compared to MM participants, OPS participants described
More frequent vaginal, anal, and insertive oral sex
More high risk partners
Less frequent condom use during anal and insertive oral sex
Men in this study engaged in intercourse with similar frequency as the normative population
Although HIV/STD interventions typically have targeted injection drug users in MM programs, OPS patients are engaging in risky sex more frequently and are therefore in need of state-of-the-art safer sex interventions
This data suggests that for treatment staff, safer sex is an appropriate topic for skills groups, relapse prevention planning, and individual counseling.
Method
Sample
Men who participated in NIDA’s Clinical Trials Network 0018 protocol, a gender-specific HIV prevention intervention
Included men who:
were in 1 of 14 methadone maintenance (MM; n=262) or outpatient psychosocial (OPS; n=236) drug treatment programs across the country
were 18+ yrs and had unprotected vaginal or anal intercourse in the past 6 months
were willing to attend HIV/STD prevention groups geared toward men, and complete assessments at baseline, and 2 wks, 3 mo, and 6 mo post-intervention
Excluded men who:
had partners trying to get pregnant
had Mini Mental Status Exam < 25
Acknowledgements
Supported by NIDA (1 U10DA , Dennis Donovan, PI).
The authors wish to thank the CTN 0018/0019 lead node teams, the 23 RRTC and site PIs, the 15 site coordinators, the 21 research assistants, the 15 therapy supervisors, and the 29 therapists who worked on this project.