1. D. Hien 1, T. KIlleen 2, A. Campbell 1, H. Jiang 1, E. Nunes 1, 1 Columbia University, New York, NY, USA. 2 Medical University of South Carolina, Charleston, SC, USA. Abstract Conclusion Methods Acknowledgements ● A significant and sustained concern for women in substance abuse treatment is the risk of HIV infection and AIDS. Women with a history of substance abuse are more likely to engage in unprotected sexual intercourse, report a greater number of sexual partners and sexual acts, and exchange sex for money or drugs. Being under the influence of alcohol or drugs may diminish inhibitions and adversely affect decisions about engaging in safer sex practices. A history of interpersonal violence and sexual abuse have also been linked to subsequent unsafe sexual practices (Senn et al., 2007). ● Strategies used to help women be more successful in negotiating safer sex include increasing self efficacy and self esteem. Both have been shown to be positively associated with a set of mediators (i.e. condom use self efficacy) that predict safer sex behavior. Insofar as an intervention targets increasing self efficacy and self-esteem, social cognitive theory would predict more significant behavioral change in sexual risk behavior when compared with HIV prevention interventions based on psychoeducation alone (the kind typically implemented in substance abuse treatment programs) (Shoptaw et al., 2002). The present study is a secondary analysis of a NIDA CTN study investigating the effectiveness of treatment for trauma and substance abuse disorder in women presenting for treatment at community treatment programs across the United States. Participants Participants were female outpatients at seven psychosocial community treatment programs affiliated with the CTN. Participants were enrolled between 2004 and 2005. In total, 353 participants were randomized to receive 12 bi-weekly group sessions of either Seeking Safety or Women’s Health Education. Outcome Definitions Women were interviewed at baseline, post intervention (7 weeks), and at 3, 6, and 12 months follow up regarding HIV sexual risk behaviors using the Risk Behavioral Survey. Statistical Analysis Participants’ demographic and baseline diagnostic characteristics were described in term of means and standard deviations, or proportions. Bivariate analyses were conducted to evaluate the associations between baseline characteristics and HIV risk behavior variables. Bivariate for group equivalence were also conducted - Chi-square (  2) for categorical variables and the two-sample t-tests for dichotomous and continuous variables. To assess treatment effect (SS vs WHE) on USO in the study, a zero-inflated negative binomial model (ZINB) with random effect was used. The ZINB model is an extension to the widely used zero- inflated Poisson (ZIP) model. Both ZINB and ZIP models can be used to model count data with excess zeros. Compared with ZIP model, the ZINB model relaxes the restriction that the variance equals the mean in a Poisson distribution. Shoptaw S, Tross S, Stephens M, Tai B, the NIDA CTN HIV/AIDS Workgroup. A snapshot of HIV/AIDS-related services in the clinical treatment providers for NIDA’s Clinical Trials Network. Drug Alcohol Depen. 2002;66(S1):S163. Senn T, Carey M, Vanable P. Childhood and adolescent sexual abuse and subsequent sexual risk behavior: Evidence from controlled studies, methodological critque, and suggestions for research. Clin Psychol Rev. 2007;28(5):711-735. Background and Rationale ● Women with trauma history and PTSD function differently depending on individual coping strategies and may cycle between avoidant sexual behavior and impulsive/risky sexual behavior, with the disinhibiting effects of substances associated with the latter. ● Interventions such as seeking safety that target self esteem and teach more adaptive coping may be more successful in risk reduction than HIV prevention educational interventions that are typically implemented in substance abuse treatment programs. Improving self efficacy overall may promote increased awareness of and ability to address safety in multiple areas of a woman’s life, including sexual risk behaviors. Table 1 Demographic, Substance Use Diagnoses and Trauma symptom severity This study was supported by National Institute on Drug Abuse, Clinical Trials Network, (U10DA13035) with the Long Island Node as the Lead Node and K24 DA022412 (Dr. E Nunes). Table 2 Sexual Behavior at Baseline HIV sex risk behaviors and PTSD: Secondary findings from a NIDA Clinical Trials Network randomized controlled trial of women in community-based substance abuse treatment. Heterosexual women with substance use disorders (SUD) are at high risk for HIV. A substantial number of women in substance abuse treatment have histories of interpersonal violence, as well as comorbid psychological disorders, such as posttraumatic stress disorder (PTSD). Aim: To examine HIV sexual risk behaviors of treatment seeking women with SUD and PTSD and the treatment effect of two interventions on sexual risk outcomes. Method: Secondary analyses were conducted with 353 women meeting criteria for SUD and full or subthreshold PTSD enrolled in a study of the effectiveness of two group interventions: 1) an integrated treatment for SUD and PTSD, and 2) a health education attention control. Bivariate associations between baseline demographic, diagnostic characteristics and HIV sex risk behavior were examined. Zero-inflated negative binomial model regressions were run to assess differences in sexual risk behaviors between intervention groups. Results: At baseline, 54% of women were sexually active in the previous 30 days, averaging one sexual partner and 5.4 unprotected sexual occasions (USO). Women with more substance use reported more sexual partners and unprotected sex. The integrated treatment for PTSD and SUD had a significant impact in decreasing sexual risk behaviors post treatment (p=.05, 95% CI 0.51-1.03). Conclusion: Women in outpatient substance abuse treatment with comorbid PTSD may reduce unprotected sexual encounters by participating in trauma integrated treatment. Increasing PTSD coping skills and understanding the role of trauma may enhance feelings of empowerment or increase efficacy to make choices that will improve sexual health. Variables Total N = 346 Seeking Safety N = 173 Women's Health N = 173 Age 39.2(9.3) 39.4(9.5)39(9.2) Ethnicity African American33.5%32.4%34.7% Caucasian46.2%47.4%45.1% Latina6.1%4.1%8.1% Other14.2%16.2%12.1% Marital Status Married34.4%30.6%38.2% Never Married37% 35.3% Div/Sep29.5%32.4%26.6% Education > 1273.4%77.5%69.4% Substance Use past 30 days5.9 (11)6.1 (9.7)5.8 (10.1) Current Dependence Cocaine70.45%72.73%68.18% Stimulants7.65%8.52%6.78% Opiates25.57% Marijuana27.20%27.84%26.55% Alcohol56.09%59.66%52.54% CAPS Severity (total)62.7(19.5)61.3(19.4)64.1(19.6) Controlled environment last 30 days (yes) 25.6%28.2%23.0% Days in a controlled environment last 30 days 13.9 (8.9)13.6(8.9)14.5(9.1) a There were no statistically significant differences between treatment groups on any of the risk factors reported. b Sexual occasions include vaginal or anal sex with a male partner. VariablesTotal Seeking Safety a Women's Health Education a N=346173 Total number of sexual occasions (TSO) b at baseline last 30 days 7.52(13.7)7.55(13.53)7.49(13.86) Currently sexually active (TSO>0) 53.49%54.65%52.33% Unprotected sexual occasions (USO) b at baseline last 30 days 5.76(11.5)5.81(10.92)5.70(12.01) Having unprotected sexual occasions (USO>0) b 46.06%47.95%44.19% Results ● The sample description is displayed in Table 1. Participants were mostly Caucasian, never married, divorced or separated, unemployed and cocaine dependence was the primary substance use disorder. There were no between group differences on demographics, substance use diagnoses or trauma symptom severity. ● Table 2 presents past 30 day HIV risk behaviors at baseline. The distribution of zero USO for thirty days prior to baseline was 53.5% (n=185), 46.1% reported at least one USO. There were no significant differences between treatment groups at baseline on sexual behavior variables. ● Figure 1 displays USO at follow-ups by intervention groups reporting either low or high USO at baseline. Based on the two part estimation in the ZINB model, when the two treatment groups had the same high USO level at baseline (=12, 75th percentile of USO baseline among cases who had any USO at baseline), the number of unprotected sexual occasions at the 12-month follow-up was 4.97 for SS vs. 8.60 for WHE, a statistically significant difference. References