1. Teaching Condom Use Skills: Practice is Superior to Observation Donald Calsyn, Ph.D. 1,2, Melinda Godinez, M.S.W. 3, Suzanne R. Doyle, Ph.D. 1, Mary Hatch-Maillette, Ph.D. 1,2 Sarah Cousins, M.A. 4, TeChieh Chen, B.A. 5 1 Alcohol & Drug Abuse Institute and 2 Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA 3 University of New Mexico, Albuquerque, NM 4 Matrix Institute, Rancho Cucamonga, CA 5 University of California San Francisco, San Francisco, CA

2. Figure 1: Study Schema Advertise Study Availability  Screen for Inclusion/Exclusion  Obtain Informed Consent from Eligible Participants  Conduct Baseline Assessment → Place in Waiting Cohort  Randomly Assign Cohort to Intervention   Standard HIV Education Gender Specific Intervention (one session) (five sessions)   Conduct Post Intervention Assessment  Conduct Three Month Follow Up Assessment  Conduct Six Month Follow Up Assessment

3. Figure 2: Condom Demonstration and Practice Materials

4. Figure 3: Change in male condom use skills over time as a function of intervention attendance * Demo+Practice>Demo Only>None ** *

5. Figure 4: Change in female condom use skills over time as a function of intervention attendance * Demo+Practice>Demo Only>None ***

6. Conclusions  Men attending HIV/STI prevention interventions while in substance abuse treatment can effectively be taught correct condom use skills.  Teaching skills by demonstration was more effective than no intervention, but less effective than having participants practice.  Differences observed included performance on items critical to preventing male condom failure such as “getting the air out,” “leaving space in the tip” and “avoiding spills during withdrawal and removal.”  Differences observed on critical female condom skill items included “spreading the lubricant evenly,” twisting outer ring and pulling for removal” and “ensuring outer ring covered vaginal opening.” Acknowledgements  Supported by NIDA (1 U10DA13714-01, 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.

7. Limitations ♦Although there was random assignment to the D+P and DO groups, NS participants self selected to not attend their assigned D+P or DO group. ♦A scoring limitation was using equal weight for all MCUS and FCUS items, as some items might be more salient for preventing condom failure than others.

8. Clinical Trials Network ∙ Dissemination Library National Drug Abuse Treatment Find it in the http://ctndisseminationlibrary.org CTN Dissemination Library! References Galvão, L. W., Oliveira, L. C., Díaz, J., Kim, D., Marchi, N., van Dam, J., Castilho, R.F., Chen, M., & Macaluso, M. (2005). Effectiveness of female and male condoms in preventing exposure to semen during vaginal intercourse: a randomized trial. Contraception, 71, 130–136. Lindemann, D.F., et al. (2005). Towards errorless condom use: A comparison of two courses to improve condom use skills. AIDS and Behavior, 9, 451,457. Van Devanter, N., Gonzales, V., Merzel, C., Parikh, N. S., Celantano, D., & Greenberg, J. (2002). Effect of an STD/HIV Behavioral Intervention on Women’s Use of the Female Condom. American Journal of Public Health, 92, 109–115. Warner, L., Newman, D. R., Kamb, M. L., Fishbein, M., Douglas, Jr., J. M., Zenilman, J., D’Anna, L., Bolan, G., Rodgers, J., & Peterman, T. for the Project RESPECT Study Group (2008). Problems with condom use among patients attending sexually transmitted disease clinics: Prevalence, predictors, and relation to incident gonorrhea and Chlamydia. American Journal of Epidemiology, 167, 341-349.