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Bailey JV, Webster R, Hunter R, Griffin M, Freemantle N, Rait G, Estcourt C, Michie S, Anderson J, Stephenson J, Gerressu M, Ang CS, Murray E. The Men's Safer Sex project: intervention development and feasibility randomised controlled trial of an interactive digital intervention to increase condom use in men. Health Technol Assess 2018; 20:1-124. [PMID: 27966409 DOI: 10.3310/hta20910] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This report details the development of the Men's Safer Sex website and the results of a feasibility randomised controlled trial (RCT), health economic assessment and qualitative evaluation. OBJECTIVES (1) Develop the Men's Safer Sex website to address barriers to condom use; (2) determine the best design for an online RCT; (3) inform the methods for collecting and analysing health economic data; (4) assess the Sexual Quality of Life (SQoL) questionnaire and European Quality of Life-5 Dimensions, three-level version (EQ-5D-3L) to calculate quality-adjusted life-years (QALYs); and (5) explore clinic staff and men's views of online research methodology. METHODS (1) Website development: we combined evidence from research literature and the views of experts (n = 18) and male clinic users (n = 43); (2) feasibility RCT: 159 heterosexually active men were recruited from three sexual health clinics and were randomised by computer to the Men's Safer Sex website plus usual care (n = 84) or usual clinic care only (n = 75). Men were invited to complete online questionnaires at 3, 6, 9 and 12 months, and sexually transmitted infection (STI) diagnoses were recorded from clinic notes at 12 months; (3) health economic evaluation: we investigated the impact of using different questionnaires to calculate utilities and QALYs (the EQ-5D-3L and SQoL questionnaire), and compared different methods to collect resource use; and (4) qualitative evaluation: thematic analysis of interviews with 11 male trial participants and nine clinic staff, as well as free-text comments from online outcome questionnaires. RESULTS (1) Software errors and clinic Wi-Fi access presented significant challenges. Response rates for online questionnaires were poor but improved with larger vouchers (from 36% with £10 to 50% with £30). Clinical records were located for 94% of participants for STI diagnoses. There were no group differences in condomless sex with female partners [incidence rate ratio (IRR) 1.01, 95% confidence interval (CI) 0.52 to 1.96]. New STI diagnoses were recorded for 8.8% (7/80) of the intervention group and 13.0% (9/69) of the control group (IRR 0.75, 95% CI 0.29 to 1.89). (2) Health-care resource data were more complete using patient files than questionnaires. The probability that the intervention is cost-effective is sensitive to the source of data used and whether or not data on intended pregnancies are included. (3) The pilot RCT fitted well around clinical activities but 37% of the intervention group did not see the Men's Safer Sex website and technical problems were frustrating. Men's views of the Men's Safer Sex website and research procedures were largely positive. CONCLUSIONS It would be feasible to conduct a large-scale RCT using clinic STI diagnoses as a primary outcome; however, technical errors and a poor response rate limited the collection of online self-reported outcomes. The next steps are (1) to optimise software for online trials, (2) to find the best ways to integrate digital health promotion with clinical services, (3) to develop more precise methods for collecting resource use data and (4) to work out how to overcome barriers to digital intervention testing and implementation in the NHS. TRIAL REGISTRATION Current Controlled Trials ISRCTN18649610. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 91. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Julia V Bailey
- E-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Rosie Webster
- E-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Rachael Hunter
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Mark Griffin
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Nicholas Freemantle
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Greta Rait
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Claudia Estcourt
- Barts and The London School of Medicine and Dentistry, Barts Sexual Health Centre, Queen Mary University of London, St Bartholomew's Hospital, London, UK
| | - Susan Michie
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jane Anderson
- Homerton Sexual Health Services, Homerton Teaching Hospitals, London, UK
| | - Judith Stephenson
- Department of Reproductive Health, Institute for Women's Health, University College London, London, UK
| | - Makeda Gerressu
- Department of Infection and Population Health, University College London, London, UK
| | - Chee Siang Ang
- Engineering and Digital Arts, University of Kent, Kent, UK
| | - Elizabeth Murray
- E-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
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Webster R, Michie S, Estcourt C, Gerressu M, Bailey JV. Increasing condom use in heterosexual men: development of a theory-based interactive digital intervention. Transl Behav Med 2017; 6:418-27. [PMID: 27528531 PMCID: PMC4987598 DOI: 10.1007/s13142-015-0338-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Increasing condom use to prevent sexually transmitted infections is a key public health goal. Interventions are more likely to be effective if they are theory- and evidence-based. The Behaviour Change Wheel (BCW) provides a framework for intervention development. To provide an example of how the BCW was used to develop an intervention to increase condom use in heterosexual men (the MenSS website), the steps of the BCW intervention development process were followed, incorporating evidence from the research literature and views of experts and the target population. Capability (e.g. knowledge) and motivation (e.g. beliefs about pleasure) were identified as important targets of the intervention. We devised ways to address each intervention target, including selecting interactive features and behaviour change techniques. The BCW provides a useful framework for integrating sources of evidence to inform intervention content and deciding which influences on behaviour to target.
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Affiliation(s)
- R Webster
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - S Michie
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - C Estcourt
- BICMS, Barts and The London School of Medicine & Dentistry, Barts Sexual Health Centre, Queen Mary University of London, St Bartholomew's Hospital, London, UK
| | - M Gerressu
- Department of Infection and Population Health, University College London, London, UK
| | - J V Bailey
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
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Pan Y, Liu H, Metsch LR, Feaster DJ. Factors Associated with HIV Testing Among Participants from Substance Use Disorder Treatment Programs in the US: A Machine Learning Approach. AIDS Behav 2017; 21:534-546. [PMID: 27933461 PMCID: PMC5583728 DOI: 10.1007/s10461-016-1628-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
HIV testing is the foundation for consolidated HIV treatment and prevention. In this study, we aim to discover the most relevant variables for predicting HIV testing uptake among substance users in substance use disorder treatment programs by applying random forest (RF), a robust multivariate statistical learning method. We also provide a descriptive introduction to this method for those who are unfamiliar with it. We used data from the National Institute on Drug Abuse Clinical Trials Network HIV testing and counseling study (CTN-0032). A total of 1281 HIV-negative or status unknown participants from 12 US community-based substance use disorder treatment programs were included and were randomized into three HIV testing and counseling treatment groups. The a priori primary outcome was self-reported receipt of HIV test results. Classification accuracy of RF was compared to logistic regression, a standard statistical approach for binary outcomes. Variable importance measures for the RF model were used to select the most relevant variables. RF based models produced much higher classification accuracy than those based on logistic regression. Treatment group is the most important predictor among all covariates, with a variable importance index of 12.9%. RF variable importance revealed that several types of condomless sex behaviors, condom use self-efficacy and attitudes towards condom use, and level of depression are the most important predictors of receipt of HIV testing results. There is a non-linear negative relationship between count of condomless sex acts and the receipt of HIV testing. In conclusion, RF seems promising in discovering important factors related to HIV testing uptake among large numbers of predictors and should be encouraged in future HIV prevention and treatment research and intervention program evaluations.
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Affiliation(s)
- Yue Pan
- Division of Epidemiology, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 N.W. 14th ST, Miami, FL, 33136, USA.
| | - Hongmei Liu
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 N.W. 14th ST, Miami, FL, 33136, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W 168th ST, New York, NY, 10032, USA
| | - Daniel J Feaster
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 N.W. 14th ST, Miami, FL, 33136, USA
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Wang C, Shi CX, Zhang B, Chen H, Wang H, Zhang N, Rou K, Cao X, Luo W, Wu Z. HIV seroconversion and risk factors among drug users receiving methadone maintenance treatment in China: A qualitative study. Drug Alcohol Depend 2016; 167:169-74. [PMID: 27567967 PMCID: PMC6625317 DOI: 10.1016/j.drugalcdep.2016.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 08/05/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We sought to explore the experiences of drug users in China who were recently diagnosed with HIV infection while engaged in methadone maintenance treatment (MMT) and to better understand their perceptions of MMT, HIV risk, and HIV prevention. METHODS We recruited clients of MMT clinics in Chongqing and Kunming who had a baseline HIV-negative test result upon entry to MMT and had been diagnosed with HIV within the past 12 months. We conducted semi-structured qualitative interviews and thematic data analysis to identify situations and factors that increased HIV risk. RESULTS Among the 27 participants who were interviewed, 15 believed their infection was due to injection drug use, 7 attributed their infection to sexual contact, and 5 were unsure as to how they became infected. High risk behaviors were common; 18 participants continued to use drugs during treatment, and 10 engaged in unprotected sex. Common themes were the difficulty of drug abstinence despite receiving MMT, social pressure to continue using drugs, and low knowledge of effective HIV prevention measures. CONCLUSION While MMT is effective in reducing drug usage and needle sharing, many clients remain at risk of HIV infection due to continued injection drug use and unprotected sex. Clients may benefit from additional counseling on HIV prevention methods as well as structural interventions to increase the availability of clean injection equipment.
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Affiliation(s)
- Changhe Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Cynthia X Shi
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China,Department of Epidemiology of Microbial Diseases and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, 135 College Street, New Haven, CT 06511, USA
| | - Bo Zhang
- Yunnan Institute for Drug Abuse, 471 Xifu Road, Kunming 650228, China
| | - Hong Chen
- Chongqing Center for Disease Control and Prevention, 8 Changjiang 2nd Road, Chongqing 400016, China
| | - Hua Wang
- Yunnan Institute for Drug Abuse, 471 Xifu Road, Kunming 650228, China
| | - Nanci Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Keming Rou
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Xiaobin Cao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Wei Luo
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing 102206, China.
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Tross S, Feaster DJ, Thorens G, Duan R, Gomez Z, Pavlicova M, Hu MC, Kyle T, Erickson S, Spector A, Haynes L, Metsch LR. Substance Use, Depression and Sociodemographic Determinants of HIV Sexual Risk Behavior in Outpatient Substance Abuse Treatment Patients. J Addict Med 2015; 9:457-63. [PMID: 26501786 PMCID: PMC4779311 DOI: 10.1097/adm.0000000000000162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The NIDA Clinical Trials Network trial of rapid HIV testing/counseling in 1281 patients was a unique opportunity to examine relationships among substance use, depressive symptoms, and sex risk behavior. METHODS Past 6-month substance use; substance use severity (Drug Abuse Screening Test - 10); depressive symptoms (Quick Inventory of Depressive Symptomatology); and three types of sex risk behavior (unprotected sex occasions [USOs] with primary partners; USOs with nonprimary partners; and USOs while high/drunk) were assessed. Zero-inflated negative binomial analyses provided: probability and rate of sex risk behavior (in risk behavior subsample). RESULTS Levels of sexual risk behavior were high, while variable across the three types of sex risk behaviors. Among the patients, 50.4% had engaged in USOs with primary partners, 42% in sex while drunk or high, and 23.8% in USOs with nonprimary partners. Similar factors were significantly associated with all three types of sex risk behaviors. For all types, problem drinking, cocaine use, and substance use severity had an exacerbating effect. Older age was associated with lower risk behavior; other relationship categories (eg, married, separated/divorced, cohabitating) were associated with greater risk behavior than was single status. Depressive symptoms were associated with decreased likelihood of USOs with a primary partner. CONCLUSIONS Sexual risk behavior is common among individuals in outpatient substance abuse treatment. Results highlight problem drinking (eg, up to three-fold) and cocaine (eg, up to twice) in increasing sex risk behavior. They demonstrate the utility of distinguishing between partner types and presence/absence of alcohol/drugs during sex. Findings argue for the need to integrate sex risk reduction into drug treatment.
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Affiliation(s)
- Susan Tross
- New York State Psychiatric Institute, Columbia University Medical Center, New York, N.Y
| | - Daniel J. Feaster
- Department of Biostatistics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Gabriel Thorens
- Department of Mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Rui Duan
- Department of Biostatistics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Zoilyn Gomez
- Department of Biostatistics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, N.Y
| | - Mei Chen Hu
- New York State Psychiatric Institute, Columbia University Medical Center, New York, N.Y
| | | | - Sarah Erickson
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Anya Spector
- New York State Psychiatric Institute, Columbia University Medical Center, New York, N.Y
| | - Louise Haynes
- Medical University of South Carolina, Charleston, South Carolina
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Medical Center, New York, N.Y
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Kyle TL, Horigian VE, Tross S, Gruber VA, Pereyra M, Mandler RN, Feaster DJ, Metsch LR. Uptake of HIV testing in substance use disorder treatment programs that offer on-site testing. AIDS Behav 2015; 19:536-42. [PMID: 25074737 PMCID: PMC4312252 DOI: 10.1007/s10461-014-0864-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Increasing rates of HIV testing within substance use disorder (SUD) treatment clients is an important public health strategy for reducing HIV transmission rates. The present study examined uptake of HIV testing among 1,224 clients in five SUD treatment units that offered on-site testing in Florida, New York, and California. Nearly one-third (30 %) of the participants, who had not previously tested positive, reported not having been tested for HIV within the past 12 months. Women, African Americans, and injection drug users had a higher likelihood of having been tested within the past 12 months. The SUD treatment program was the most frequently identified location of participants' last HIV test. Despite the availability of free, on-site testing, a substantial proportion of clients were not tested, suggesting that strategies to increase uptake of testing should include addressing barriers not limited to location and cost.
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Affiliation(s)
- Tiffany L Kyle
- Aspire Health Partners, 5151 Adanson Street, Orlando, FL, 32804, USA,
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Fisher WA, Fisher JD, Shuper PA. Social Psychology and the Fight Against AIDS. ADVANCES IN EXPERIMENTAL SOCIAL PSYCHOLOGY 2014. [DOI: 10.1016/b978-0-12-800284-1.00003-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Hensel DJ, Stupiansky NW, Herbenick D, Dodge B, Reece M. Sexual pleasure during condom-protected vaginal sex among heterosexual men. J Sex Med 2013; 9:1272-6. [PMID: 22781082 DOI: 10.1111/j.1743-6109.2012.02700.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Public health condom promotion efforts increasingly focus on the importance of sexual pleasure; however, little is known about sexual event-specific factors that may increase or decrease perceptions of sexual pleasure when condoms are used. AIMS To examine event-level factors associated with ratings of sexual pleasure during condom-protected vaginal intercourse. METHODS Data were collected in 2008 from 1,875 men during a prospective daily diary study of sexual behavior and condom use. Sexual pleasure was assessed during condom-protected vaginal intercourse considering situational, relational, intrapersonal, and behavioral predictors. Analyses were generalized estimating equation ordinal regression. MAIN OUTCOME MEASURES Event-specific perceptions of sexual pleasure (three categories: not at all enjoyable to extremely enjoyable). RESULTS Vaginal intercourse was reported on 29.8% (N = 8,876/29,714) of diary days; complete condom use was reported for 59.1% (5,249/8,876) of all vaginal intercourse events. This was confusing by using the word "all sexual events." Higher sexual pleasure ratings during complete condom use were associated with older age, manual stimulation of one's genitals, receiving oral sex, and performing oral sex. Sexual pleasure ratings also increased in association with intercourse duration, intercourse intensity, ejaculation, erection perception, and condom comfort. Sexual pleasure ratings were lower with erection difficulty and partner discomfort during sex. CONCLUSIONS These data advance understanding of sexual pleasure during condom use, suggesting that sexual pleasure increases in conjunction with specific relational, physiological, and condom perceptions. These findings offer points upon which clinicians and health educators can engage men in an ongoing dialogue about augmenting sexual pleasure in the context of condom use.
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Affiliation(s)
- Devon J Hensel
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Hosain GMM, Berenson AB, Tennen H, Bauer LO, Wu ZH. Attention deficit hyperactivity symptoms and risky sexual behavior in young adult women. J Womens Health (Larchmt) 2012; 21:463-8. [PMID: 22303821 DOI: 10.1089/jwh.2011.2825] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study was undertaken to assess the association between adult attention deficit/hyperactivity disorder (ADHD) symptoms and high-risk sexual behavior. METHODS This cross-sectional study interviewed 462 low-income women aged 18-30 years. We used the 18-item Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist to assess ADHD symptoms. Risky sexual behaviors included sex before 15 years of age, risky sex partners in lifetime, number of sex partners in the last 12 months, condom use in the last 12 months, alcohol use before sex in the last 12 months, traded sex in lifetime, and diagnosed with sexually transmitted infection (STI) in lifetime. RESULTS Mean ADHD symptom score was 19.8 (SD±12.9), and summary index of all risky sexual behavior was 1.77 (SD±1.37). Using unadjusted odds ratios (OR), women who endorsed more ADHD symptoms reported engaging in more risky sexual behaviors of all types. However, when multivariable logistic regression was applied adjusting for various sociodemographic covariates, the adjusted ORs remained significant for having risky sex partners and having ≥3 sex partners in the prior 12 months. We observed some differences in risky sexual behavior between two domains of ADHD. CONCLUSIONS The ADHD symptom score appears to be associated with some risky sexual behaviors and deserves further attention. A brief ADHD screening can identify this high-risk group for timely evaluation and safe sex counseling.
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Affiliation(s)
- G M Monawar Hosain
- Department of Ob-Gyn, University of Texas Medical Branch, Galveston, Texas, USA
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Calsyn DA, Baldwin H, Niu X, Crits-Christoph P, Hatch-Maillette MA. Sexual risk behavior and sex under the influence: an event analysis of men in substance abuse treatment who have sex with women. Am J Addict 2011; 20:250-6. [PMID: 21477053 DOI: 10.1111/j.1521-0391.2011.00123.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to determine if there is evidence for a causative link between sex under the influence of drugs or alcohol and risky sex for men in substance abuse treatment. Men in treatment participating in a multisite HIV prevention protocol who reported on baseline, 3, or 6 months computerized assessments the details of their most recent sexual events, and who reported having sexual events under the influence and not under the influence, and who reported most recent events that did and did not include condom use served as participants (n = 37). Safe sex was not significantly more likely to happen when participants were under the influence of drugs or alcohol during their most recent sexual event (48.3%) than when they were not under the influence (49%, p = .82). In this high-risk in treatment sample, a causative link between sex under the influence of drugs or alcohol and sexual risk behavior was not supported.
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Affiliation(s)
- Donald A Calsyn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1107 NE 45th Street, Seattle, WA 98105, USA.
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Song YS, Calsyn DA, Doyle SR, Dierst-Davies R, Chen T, Sorensen JL. Predictors of condom use among men enrolled in drug treatment programs. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2009; 21:460-473. [PMID: 19842829 PMCID: PMC3689147 DOI: 10.1521/aeap.2009.21.5.460] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study identified predictors of condom use and developed a model of condom use in a sample of men (n = 324) enrolled in drug treatment. Utilizing a series of logistic regression analyses reported condom use was predicted by possession of condoms, future intention to use condoms, future intention to increase condom use, having a high-risk partner, low Condom Barriers Scale scores, being unmarried and ethnic minority status. A probit path analysis revealed the following model of condom use among men in drug treatment: Taking condoms from clinic stocks was the best predictor of condom possession, which in turn was the best predictor of condom use. These study findings identify condom availability in treatment programs as an important risk reduction intervention. Treatment programs can apply these predictors of condom use to better identify individuals at risk for HIV and sexually transmitted infections to better target prevention interventions.
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Affiliation(s)
- Yong S Song
- Department of Psychiatry, University of California at San Francisco at San Francisco General Hospital, USA.
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Calsyn DA, Hatch-Maillette M, Tross S, Doyle SR, Crits-Christoph P, Song YS, Harrer JM, Lalos G, Berns SB. Motivational and skills training HIV/sexually transmitted infection sexual risk reduction groups for men. J Subst Abuse Treat 2009; 37:138-50. [PMID: 19150206 PMCID: PMC2749552 DOI: 10.1016/j.jsat.2008.11.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 10/17/2008] [Accepted: 11/24/2008] [Indexed: 10/21/2022]
Abstract
The effectiveness of a motivational and skills training HIV/AIDS group intervention designed for men in substance abuse treatment was evaluated. Men in methadone maintenance (n = 288) or outpatient psychosocial treatment (n = 302) completed assessments at baseline, 2 weeks, 3 months, and 6 months postintervention. Participants were randomly assigned to attend either Real Men Are Safe (REMAS; five sessions containing information, motivational exercises, and skills training) or HIV education (HIV-Ed; one session containing HIV prevention information). REMAS participants engaged in significantly fewer unprotected vaginal and anal sexual intercourse occasions (USO) during the 90 days prior to the 3- and 6-month follow-ups than HIV-Ed participants. Completing REMAS resulted in an even stronger effect: Completers reduced their number of USO by 21% from baseline to 6-month follow-up. In contrast, HIV-Ed completers increased the number of USO by 2%. A motivational and skills training HIV prevention intervention designed for men was associated with greater sexual risk reduction over standard HIV-Ed. Substance abuse treatment programs can therefore help reduce sexual risk among their clientele by providing a more intensive intervention than what is traditionally provided.
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Affiliation(s)
- Donald A Calsyn
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105, USA.
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Stein MD, Anderson BJ, Caviness CM, Rosengard C, Kiene S, Friedmann P, Clarke JG. Relationship of alcohol use and sexual risk taking among hazardously drinking incarcerated women: an event-level analysis. J Stud Alcohol Drugs 2009; 70:508-15. [PMID: 19515290 DOI: 10.15288/jsad.2009.70.508] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To understand the association of alcohol use with sex and unprotected sex among hazardously drinking incarcerated women, we examined the relationship of these behaviors on any given day. METHOD Participants endorsed unprotected sex and hazardous alcohol consumption (four or more drinks at a time on at least 3 separate days in the previous 3 months or a score of 8 or above on the Alcohol Use Disorders Identification Test). Participants recalled behaviors in the 90 days before incarceration using the Timeline Followback method. Generalized estimating equation models estimated the effect of daily alcohol use and selected covariates on the odds of sexual-risk behavior. RESULTS The 245 participants averaged 34 years of age and were 71.4% white; 67.8% used cocaine. On most (84.7%) drinking days, women consumed four or more drinks. One hundred forty-one participants (57.6%) reported sex with only main partners, 10.6% with only casual partners, and 30.6% with both casual and main partners. The likelihood of having any sex (odds ratio = 1.78, p < .01) and unprotected sex (odds ratio = 1.95, p < .01) was higher on days when participants consumed alcohol compared with nondrinking days. However, when the analysis was restricted to days on which participants reported having sex, the odds of having unprotected sex was not significantly associated with drinking. CONCLUSIONS Among incarcerated women who reported hazardous drinking, alcohol use was associated with an increased likelihood of sexual activity and a concomitant increase in unprotected sex. However, use of alcohol was not significantly associated with condom use on days when participants were sexually active.
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Affiliation(s)
- Michael D Stein
- Department of Medicine and Community Health, Warren Alpert School of Medicine, Brown University and General Medicine Research, Butler Hospital, 345 Blackstone Boulevard, Providence, Rhode Island 02906, USA.
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Marvel F, Rowe CL, Colon-Perez L, DiClemente RJ, Liddle HA. Multidimensional family therapy HIV/STD risk-reduction intervention: an integrative family-based model for drug-involved juvenile offenders. FAMILY PROCESS 2009; 48:69-84. [PMID: 19378646 DOI: 10.1111/j.1545-5300.2009.01268.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Drug and juvenile justice involved youths show remarkably high rates of human immunodeficiency virus (HIV)/sexually transmitted disease (STD) risk behaviors. However, existing interventions aimed at reducing adolescent HIV risk behavior have rarely targeted these vulnerable young adolescents, and many approaches focus on individual-level change without attention to family or contextual influences. We describe a new, family-based HIV/ STD prevention model that embeds HIV/STD focused multifamily groups within an adolescent drug abuse and delinquency evidence-based treatment, Multidimensional Family Therapy (MDFT). The approach has been evaluated in a multisite randomized clinical trial with juvenile justice involved youths in the National Institute on Drug Abuse Criminal Justice Drug Abuse Treatment Studies (www.cjdats.org). Preliminary baseline to 6-month outcomes are promising. We describe research on family risk and protective factors for adolescent problem behaviors, and offer a rationale for family-based approaches to reduce HIV/STD risk in this population. We describe the development and implementation of the Multidimensional Family Therapy HIV/STD risk-reduction intervention (MDFT-HIV/ STD) in terms of using multifamily groups and their integration in standard MDFT and also offers a clinical vignette. The potential significance of this empirically based intervention development work is high; MDFT-HIV/STD is the first model to address largely unmet HIV/STD prevention and sexual health needs of substance abusing juvenile offenders within the context of a family-oriented evidence-based intervention.
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Affiliation(s)
- Francoise Marvel
- Department of Epidemiology and Public Health, Center for Treatment Research on Adolescent Drug Abuse, University of Miami Miller School of Medicine, 1120 NW 14th Street Stc. 1019, Miami, FL 33136, USA
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Klein H. DIFFERENCES IN HIV RISK PRACTICES SOUGHT BY SELF-IDENTIFIED GAY AND BISEXUAL MEN WHO USE INTERNET WEBSITES TO IDENTIFY POTENTIAL SEXUAL PARTNERS. JOURNAL OF BISEXUALITY 2009; 9:125-140. [PMID: 31097923 PMCID: PMC6516776 DOI: 10.1080/15299710902881533] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Men who have sex with men (MSM) account for the largest number of persons diagnosed with AIDS in the United States, with higher-than-average rates of drug use and unprotected sex being cited as the principal reasons underlying their high rates of HIV infection. Recent evidence has suggested that the use of Websites specifically designed to promote unsafe sexual practices (e.g., Bareback.com, BarebackRT.com, Bare4ever.com) may be particularly common among MSM, thereby fostering their risky behaviors. In light of these findings, the present study, which compares HIV risk behaviors sought by self-identified gay and bisexual men, is based on a content analysis of 1,316 ads/profiles posted on one of the most popular men who have sex with other men (MSM) Websites (namely, Bare-back.com) that specifically fosters unprotected sex. Ads/profiles were selected randomly based on the American ZIP code of residence. Data were collected between September 2006 and January 2007. Rates of advertised-for high-risk sexual behaviors were very high for gay and bisexual men alike, particularly for oral sex involving ejaculation into the mouth, anal sex involving ejaculation into the anus, multiple partner sex, and felching (i.e., eating ejaculatory fluid out of an anus into which at least one person previously ejaculated). Analytical comparisons of gay and bisexual men showed that, on various dimensions, the bisexual men in this sample had either similar or lower levels of sexual risk compared to the gay men. The HIV intervention-related implications of these findings are discussed.
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Affiliation(s)
- Hugh Klein
- Kensington Research Institute, Silver Spring, MD and Center for the Study and Prevention of Drug Use, Morgan State University, Baltimore, MD
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Klein H. HIV risk practices sought by men who have sex with other men, and who use internet websites to identify potential sexual partners. Sex Health 2008; 5:243-50. [PMID: 18771639 DOI: 10.1071/sh07051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 02/15/2008] [Indexed: 11/23/2022]
Abstract
Men who have sex with men (MSM) account for the largest number of persons diagnosed with AIDS in the USA, with higher than average rates of drug use and unprotected sex being cited as the principal reasons underlying their high rates of HIV infection. Recent evidence has suggested that the use of websites specifically designed to promote unsafe sexual practices may be particularly common among MSM, thereby fostering their risky behaviours. In light of these findings, the present study is based on a content analysis of 1316 ads/profiles posted on one of the most popular MSM websites that specifically fosters unprotected sex. Ads/profiles were selected randomly based on the American ZIP code of residence. Data were collected between September 2006 and January 2007. Rates of advertised for high-risk sexual behaviours were very high, particularly for oral sex involving ejaculation into the mouth (88.0% for receptive oral sex, 77.4% for insertive oral sex), anal sex involving ejaculation into the anus (79.7% for insertive anal sex, 69.4% for receptive anal sex), multiple partner sex (77.9%) and felching (16.5%). A multivariate analysis of the correlates of sexual risk preferences identified seven factors that were related to a propensity towards enhanced sexual risk: younger age (beta = 0.12, P = 0.0001), not being African American (beta = 0.05, P = 0.0341), self-identification as a sexual 'bottom' (beta = 0.20, P = 0.0001), not caring about one's potential sex partners' HIV serostatus (beta = 0.15, P = 0.0001), preferring to have sex while under the influence of drugs (beta = 0.08, P = 0.0022), a greater involvement in and commitment to the use of the website to locate potential unprotected sex partners (beta = 0.16, P = 0.0001) and not being HIV-negative (beta = 0.08, P = 0.0081). The HIV intervention-related implications of these findings are discussed.
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Affiliation(s)
- Hugh Klein
- Kensington Research Institute, Silver Spring, MD 20910, USA.
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18
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Abstract
OBJECTIVE To identify barriers to condom use. METHODS Data were extracted through MEDLINE from papers published between 1993 and 2007. Surveys, reviews, clinical studies and comments were included in this review. The impact of cost, moral, social, personal and psychological factors were taken into consideration. RESULTS Several factors were associated with non-use of a condom during sexual intercourse. Their cost often posed a barrier to condom use for the poor, even in developed countries. In many communities, moral values, ethnic and religious factors also played a role. Among other social factors, gender inequality, lack of a dialogue among partners with regard to condom use, and the stigma attached to the condom could all lead to unprotected sexual intercourse. Personal factors such as aversion to the condom, consumption of alcohol or use of drugs prior to sexual intercourse, and anxiety and depression all were negatively associated with condom use. CONCLUSION Their cost evidently poses a barrier to the use of condoms by the poor. Beside social stigmas and personal reluctance, prevailing moral norms and religious interdicts also adversely affect use of these devices in many communities. Because of their disastrous consequences in the domain of public health each of these barriers must be effectively addressed.
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Affiliation(s)
- N N Sarkar
- Department of Reproductive Biology, All India Institute of Medical Sciences, New Delhi, India.
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Leigh BC, Ames SL, Stacy AW. Alcohol, drugs, and condom use among drug offenders: an event-based analysis. Drug Alcohol Depend 2008; 93:38-42. [PMID: 17928167 PMCID: PMC2239344 DOI: 10.1016/j.drugalcdep.2007.08.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Revised: 08/10/2007] [Accepted: 08/14/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Studies of the association between substance use and condom use in specific sexual encounters often do not separate the effects of alcohol and different types of drugs. Because the pharmacological effects and social settings of various substances differ, their effects on unprotected intercourse may vary as well. GOAL This study examined the relationship between alcohol and drug use and the use of condoms in sexual encounters with casual partners in a high-risk population of drug offenders. DESIGN Participants in court-ordered drug diversion programs (n=536; 26% female) completed a questionnaire in which they reported on the circumstances of their most recent sexual encounter with a casual partner. RESULTS In multivariate logistic models, alcohol use in conjunction with sex was not related to decreased condom use in either men or women. Amphetamines (smoked or injected) were associated with decreased condom use, while cocaine, marijuana, and orally-administered amphetamines were not significantly associated with condom use. CONCLUSIONS In this high-risk sample, links between substance use and unprotected sex differ with type of drug used.
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Affiliation(s)
- Barbara C. Leigh
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA
| | - Susan L. Ames
- Department of Psychology, University of California, Los Angeles, CA
| | - Alan W. Stacy
- Department of Psychology, University of California, Los Angeles, CA
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