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Sexual practices in methadone maintenance and outpatient
psychosocial drug treatment programs
Hatch-Maillette,
1
M. ,
Calsyn,
1UW
1,2
D.A ,
Doyle,
1
S. ,
2UW
Woods,
3
A. ,
Coyer,
4
S. ,
Sillo,
3Compass
5,6
G. ,
Woody,
7
G.
4Prestera
Alcohol & Drug Abuse Institute, Seattle, WA.,
School of Medicine, Seattle, WA.,
Recovery Services, Toledo, OH.,
Center, Huntington,
WV., 5UCLA Integrated Substance Abuse Programs, Los Angeles, CA., 6Matrix Institute, Rancho Cucamonga, CA., 7University of Pennsylvania, Philadelphia, PA.
Introduction
Method, cont.
Results, cont.
Results, cont.
 Sexual risk reduction has been one focus of many
studies on HIV prevention efforts with substance abusers.
Procedure
Sexual Activity in Past 90 Days
Proportion of Condom Use
 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:
 OPS participants reported significantly more sexual
encounters than MM participants in several areas:
 MM participants used condoms more often, though both groups
reported infrequent use overall
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 subsamples of:
 Number & type of sexual partners
 Men who have sex with men
 Frequency & type of sexual behaviors
 Sex trade workers
 Condom use
 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.
 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
Method
 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.
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
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.
Proportion of High Risk Partners
 Excluded men who:
 had partners trying to get pregnant
 had Mini Mental Status Exam < 25
 “High risk” defined as >1 partner, OR 1 partner for <6 mo,
OR HIV+ partner
Acknowledgements
 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)
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.