Can Sexual Risk Reduction Be Addressed in Substance Use Treatment Programs?
Human immunodeficiency virus/sexually transmitted disease (HIV/STD) risk reduction has become a central goal of substance use treatment programs, but its implementation with regard to sexual risk reduction lacks successful pragmatic models. Tross and colleagues studied the implementation of safer sex skills building (SSB) groups among 515 women in 12 drug treatment programs participating in the NIDA Clinical Trials Network. Women who had unprotected vaginal or anal intercourse in the past 6 months were randomized to either SSB (5 ninety-minute groups using problem solving and skills rehearsal to increase HIV/STD risk awareness and condom use including partner negotiation) or HIV/STD education (HE) (1 sixty-minute group covering HIV/STD disease, testing, treatment, and prevention). Participants were assessed at 3 and 6 months for the occurrence of unprotected sex in the past 3 months.
- Although only 60–70% of participants were available for follow-up and less than two-thirds of each group received the intervention, the following significant effects were noted:
- Unprotected sex decreased from a baseline median of 19 episodes in 3 months to 15 and 17 episodes in the SSB and HE groups, respectively (no significant difference between groups).
- Unprotected sex further decreased to 14 episodes in the SSB group at 6-month follow-up (a 29% decrease) but increased to 24 in the HE group (p<0.0377).
Despite low intervention participation and follow-up assessment, this clinical trial provides encouraging if modest evidence that desired changes can be achieved using behavioral interventions to address sex risk in substance use treatment. Additional studies including men, using interventions briefer than 7.5 hours, and measuring STD outcomes will further contribute to this important component of HIV prevention.Jeffrey H. Samet, MD, MA, MPH