Reducing Sexual Risk Behaviors for HIV/STDs in Women with Alcohol Use Disorders (AUDs)

Background and Purpose: Alcohol and drug dependent women are at increased risk for HIV/STDs, yet the impact of substance abuse treatment on sex risk behaviors is not well understood. Safer Sex Skill Building (SSB), a 5-session HIV/STD intervention, was developed primarily for women with illicit drug problems (Schilling et al., 1993), which was found to be effective in reducing sexual risk behaviors at 6 month follow-up (Tross et al., 2008). The present R03 NIAAA funded research modified SSB to include alcohol content (SSB+A) and then pilot tested it in a residential substance abuse treatment setting with 32 women reporting AUDs and recent sexual risk behaviors. The objective of the study was to examine rates of unprotected penetrative intercourse and condom use at 2 and 6 month follow-up in women randomized to SSB+A (5 session experimental group) or a single-session HIV/STD education control group (HE).

Methods: Participants were recruited within 14 days following their admission to residential care. Participant eligibility criteria were: 18 years or older; DSM-IV diagnosis of lifetime Alcohol Abuse/Dependence (with or without other drug use disorders); and unprotected penetrative sexual intercourse in the past 6 months before their admission to residential care. Baseline assessments were completed subsequent to informed consent. Following baseline assessments, participants were randomly assigned to either SSB+A (N = 17) or HE (N = 15) group. Follow-up assessments were conducted at 2 and 6 months post-discharge from residential care, and three-fourths of sample (N=24) participated in follow-up. Data analyses included Chi-square, t-test, and a generalized linear mixed model.

Results: Longitudinal results across 3 time periods (baseline, 2 months and 6 months) displayed no group effects on any variables (Alcohol days, Sex days, Alcohol * Sex days, Drug * Sex days, # of sexual acts with condoms, and # of sexual acts without condoms). However, there were significant reductions in several risk variables across Time. More importantly, the interaction term between Group and Time was significant only for sex with a condom (p = 0.0474.), which was the study outcome measure. Number of sexual acts with condoms for SSB+A group was lower than that of HE at baseline (0.46 for SSB+A vs. 3.91 for HE) and 2 month follow-up (1.00 for SSB+A vs. 3.73 for HE), but was significantly higher than HE at 6 month follow-up (6.62 for SSB+A vs. 2.35 for HE). That is, SSB+A women used condoms during sex at 6-mo follow-up more frequently than HE women.

Conclusions and Implication: The results of the study are consistent with those of Tross et al. (2008), where SSB and HE outcomes were similar at 3 mo follow-up but showed differences at 6 month follow-up. While sample size was small in the present pilot study, outcomes demonstrate the effectiveness of SSB+A in reducing sexual risk behaviors of AUD women and support the need for further research using the SSB+A intervention with a larger sample of AUD women.