Real Men Are Safe (REMAS)

Investigators: Donald A. Calsyn, PhD, Mary Hatch-Maillette, PhD, Susan Tross, PhD, Suzanne R. Doyle, PhD, Yong S. Song, PhD, Judy M. Harrer, PhD, Genise Lalos, MA, Sara B. Berns, PhD

REMAS is a group-level, clinic-based behavioral intervention designed to reduce HIV/STI risk among male substance abuse treatment center attendees. More specifically, the program aims to reduce the number of times that men engage in unprotected vaginal and anal sexual intercourse, or have sex while under the influence of drugs or alcohol. Two trained male health counselors teach participants information, help participants develop risk-reduction skills, and motivate behavior change through group discussion, role-play, and condom use skill training. REMAS is comprised of five 90-minute sessions where participants learn about HIV risky-behaviors, HIV prevention planning, and methods for communicating about safer sex and discussing sex without drugs. Click here to view more detailed information on this program.

Reproductive Health Counseling for Young Men

Investigators: Ross Danielson, Anne Plunkett, Shirley Marcy, William Wiest, & Merwin Greenlick

Originally developed for boys between 15 and 18 years of age, this is a one-hour, single-session, clinic-based intervention. The program is designed to meet the needs of sexually active and inactive teens, and to promote abstinence as well as contraception. The session begins with a video presentation that is viewed privately by each teen. The materials address reproductive anatomy, fertility, hernia, testicular self-examination, STDs (including HIV/AIDS), contraception (including abstinence), communication skills, and access to health services. A half-hour private consultation with a health care practitioner follows the presentation. Guided by the young men's interests, the consultation may include such topics as sexuality, fertility goals, and reproductive health risks, along with rehearsal and modeling of sexual communication. A field study of the intervention was conducted with 1,195 high school-aged males visiting health maintenance organizations in two Northwestern cities. Compared to a control group of their peers, sexually active program participants were significantly more likely to use effective contraception at the one-year follow-up assessment, especially if they were not yet sexually active at the time of the intervention. Sexually active female partners of program participants were also more likely to use effective contraception at the follow-up. Click here to view more detailed information on this program.

Rikers Health Advocacy Program (RHAP)

Investigators: Stephen Magura, Janet Shapiro, & Sung-Yeon Kang

This program, originally developed for use with incarcerated male adolescent drug users between 16 and 18 years of age, consists of four one hour small group sessions focusing on health education issues, particularly HIV/AIDS. Adapting techniques of Problem Solving Therapy, the facilitator guides eight-person groups in discussing the following topics: general health, HIV and AIDS, drug abuse and its consequences, sexual behavior, health and AIDS-risk behaviors, and strategies for seeking health and social services. Active learning is emphasized, with opportunities for youths to define high-risk attitudes and behaviors, suggest alternative actions, and engage in role play and rehearsal activities. A field study of the curriculum compared the attitudes and behaviors of RHAP participants with those of a control group of teens, selected from a waiting list for the program. Both samples were predominantly African-American and Hispanic. Following the intervention, program participants were more likely to use condoms during intercourse, compared to the comparison group of teens. RHAP is supported by the Office of Adolescent Health (OAH)'s Teen Pregnancy Prevention (TPP) program as an EBI that is medically accurate, age appropriate, and has proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. Click here to view more detailed information on this program.

SMART Couples

Investigators: Robert Remien, PhD, Michael Stirratt, PhD, Joanna Dognin, PsyD, Emily May, MA, Curtis Dolezal, PhD, Alex Carballo-Dieguez, PhD, Nabila El Bassel, DSW, Tiffany Jung, NP, Patricia Warne, PhD, & Glenn Wagner, PhD

SMART COUPLES is a four-session intervention delivered by a nurse practitioner to serodiscordant (mixed HIV status) couples. The program aims to increase antiretroviral therapy (ART) adherence in the partner living with HIV/AIDS by increasing knowledge about the importance of medical care adherence, increasing adherence motivation and self-monitoring, increasing problem solving skills to overcome adherence issues, increasing self-efficacy, and optimizing partner support. In addition, the program was designed to foster active support between partners and help couples address issues of sex, intimacy, and transmission risk behaviors. During four 45- to 60-minute sessions, the couples engage in structured discussion and instruction, as well as specific problem-solving and couple-communication exercises. The nurse practitioner helps participants learn the different components of medical care adherence, and how a partner can help prompt adherence. Participants are also given an opportunity to discuss barriers to adherence, and how to communicate with their partners about different health care concerns including sexual risk taking. Finally, couples determine what their .triggers. are for poor medication adherence, and how to avoid these triggers in the future. Click here to view more detailed information on this program.

Safer Sex Efficacy Workshop

Investigators: Karen Basen-Engquist

This single session, three-hour workshop is designed to increase college students' self-efficacy, or belief in their own ability to act successfully to prevent HIV/AIDS and other sexually transmitted diseases. Drawing upon social learning theory, the program includes numerous role-play and skill-building exercises, and is led by peer educators who are trained to serve as persuasive models. To give students the knowledge necessary to practice preventive behaviors, the leaders begin by facilitating a group discussion about HIV/AIDS and STDs, including transmission and prevention. During the next section, participants discuss personal experiences of and feelings about AIDS and other STDs. Finally, the students role play safe-sex discussions and learn about correct condom use, gaining confidence in their abilities in the process. A field study of the workshop was conducted with 209 undergraduate students enrolled in a health education class at the University of Texas. Compared to comparison groups of their peers, program participants showed significant increases in self-efficacy at the two month follow-up assessment. Sexually active students also showed an increase in their frequency of condom use. Click here to view more detailed information on this program.

Safer Sex Intervention (SSI)

Investigators: Lydia A. Shrier, MD, MPH, Rose Ancheta, MPH, Elizabeth Goodman, MD, Victoria Chiou, BA, Michelle R. Lyden, RN, PNP, & S. Jean Emans, MD

Data from the Centers for Disease Control and Prevention suggest that over 50% (and in some years, as high as two thirds) of the population who contract an STI are under the age of 25, and disproportionately, are adolescent girls. Adolescent girls with an STI infection are at risk for recurrence and more long-term reproductive health issues such as pelvic inflammatory disease (PID) and infertility. Safer Sex Intervention (SSI) is an individualized STI intervention program aimed at sexually active young women, ages 13-23, who have been diagnosed with an STI. The overall goals are to reduce high-risk sexual behaviors, increase condom use and prevent the recurrence of an STI among sexually active young women. The program is appropriate for use in clinics or community based organizations led by a female health educator. This individualized intervention was designed to be delivered at the time of STI diagnosis/treatment, when the participant was most likely to be contemplating her diagnosis relative to her sexual risk behaviors. The intervention is administered 1-on-1 and face-to-face using one of two discrete 30- to 50-minute sessions. Safer Sex Intervention (SSI) was evaluated with an opportunistic study design (at time of STI treatment) that included baseline, 1, 3, 6 and 12 month follow up. Subjects were female, under 24 years of age, with a diagnosis and treatment plan for either cervicitis or PID. At 1 month, the intervention condition subjects had increased sexual risk knowledge (P=.02), more positive attitudes towards condom use (P=.007). At 6 months, intervention subjects report fewer instances of sexual intercourse with non-main partners than the standard-of-care condition. In other words, they were more likely to report lower sexual risk (sex with a non-main partner) as compared to the standard-of-care (control) condition (P=.01). Consistent with findings at 1 month, the intervention condition had a continued increase in positive attitudes regarding condoms (P=.007). One year after SSI, the girls who received the program were more likely to have a main sexual partner and thus, decreased their risk (P=.07) and were also less likely to have recurrence of an STI than the control group (but this was not significant; P=.17). SSI is supported by the Office of Adolescent Health (OAH)'s Teen Pregnancy Prevention (TPP) program as an EBI that is medically accurate, age appropriate, and has proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. Click here to view more detailed information on this program.

Safety Counts: A Cognitive-Behavioral Intervention to Reduce HIV/Hepatitis Risks among Drug Users Who Are Not in Drug Treatment

Investigators: Michele Wood, Jonny Andía, Gricel Arredondo, Nan Corby, Jason Farrell, Camilla Harshbarger, Gary MacDonald, Sharon Novey, Kevin O’Connor, Fen Rhodes, Paul Simons, James Testaverde, & the Centers for Disease Control and Prevention (CDC)

The Safety Counts program is a proven intervention for out-of-treatment drug-using persons that will enable them to reduce their risk of becoming infected with or transmitting the human immunodeficiency virus (HIV) and hepatitis viruses such as hepatitis C. The Safety Counts intervention is appropriate for HIV-positive as well as HIV-negative drug users. Safety Counts is based on research that found this intervention to be effective in reducing high-risk sex and drug-use behaviors among both injection and noninjection drug users. As such, it is recommended for implementation by community-based organizations (CBOs) serving drug users. Through structured group and individual activities, the intervention assists clients in setting personal risk reduction goals and developing specific steps for achieving them. In partnership with behavioral counselors and outreach workers, clients design and manage their personalized goals for reducing their risks of acquiring or transmitting HIV and viral hepatitis. Ongoing support for achieving risk reduction goals is provided through sustained contact with program staff, interactions with peers who are enrolled in the program, and exposure to the personal stories of other drug users in the local community who have been successful in reducing their own risks. Clients participate in the intervention for a period of 4 months. This client-centered intervention benefits the client and the community. The research showed that the intervention reduced HIV risks by reducing drug use, increasing condom use, and increasing self-reported entry into drug treatment. Clients benefit from the strong outreach component of Safety Counts and from referrals to medical and social services. For HIV-positive clients, Safety Counts may allow them to deal with issues beyond substance use and HIV, such as addressing risk behaviors that can lead to contracting hepatitis and other infections. All clients learn how to make positive changes in their lives through setting specific goals and developing action steps to achieve their goals. These skills empower clients to take charge of their own risk behaviors, thereby benefiting themselves, their partners, their families, and their communities.

Safety Point

Investigators: Fen Rhodes

This program is a community-based intervention that seeks to reduce sex- and drug-related HIV risk factors in populations of injection drug and crack cocaine users. The intervention consists of nine sessions conducted by indigenous outreach workers over a period of four to six months. Participants attend two sessions of NIDA (National Institute on Drug Abuse) standard HIV counseling and testing, two group workshop sessions, and one individual counseling session. In addition, all participants receive a minimum of two planned supportive visits from outreach staff, and are encouraged to attend a minimum of two risk-reduction social events. Monetary and non-monetary incentives are used to encourage attendance. This program's effectiveness was evaluated in comparison to the effectiveness of the NIDA standard HIV counseling and testing intervention for reducing risky behavior among IDUs. Participants were interviewed at enrollment and five to nine months after the intervention. Urine tests at enrollment and follow-up allowed researchers to collect information on opiate and cocaine use. In comparison with participants in the NIDA standard intervention, participants in the enhanced intervention were significantly more likely to increase their self-reported condom use, reduce or cease their self-reported drug use, seek drug-abuse treatment, and/or have a negative urine test for cocaine or opiates at follow-up. (Rhodes, Wood and Hershberger, 1999). Click here to view more detailed information on this program.

Santa Cruz County Male Involvement Program

Investigators: Lynn McKibbin, Lisa Cederblom, & Belinda Carter

The Santa Cruz County Male Involvement Program (hereafter, Male Involvement Program) is a collaborative school-, community-, and clinic-based intervention, which was originally implemented as part of a statewide, male-focused pregnancy prevention effort funded by the California Department of Health Services. The overall goals of the Male Involvement Program are: to increase knowledge, skills, and motivation of at-risk adolescent boys and young adult men in order to actively promote their role in reducing teen pregnancies; to increase community and individual awareness regarding the importance of the roles and responsibilities of young males in the prevention of teen pregnancies and to reinforce community values that support these roles; and to increase males' access to reproductive health information and contraceptive supplies. To foster community support surrounding male involvement in the prevention of unintended pregnancies, the Information Campaign focuses on four activities: (1) the design and distribution throughout the county of posters regarding the importance of male involvement in teen pregnancy prevention; (2) pamphlets about the program and fathers' rights and responsibilities; (3) male involvement events; and (4) media purchases, including radio spots and signs on public buses with male involvement messages. In Santa Cruz County, program participants were instrumental in designing media slogans and images. The Male Involvement Program was chosen for the Archive of Male-Oriented Pregnancy Prevention Programs because it has clear goals and objectives; it has been sustainable for a number of years; and both staff and participants expressed satisfaction with the program. In addition, the program has received both local and international honors.

School-Linked Reproductive Health Services (The Self Center)

Investigators: Laurie Schwab-Zabin, Janet B. Hardy, & Rosalie Streett

Originally launched as a partnership between junior and senior high schools and a neighborhood clinic, this program combines education, counseling, and reproductive services into a comprehensive intervention for youth. Services are provided by a team of nurses and social workers who divide their time between the schools and clinic. School-based components include: (1) at least one presentation to each homeroom class per semester to introduce the program and begin discussing values clarification, decision making, and reproductive health; ( 2) informal discussion groups that arise as students seek advice and information from staff on such themes as pubertal development, drug use, and parenting; and (3) individual counseling sessions, available as needed, with a social worker. At the clinic, reproductive and extended counseling services are provided, and referrals are given for teens requiring medical care. Staff encourage students waiting for appointments to participate in discussion groups and examine educational videos and pamphlets. A three-year field test of the intervention was conducted in a low-income neighborhood in Baltimore, Maryland, where elevated rates of sexual activity and teen pregnancy had been recorded. Compared to their peers attending comparable schools, students in the target schools showed reduced levels of sexual activity and (among the sexually active) more effective use of contraception. These effects were greatest among the younger, sexually active girls and boys whose use of contraception was minimal at the start of the program. A delay in the onset of sexual activity was also recorded among abstinent youth. Click here to view more detailed information on this program.