Compendium of Evidence-Based Interventions and
Best Practices for HIV Prevention
Real Men Are Safe (REMAS)
Sexually active men in drug treatment
Goals of Intervention
- Reduce unprotected vaginal and anal sexual intercourse occasions
The REMAS intervention is a workshop of 5 group sessions (90 min each, 3 to 8 men per group). Lectures, role-plays, peer group discussions and motivational self-assessment exercises are conducted with almost equal focus on information delivery and skill building and a lesser focus on motivation. Intervention materials are appropriate for men who have sex exclusively with women, as well as men who have sex with men. Topics include HIV/AIDS information, HIV risky behaviors (both sexual and injection practices), condom demonstration, identifying triggers, risk reduction problem solving, enhancing sex without drugs, and responsibility and communication in sexual relationships.
- Information-Motivation-Behavioral Change (IMB) Model
Five 90-minute group sessions
Methadone clinics, psychosocial outpatient clinics
- Role play
An intervention package is currently available for download. Please contact Dr. Donald A. Calsyn, Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Ste. 120, Box 354805 Seattle, WA 98105-4631, email: firstname.lastname@example.org with any questions regarding the intervention materials.
The original evaluation was conducted in Hartford, CT; New York, NY; Philadelphia, PA; Raleigh, NC; Seattle, WA; San Francisco, CA; Norwalk, CT; Huntington, WV; High Point, NC; Columbia, SC; Toledo, OH; Santa Fe, NM; and Rancho Cucamonga, CA between 2004 and 2006.
Key Intervention Effects
- Reduced unprotected sex
The analytic study sample of 417 men was characterized by the following:
- 56% White, 28% African American, 13% Hispanic, 2% American Indian, 1% Asian, 1% Other
- 100% Male (% MSM not reported)
- Mean age of 40 years
- Mean education of 12.2 years
Methadone clinics and psychosocial outpatient clinics
Men were eligible if they were at least 18 years of age, currently in methadone treatment for 30 days or more at a participating clinic, engaging in unprotected vaginal or anal intercourse during the past 6 months (with women or men or both), able to speak and understand English, free of observable gross mental status impairment, and did not have a primary sexual partner intending to get pregnant during the study period.
Cohorts of 3 to 8 men (N = 590 men) were randomly assigned to 1 of 2 groups: REMAS intervention (n = 291) or HIV Education comparison (n = 299).
The HIV Education comparison group received 1 session (60 minutes) that represented a standardized treatment-as-usual intervention. It covered only the information component of the IMB Model and consisted of selected educational material from the first 2 sessions of the REMAS intervention, including HIV/AIDS definitions, transmission, testing and counseling, treatment, and prevention. Counselors delivered this session using flip charts and informational and resource hand out materials.
Relevant Outcomes Measured and Follow-up Time
- Sex behaviors (including frequency of unprotected vaginal and anal sexual occasions by partner type during the last 90 days and condom use by partner type) were measured at 3 and 6 months post-intervention.
75% retained at 3 months
65% retained at 6 months
75% retained at 3 months
70% retained at 6 months
- Intervention participants reported significantly fewer unprotected sexual occasions in past 90 days than comparison participants at 3-month (p < .001) and 6-month follow-ups (p < .001).
- In subset analyses, intervention participants who attended at least 3 REMAS intervention sessions (completers) reported significantly fewer unprotected sexual occasions with any partner at 3-month (p < .0001) and 6-month follow-ups (p < .0001) than participants who attended the single HIV Education session.
- Additional significant intervention effects among completers were reported for the following outcomes: unprotected sexual occasions with regular partners at 3-month follow-up (p < .0001) and 6-month follow-up (p < .0001); unprotected sexual occasions with casual partners at 3-month follow-up (p < .0002).
- This intervention fails to meet the best-evidence criteria due to the fact that cohorts of 3-8 men were allocated to treatment groups, but analyses were at the individual level without analytic adjustment.
- Calsyn, D. A., Hatch-Maillette, M., Tross, S., Doyle, S. R., Crits-Christoph, P., Song, Y. S., et al. (2009). Motivational and skills training HIV/sexually transmitted infection sexual risk reduction groups for men. Journal of Substance Abuse Treatment, 37, 138-150.
Researcher: Dr. Donald A. Calsyn
Alcohol and Drug Abuse Institute
University of Washington
1107 NE 45th St., Ste. 120
Seattle, WA 98105-4631