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Compendium of Evidence-Based Interventions and
Best Practices for HIV Prevention

Safer Sex Skills Building (SSSB)


Intervention Description

Target Population
Heterosexually active women in drug treatment

Goals of Intervention

  • Increase condom use
  • Decrease unsafe sexual behaviors
  • Increase safer sex negotiation skills
  • Increase HIV/STD risk awareness

Brief Description

Safer Sex Skills Building (SSSB) is a group intervention consisting of 5 sessions, approximately 90 minutes each, designed to increase HIV/STD risk awareness, condom use, and partner negotiation skills of women attending community outpatient drug treatment programs. Two female counselors deliver the intervention to groups of 3-8 women over 3 weeks, using active problem solving, behavioral modeling, role-play rehearsal, interval practice, troubleshooting, and peer feedback and support. Topics include HIV transmission, testing and counseling, prevention and treatment; personal risk assessment and awareness, triggers, and support; skills for condom use, safer sex negotiation, and safety planning; partner abuse risk assessment; and “slip” behaviors. Special emphasis is placed on women’s safer sex negotiation skills and safeguards against the risk of partner abuse that may result from safer sex assertiveness.

Theoretic Basis
Not reported

Intervention Duration
Five sessions, approximately 90 minutes each, delivered over 3 weeks

Intervention Settings
Community-based methadone maintenance programs and outpatient psychosocial treatment programs

Two female counselors

Delivery Methods

  • Demonstration
  • Discussion
  • Modeling
  • Practice
  • Role play

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Intervention Package Information

An intervention package is currently available for download. Please contact Dr. Susan Tross, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 15, New York, NY 10032, e-mail: with any questions regarding the intervention materials.

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Evaluation Study and Results

The original evaluation was conducted in 12 urban & rural sites distributed across 9 states located in the West (2 sites), Midwest (2 sites), Northeast (4 sites), and Southeast (4 sites). The study was conducted between 2004 and 2006.

Key Intervention Effects

  • Reduced unprotected vaginal and anal sex

Study Sample
The baseline study sample of 515 women in drug treatment was characterized by the following:

  • 58% White, 24% African American, 9% Hispanic, 9% Mixed or Other
  • 100% Female
  • 54% ≤ 40 years, 46% > 40 years old
  • 28% <12 years of education, 38% completed 12 years of education, 34% >12 years of education

Recruitment Settings
Community-based methadone maintenance programs and outpatient psychosocial treatment programs.

Eligibility Criteria
Women were eligible if they were older than 18 years, participating in drug treatment ≥30 days, had unprotected vaginal or anal intercourse with a male partner in the past 6 months, did not exhibit significant cognitive impairment, and were not pregnant or immediately planning pregnancy.

Assignment Method
Cohorts of 3 to 8 women (N = 515 women) were randomly assigned to 1 of 2 groups: SSSB intervention (n = 250) or HIV/STD Education (HE) comparison (n = 265).

Comparison Group
The HIV/STD Education (HE) comparison was a single 60-minute session and delivered to groups of 3-8 women. It included discussions on HIV/STD disease and definitions, transmission, testing and counseling, treatment, and prevention information. The intervention was co-led by a pair of female counselors using a didactic presentation style and question-and-answer format along with flip chart visual materials and handouts.

Relevant Outcomes Measured and Follow-up Time

  • Sex behaviors (including number of unprotected vaginal and anal intercourse occasions by partner type and number of partners in the past 3 months) were measured at 3 and 6 months post-intervention

Participant Retention

  • SSSB Intervention:

    62% retained at 3 months
    62% retained at 6 months

  • HE Comparison: 

    70% retained at 3 months
    67% retained at 6 months

Significant Findings

  • At the 6-month follow-up, SSSB intervention participants reported significantly fewer occasions of unprotected vaginal or anal sex than HE comparison participants (p < .04).
  • Intervention participants who attended at least 3 SSSB intervention sessions reported significantly fewer occasions of unprotected vaginal or anal sex than comparison participants who attended the single HE session at the 6-month follow-up (p < .009).
  • This intervention fails to meet the best-evidence criteria due to retention rates <70% at the 3- and 6-month post-intervention assessments.

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References and Contact Information

  • Tross, S., Campbell, A.N., Cohen, L.R., Calsyn, D., Pavlicova, M., Miele, G.M., et al. (2008). Effectiveness of HIV/STD Sexual Risk Reduction Groups for Women in Substance Abuse Treatment Programs: Results of NIDA Clinical Trials Network Trial. Journal of Acquired Immune Deficiency Syndrome, 48, 1-9.

Researcher: Dr. Susan Tross
Department of Psychiatry HIV Center for Clinical and Behavioral Studies
New York State Psychiatric Institute
1051 Riverside Drive, Unit 15
New York, NY 10032

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