Cultural Revisions to HIV Intervention Improve Outcome

Real Men are Safe (REMAS) is an HIV intervention and prevention program designed for men receiving treatment for drug and alcohol dependency. It is delivered in five sessions with the aim of reducing unprotected sex and increasing sexual protection and condom use. However, initial results of REMAS show that although white men increased their safe sex practices, African-American men and Hispanic men did not show significant improvements. Minority men make up the highest percentage of HIV-positive men in the program and in the general population. Therefore, these findings would indicate that a more culturally sensitive approach is necessary.

Donald A. Calsyn of the Alcohol and Drug Abuse Institute at the University of Washington decided to add a cultural component to the REMAS and see if that would make a difference in the minority HIV positive men. In a recent study, Calsyn delivered the culturally adapted intervention, known as REMAS-CA, to men in four different community treatment centers.

The 66 men in REMAS-CA were compared to 136 who were part of REMAS and follow-up measures of HIV risk, condom use, and substance use were conducted. Calsyn found that attendance was nearly 87% in REMAS-CA compared to 75% in the original REMAS. Also, REMAS-CA decreased the number of unprotected sexual encounters for African-American and white men significantly, but had little effect on unprotected sex for the Hispanic men.

One of the strengths of REMAS-CA is its focus on ethnic differences. Rather than targeting a particular cultural or ethnic group, the intervention addresses issues that are commonly faced by all men. “An intervention such as REMAS-CA should be more feasible for clinics to implement because it defines culture broadly and thus can be used with men from all backgrounds,” added Calsyn.

Because it did not have a drastic impact on Hispanic men, perhaps further modifications could be made to make it more appealing and effective for men of Hispanic heritage. Until that time, these results show that even minor modifications to the original REMAS have a big influence on sexual practices among HIV-positive men.

Calsyn, Donald A., PhD., et al. (2013). An HIV Prevention Intervention for Ethnically Diverse Men in Substance Abuse Treatment: Pilot Study Findings. American Journal of Public Health 103.5 (2013): 896-902. ProQuest. Web.

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  • remi


    May 21st, 2013 at 11:54 PM

    I’d love to know what changes were made to make the program more culturally inclusive.When these changes can bring about a big change in results, I’m sure they could also be included in other target programs.

  • hilda


    May 22nd, 2013 at 3:49 AM

    Really surprised to learn that this is still an issue among men from across all ethnic groups, that this issue of playing it safe when it comes to having sex is seen as something that a real man doesn’t do. Well, good thing some improvements are being made, because last time I checked HIV doesn’t really care if you are a real man or not.

  • Cely


    May 22nd, 2013 at 12:41 PM

    The thought of having unprotected sex with someone is so repulsive to me, especially in the early stages of a relationship, that I hate to think that women are still allowing themselves to be taken advantage of in this way. So great that this is targeting men, but what about some self esteem classes for these women who don’t think enough of themselves to either just say no or to get they guys to use a condom?

  • Zachary t

    Zachary t

    May 23rd, 2013 at 4:12 AM

    This is a very good point. Yes there are things that different cultural gorups will experience in different ways. But when it all boils down to it, we are all guys and there are still these across the board thoughts and feelings that most of us will have all because we are guys. And this isn’t defined by what ethnic group or cultural group we are or identify with. I think that if more of these programs really got it down to the details and see this as being a guy thing, then we could make a little more progress in this effort of prevention. Maybe some of the past failings have been because the programs have tried to be too specific, which in essence narrows the overall numbers we have been able to reach. But if you make it a little more general, then the message becomes one that can be embraced and heard by many more people.

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