Methods: The EMPWR program is being evaluated through a randomized controlled trial with N=300 Native American adults, 18-55 years old, who recently engaged in binge substance use. EMPWR consists of 2 sessions administered by Native paraprofessionals aimed at improving rates of STI screening and helping participants understand their personal risk factors for STIs. Data were collected over 6 months. Baseline differences in STI/HIV transmission knowledge, risk and protective behaviors, self-efficacy and condom use intentions were examined by sex using Chi2 testing. Multiple logistic regression examined which factors predicted condom use by sex.
Results: STI/HIV transmission knowledge was low, with 75% of participants answering <33% of knowledge questions correctly. Men correctly answered fewer questions than women. Condom use at last sex was also low (34.9%). Men reported slightly higher condom use than women (39.7% vs. 29.3%, p=0.0731). Men reported more often carrying a condom (46.1% vs. 17.9%, p<0.0001) and having more than one partner in the last three months (43.7% vs. 24.4%, p-value=0.0014), while women reported more often having sex with someone who has a STI (25.0% vs. 8.7%, p=0.0008). Women more often reported asking a new partner to use a condom if they were high/drunk (51.1% vs. 34.8%, p=0.0044), or refusing to have sex if a new partner refused condom use (60.4% vs. 39.1%, p=0.0002). Among men, those who refused to have sex if their partner refused to use a condom, intended to refuse next sex if their partner refuses a condom, and carried condoms had higher odds of condom use at baseline. Among women, those who intended to use a condom or had ever stopped sex to put on a condom had higher odds of condom use at baseline.
Conclusion: There are important differences between men and women regarding STI/HIV transmission knowledge, risk behaviors, and factors that impact condom use among this sample of NA binge substance using adults. Understanding how these factors differ by sex is important for tailoring interventions and maximizing impact among a high-risk population.