The Efficacy of an Integrated Risk Reduction Intervention for HIV-Positive Women With Child Sexual Abuse Histories

Neuropsychiatric Institute, University of California at Los Angeles, Los Angeles, California 90024-1759, USA.
AIDS and Behavior (Impact Factor: 3.49). 01/2005; 8(4):453-62. DOI: 10.1007/s10461-004-7329-y
Source: PubMed


Child sexual abuse (CSA) is associated with HIV risk behaviors [Bensley, L., Van Eenwyk, J., and Simmons, K. W., 2003.] and more prevalent among women living with HIV than in the general population [Koenig, L. J., and Clark, H., 2004]. This randomized Phase~I clinical trial tested the impact of a culturally congruent psychoeducational intervention designed to reduce sexual risks and increase HIV medication adherence for HIV-positive women with CSA histories. An ethnically diverse sample of 147 women were randomized to two conditions: an 11-session Enhanced Sexual Health Intervention (ESHI) or an attention control. Results based on "intent to treat'' analyses of pre-post changes are reported here. Additional analyses explored whether the observed effects might depend on "intervention dose,'' i.e., number of sessions attended. Women in the ESHI condition reported greater sexual risk reduction than women in the control condition. Although there were no differences between women in the ESHI and control groups on medication adherence, women in the ESHI condition who attended 8 or more sessions reported greater medication adherence at posttest than control women. The findings provide initial support for this culturally and gender-congruent psychoeducational intervention for HIV-positive women with CSA, and highlight the importance of addressing the effects of CSA on sexual risk reduction and medication adherence in preventive interventions for women.

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    • "As a group, African American women were also less likely to be insured, more likely to receive care in less than optimal organizational settings (such as the emergency room), and experience lack of continuity in the health care received (Fiscella, et al. 2002). Lack of cultural competency in health care workforce, or geographically influenced barriers (lack of transportation or strenuous distances to nearest healthcare facility) compounds the negative influences of these diseases (Wyatt, 2004; Sanders-Phillips, 2002). "
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    ABSTRACT: HIV-positive individuals are living longer today as a result of continuing advances in treatment but are also facing an increased risk for chronic diseases such as diabetes, and hypertension. These conditions result in a larger burden of hospitalization, outpatient, and emergency room visits. Impoverished African American women may represent an especially high-risk group due to disparities in health care, racial discrimination, and limited resources. This article describes an intervention that is based on the conceptual framework of the socio-ecological model. Project THANKS uses a community-based participatory, and empowerment building approach to target the unique personal, social, and environmental needs of African American women faced with the dual diagnosis of HIV and one or more chronic diseases. The long-term goal of this project is to identify features in the social and cultural milieu of these women that if integrated into existing harm reduction services can reduce poor health outcomes among them.
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    • "Hyperarousal, another core symptom of post-traumatic stress, can also affect the individual's ability to accurately assess risk.[52], [55] Interventions to address the sequelae and symptomatology of stressful events and traumatic experiences have shown promise in reducing sexual transmission risk behaviors among HIV-infected individuals with histories of trauma;[11], [12] while such interventions have primarily been developed in high-income countries, increasing emphasis is being placed on the expansion of evidence-based mental health services and the integration of quality mental health care with other medical services for HIV-infected patients in low-income countries.[56], [57] "
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    ABSTRACT: The reduction of HIV transmission risk behaviors among those infected with HIV remains a major global health priority. Psychosocial characteristics have proven to be important correlates of sexual transmission risk behaviors in high-income countries, but little attention has focused on the influence of psychosocial and psychological factors on sexual transmission risk behaviors in African cohorts. The CHAT Study enrolled a representative sample of 499 HIV-infected patients in established HIV care and 267 newly diagnosed HIV-infected individuals from the Kilimanjaro Region of Tanzania. Participants completed in-person interviews every 6 months for 3 years. Using logistic random effects models to account for repeated observations, we assessed sociodemographic, physical health, and psychosocial predictors of self-reported unprotected sexual intercourse. Among established patients, the proportion reporting any recent unprotected sex was stable, ranging between 6-13% over 3 years. Among newly diagnosed patients, the proportion reporting any unprotected sex dropped from 43% at baseline to 11-21% at 6-36 months. In multivariable models, higher odds of reported unprotected sex was associated with female gender, younger age, being married, better physical health, and greater post-traumatic stress symptoms. In addition, within-individual changes in post-traumatic stress over time coincided with increases in unprotected sex. Changes in post-traumatic stress symptomatology were associated with changes in sexual transmission risk behaviors in this sample of HIV-infected adults in Tanzania, suggesting the importance of investing in appropriate mental health screening and intervention services for HIV-infected patients, both to improve mental health and to support secondary prevention efforts.
    PLoS ONE 12/2013; 8(12):e82974. DOI:10.1371/journal.pone.0082974 · 3.23 Impact Factor
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    • "CSA among HIV-infected individuals is a public health concern because it is associated with engagement in unprotected intercourse and substance abuse (Holmes, 1997; Kalichman et al., 2002; O'Leary, Purcell, Remien, & Gomez, 2003; Markowitz et al., 2011; Welles et al., 2009). Despite the growing recognition of the need for HIV prevention and mental health interventions to take into account the experience of CSA (Chin, Wyatt, Carmona, Loeb, & Myers, 2004; Greenberg, 2001; Parillo, Freeman , Collier, & Young, 2001; Sikkema et al., 2004), few interventions have been developed specifically for HIV-infected persons with CSA (Sikkema et al., 2007, 2004; Williams et al., 2008; Wyatt et al., 2004). "
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    ABSTRACT: Objective: To examine whether (a) Living in the Face of Trauma (LIFT), a group intervention to address coping with HIV and childhood sexual abuse (CSA), significantly reduced traumatic stress over a 1-year follow-up period more than an attention-matched support group comparison intervention; and (b) reductions in avoidant coping over time mediated reductions in traumatic stress. Method: In a randomized controlled trial, 247 participants completed measures of traumatic stress and avoidant coping at pre- and post intervention, and at 4-, 8-, and 12-month follow-ups. Latent growth curve modeling examined changes over the 5 time points; standardized path coefficients provide estimates of effects. Results: As compared with the support intervention, the coping intervention led to a reduction in traumatic stress over time (b = -.20, p < .02). Participants in the coping intervention also reduced their use of avoidant coping strategies more than did participants in the support intervention (b = -.22, p < .05). Mediation analyses showed reductions in avoidant coping related to reductions in traumatic stress (b = 1.45, p < .001), and the direct effect of the intervention on traumatic stress was no longer significant (b = .04, ns), suggesting that changes in avoidant coping completely mediated intervention effects on traumatic stress. Conclusions: The LIFT intervention significantly reduced traumatic stress over time, and changes in avoidant coping strategies mediated this effect, suggesting a focus on current stressors and coping skills improvement are important components in addressing traumatic stress for adults living with HIV and CSA.
    Journal of Consulting and Clinical Psychology 10/2012; 81(2). DOI:10.1037/a0030144 · 4.85 Impact Factor
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