Wyatt GE, Longshore D, Chin D, Carmona JV, Loeb TB, Myers HF, et al. The efficacy of an integrated risk reduction intervention for HIV-positive women with child sexual abuse histories
ABSTRACT 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.
- SourceAvailable from: Patrick A Wilson
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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). "
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. (PsycINFO Database Record (c) 2012 APA, all rights reserved).Journal of Consulting and Clinical Psychology 10/2012; 81(2). DOI:10.1037/a0030144 · 4.85 Impact Factor
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- "Further, in samples of women who have been victimized by men, not being able to discuss healthier sexual behavior with partners may be due to fear of being abused or assaulted even for suggesting it (Hobfoll et al., 2002; Ickovics & Rodin, 1992; Jemmott, Catan, Nyamathi, & Anastasia, 1995). A disproportionately high number of inner-city women are subjected to sexual, physical and emotional abuse during childhood and into adulthood, and thus may fear future abuse, or triggers to previous trauma, if they challenge male partners (Ickovics & Rodin, 1992; Kalichman, Williams, Cherry, Belcher, & Nachimson, 1998; St. Lawrence, Wilson, Eldridge, Brasfield, & O'Bannon, 2001; Wingood & DiClemente, 1997; Wyatt et al., 2004). "
ABSTRACT: Posttraumatic stress disorder (PTSD) has been shown to predict later self-reported sexual risk behavior, yet behavioral research is lacking in this area. The present study investigated the impact of PTSD severity on negotiation and interpersonal skills effectiveness in simulated high-risk sexual situations among 368 inner-city women. Participants engaged in role-play scenarios involving (1) refusing sexual intercourse without a condom, (2) abstaining from drinking before sex, and (3) refusing sex until both partners were tested for HIV. Interviews were audiotaped and rated along dimensions of negotiation effectiveness by raters for whom participant ethnicity was masked. Hierarchical linear regression analyses were conducted to investigate the effect of PTSD and ethnicity on 4 theoretically derived skill sets: (1) assertiveness, (2) using health and preparedness skills, (3) social joining skills, and (4) higher order negotiation skills. Generally, results indicated that PTSD severity predicted poorer rated negotiation effectiveness among European Americans, but not African Americans. African Americans' expectations that may prepare them for facing more hardship may help explain ethnic differences. (PsycINFO Database Record (c) 2012 APA, all rights reserved)Psychological Trauma Theory Research Practice and Policy 11/2011; 3(4):342-348. DOI:10.1037/a0020589 · 0.89 Impact Factor
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- "Although research indicates a higher prevalence of HIV risk behaviors among CSA survivors, only two of these RCTs targeted survivors who engage in these behaviors (Sikkema et al., 2007; Wyatt et al., 2004), and those studies focused specifically on CSA survivors who were HIV-positive. They found group psychotherapy was effective in reducing intrusion and avoidance symptoms (Sikkema et al., 2007), reducing sex risk behaviors (Wyatt et al., 2004), and improving medication adherence (Wyatt et al., 2004). "
ABSTRACT: This randomized controlled trial compared trauma-focused group psychotherapy (TFGT) with present-focused group psychotherapy (PFGT) and a waitlist condition for 166 survivors of childhood sexual abuse who were at risk for HIV infection. Primary outcomes included risk for HIV infection (based on sexual revictimization, drug and alcohol use, and risky sex) and posttraumatic stress disorder (PTSD) symptoms. It was hypothesized that TFGT would be superior to the PFGT and waitlist conditions and that receiving either treatment (combining both TFGT and PFGT) would be superior to no treatment (waitlist condition). Intention-to-treat analyses for HIV risk found that all conditions reduced risk; however, there was no effect for condition on HIV risk. Intention-to-treat analyses for PTSD symptoms found a reduction for all conditions. There was no advantage for either TFGT or PFGT in reducing PTSD symptoms; however, there was an effect for treatment compared with the waitlist condition. On secondary outcomes, there was a greater reduction in anger for TFGT compared with PFGT, and when comparing treatment with the waitlist condition, there was a greater reduction in hyperarousal, reexperiencing, anger, and impaired self-reference for the treatment condition. Adequate dose analyses generally confirmed the intention-to-treat findings and additionally found that treatment led to reductions in depression, dissociation, and sexual concerns. (PsycINFO Database Record (c) 2012 APA, all rights reserved)Psychological Trauma Theory Research Practice and Policy 02/2011; 3(1):84-93. DOI:10.1037/a0020096 · 0.89 Impact Factor