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
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.
Available from: Ndidi Amutah
- "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.
Available from: Venance Maro
- "Hyperarousal, another core symptom of post-traumatic stress, can also affect the individual's ability to accurately assess risk.,  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;,  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.,  "
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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.
- "trivial writing control) on psychological outcomes, pain, or physical functioning in 37 people with HIV. Wyatt et al. (2004) used trauma writing as part of her integrated risk reduction/prevention intervention in people with HIV and found a positive impact on sexual risk reduction and adherence to medications in those who attended more sessions. Of interest, none of these studies included PTSD symptoms or physical symptoms as outcomes. "
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Trauma histories and symptoms of PTSD occur at very high rates in people with HIV and are associated with poor disease management and accelerated disease progression. The authors of this study examined the efficacy of a brief written trauma disclosure intervention on posttraumatic stress, depression, HIV-related physical symptoms, and biological markers of HIV disease progression.
HIV-infected men and women were randomized to four 30-min expressive writing sessions in either a treatment (trauma writing) or an attention control (daily events writing) condition. The disclosure intervention augmented the traditional emotional disclosure paradigm with probes to increase processing by focusing on trauma appraisals, self-worth, and problem solving. Outcomes were assessed at baseline, 1-, 6-, and 12-month follow-up.
Hierarchical linear modeling (N = 244, intent-to-treat analyses) revealed no significant treatment effects for the group as a whole. Gender by treatment group interactions were significant such that women in the trauma-writing group had significantly reduced posttraumatic stress disorder (PTSD) symptoms (p = .017), depression (p = .009), and HIV-related symptoms (p = .022) compared with their controls. In contrast, men in the trauma-treatment condition did not improve more than controls on any outcome variables. Unexpectedly, men in the daily-event-writing control group had significantly greater reductions in depression then men in the trauma-writing group. Treatment effects were magnified in women when the analysis was restricted to those with elevated PTSD symptoms at baseline.
A brief (4-session) guided written emotional disclosure intervention resulted in significant and meaningful reductions in PTSD, depression, and physical symptoms for women with HIV, but not for men.
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