Interpersonal violence (IV) and HIV and other sexually transmitted infections (HIV/STIs) are frequent and interconnected public health problems facing women, especially incarcerated women. Incarcerated women are of public health concern because they have extremely high rates of lifetime IV and they are extremely likely to engage in behaviors which place them and others at risk for HIV/STI infection as they re-enter the community. Furthermore, psychopathology and impairment related to interpersonal violence exposure, in particular affect dysregulation and social dysfunction, may further compromise HIV safety behaviors in women who have experienced interpersonal violence. To date, no interventions have been developed or tested to address the needs of incarcerated women with lifetime IV, which include the challenges of addressing violence-related deficits (poor affect modulation and poor social support) within the context of sexual safety, sexual safety with violent partners, and maintaining sexual and personal safety in the context of the stresses of community re-integration. The empirically supported Women's CoOp HIV prevention intervention (WC) has been successful in reducing sex risk, violent victimization, substance use, and homelessness in other populations of high-risk women;key concerns in the lives of incarcerated women who have experienced violence, especially in their transition to the community. Our study proposes to tailor WC for the context of incarcerated women with lifetime IV and then integrate it with novel intervention components (i.e., skills to increase affect modulation and social support) to maintain sexual safety. More specifically, the purposes of this R34 Exploratory Research Project are to (a) integrate strategies for affect management and increased social support/access to community resources into WC and tailor the integrated intervention for incarcerated women with lifetime interpersonal violence, and (b) conduct a randomized pilot trial in a sample of 40 incarcerated women with IV to demonstrate the feasibility and acceptability of the proposed recruitment methods and research design, of the therapist training methods and of delivering the proposed intervention, which will lay the groundwork for future R01 clinical trials. We will also explore confidence intervals around preliminary differences between the enhanced WC intervention and a dose-matched control condition (Nutrition Program) on the following outcomes through 8 months post prison release: reduced unprotected vaginal or anal sex occasions and fewer cases of vaginal trichomoniasis (primary);reduced interpersonal violence episodes, symptoms of PTSD and depression, and drug using/heavy drinking days (secondary);and increased affect management and social support (including effectiveness in obtaining substance use, mental health treatment and other resources) (tertiary). If the proposed intervention is found to be efficacious in our vulnerable target population, we anticipate that it could have significant implications for HIV/STI prevention efforts for a more heterogeneous population of individuals who have experienced interpersonal violence.
Interpersonal violence and HIV and other sexually transmitted infections (HIV/STIs) are significant and interconnected public health problems facing women, especially incarcerated women. Incarcerated women with histories of interpersonal violence are of public health concern because they are extremely likely to engage in behaviors which place them and others at risk for HIV and STI infection as they re-enter the community. This study proposes to pilot test an HIV prevention intervention that has empirical support in other vulnerable populations of women that we will enhance and tailor to address the needs of incarcerated women who have experienced interpersonal violence.
|Johnson, Jennifer E (2014) Integrating psychotherapy research with public health and public policy goals for incarcerated women and other vulnerable populations. Psychother Res 24:229-39|