As HIV infection continues to spread among women and people of color, it is important to develop interventions to reduce the incidence of risky sex and drug-related practices, improve HIV treatment adherence, and promote health care utilization. One factor not typically addressed in current interventions for women is child sexual abuse (CSA), an important predictor of high-risk sexual behaviors, substance use, and psychological sequelae. This revised proposal, a 4-year randomized clinical trial of a behavioral risk-reduction intervention builds on findings from the Women & Family Project (WFP), a natural history study of how HIV affects women, and other research. Specifically, we propose to develop and test an Enhanced Sexual Health Intervention (ESH), designed to reduce behavioral and interpersonal risks and increase health behaviors. After piloting a 12-week intervention on a multi-ethnic sample of 25 HIV-positive women (9 African Americans, 8 Latinas, 8 European Americans), we will recruit 220 HIV-positive women: 65 African American, 64 Latina and 65 European American women-110 from the WFP with CSA and 110 that are newly recruited with CSA. These women will be randomly assigned to 2 treatment conditions: a Basic Intervention (B), a usual-care/information control, and the Enhanced Sexual Health Intervention (ESH). The 12-week intervention includes pre- and post-testing, and 1- and 3-month follow-up for the B condition, followed by the 12-week ESH intervention. The B condition will then receive the 12-week intervention, followed by the 1-, 3-, and 6-month follow-ups. Each condition will be compared using a combination of univariate and multivariate procedures to determine whether 1) The ESH differentially reduces behavioral and interpersonal risks and promotes healthy behaviors; 2) the ESH yields differential outcomes as a function of language, ethnicity, drug use history, severity of abuse, disease, and relationship status, and, 3) the treatment outcomes are mediated by changes in self-efficacy, acquisition of new risk reduction skills, changes in sexual health domains, or changes in affective states (e.g., depression, anxiety, and psychological well-being). This project will generate a well-tested, women-centered curriculum that can be used in other HIV interventions or in HIV clinics with multi-ethnic samples of women, and help to broaden our understanding of consensual and non-consensual sexual experiences that contribute to sexual and drug-related risk taking, HIV treatment non-adherence, and ineffective health care utilization.
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