The prevalence and adverse emotional consequences of sexual abuse and trauma are well established. Although descriptive studies have established the relationship between a history of child sexual abuse and HIV risk behavior, there has been limited research focused on the experience and impact of sexual abuse histories among people living with HIV disease. This application requests four years of support to evaluate the effectiveness of a secondary prevention intervention for people with HIV infection who are coping with traumatic stress related to sexual abuse. The intervention model integrates the cognitive theory of stress and coping and the transactional framework for under- standing sexual abuse outcomes. The multi-session group intervention will include five key components: 1) development of social support to establish a sense of safety and stability; 2) identification and expression of emotions related to past trauma and current HIV-related stressors; 3) development of adaptive coping skills and mastery over trauma symptoms and HIV-related stressors; 4) cognitive and behavioral skills to enhance self-care activities, including HIV medication adherence, substance abuse treatment, and reduction of sexual risk behaviors; and, 5) goal setting, problem-solving and support-seeking skills development for maintenance of behavioral and emotional changes. 240 men and women with HIV infection who are experiencing trauma-related stress and psychiatric distress will be randomly assigned to an HIV and trauma coping group or a support group comparison condition. Assessments collected at baseline, post-intervention, and 4-, 8- and 12- month follow-up points will be used to determine intervention outcome effects. It is hypothesized that, relative to HIV-infected participants assigned to the comparison condition, HIV infected participants in the HIV and trauma coping intervention will exhibit: (a) reduced psychological distress as assessed by measures of traumatic stress, global psychiatric distress, depression and anxiety; (b) development and implementation of adaptive ways of coping with HIV and traumatic stress; (c) higher ratings of quality-of-life; (d) decreased substance use and sexual risk behavior; (e) increased treatment adherence and health care services utilization; and, (f) improved health status as indicated by HIV symptomatology, CD4 cell and viral load counts. If successful, this research will identify an HIV and trauma coping intervention model for the secondary prevention of mental health disorders and disease progression among HIV-infected persons, which is urgently needed for medical and mental health programs that serve persons with HIV infection.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH062965-02
Application #
6392936
Study Section
Special Emphasis Panel (ZRG1-AARR-8 (01))
Program Officer
Gordon, Christopher M
Project Start
2000-09-30
Project End
2004-08-31
Budget Start
2001-09-01
Budget End
2002-08-31
Support Year
2
Fiscal Year
2001
Total Cost
$496,686
Indirect Cost
Name
Yale University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
082359691
City
New Haven
State
CT
Country
United States
Zip Code
06520
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Willie, Tiara C; Overstreet, Nicole M; Peasant, Courtney et al. (2016) Anxiety and Depressive Symptoms Among People Living with HIV and Childhood Sexual Abuse: The Role of Shame and Posttraumatic Growth. AIDS Behav 20:1609-20
Wilson, Sarah M; Sikkema, Kathleen J; Ranby, Krista W (2014) Gender moderates the influence of psychosocial factors and drug use on HAART adherence in the context of HIV and childhood sexual abuse. AIDS Care 26:959-67
Sikkema, Kathleen J; Ranby, Krista W; Meade, Christina S et al. (2013) Reductions in traumatic stress following a coping intervention were mediated by decreases in avoidant coping for people living with HIV/AIDS and childhood sexual abuse. J Consult Clin Psychol 81:274-83
Neufeld, Sharon A S; Sikkema, Kathleen J; Lee, Rachel S et al. (2012) The development and psychometric properties of the HIV and Abuse Related Shame Inventory (HARSI). AIDS Behav 16:1063-74
Puffer, Eve S; Kochman, Arlene; Hansen, Nathan B et al. (2011) An evidence-based group coping intervention for women living with HIV and history of childhood sexual abuse. Int J Group Psychother 61:98-126
Meade, Christina S; Drabkin, Anya S; Hansen, Nathan B et al. (2010) Reductions in alcohol and cocaine use following a group coping intervention for HIV-positive adults with childhood sexual abuse histories. Addiction 105:1942-51
Persons, Elizabeth; Kershaw, Trace; Sikkema, Kathleen J et al. (2010) The impact of shame on health-related quality of life among HIV-positive adults with a history of childhood sexual abuse. AIDS Patient Care STDS 24:571-80
Meade, Christina S; Hansen, Nathan B; Kochman, Arlene et al. (2009) Utilization of medical treatments and adherence to antiretroviral therapy among HIV-positive adults with histories of childhood sexual abuse. AIDS Patient Care STDS 23:259-66
Sikkema, Kathleen J; Hansen, Nathan B; Meade, Christina S et al. (2009) Psychosocial predictors of sexual HIV transmission risk behavior among HIV-positive adults with a sexual abuse history in childhood. Arch Sex Behav 38:121-34

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