This is a revision of application 1-R03-MH63643-01 in response to NIMH Program Announcement PAR-99-140 """"""""Small Grants Program"""""""" as an R03 small grant application. This two-year study will develop and pilot test a human immunodeficiency virus (HIV) risk reduction intervention for adults who are living with HIV, are experiencing trauma-related stress symptoms, and are at risk for HIV transmission. Our central premise is that by first treating trauma symptoms, we will enhance the effects of a skills-building HIV risk reduction intervention for adults experiencing trauma related symptoms. To this effect, the PI has developed an innovative group intervention based on a model that trauma-related symptoms have direct effects on HIV risk behavior. Thus, the successful treatment of trauma- related symptoms would facilitate HIV risk behavior change. The proposed study will be conducted in 2 phases. In Phase 1, focus groups will be conducted with 15 men and 15 women, all of whom are receiving HIV-related treatment in community clinics. The information obtained from the focus groups will be used to tailor the content and delivery of the intervention. In Phase 2,105 HIV-positive men and women who report experiencing a traumatic stressor, report engaging in HIV risk behavior in the past 3 months, and report experiencing trauma-related stress symptoms in the past three months will be randomly assigned to one of three study groups: (1) standard HIV risk reduction intervention only (n = 35); (2) standard HIV risk reduction intervention + trauma-focused stress reduction intervention (n = 35); or (3) trauma-focused stress reduction intervention only (n = 35). The research will be guided by the distress model and social cognitive theory.
The specific aims of the proposed study are: a) to determine if decreasing trauma-related stress improves HIV risk reduction behavior above a standard HIV risk reduction intervention alone; b) to determine whether key variables (i.e., demographic variables and psychosocial variables) moderate the intervention's effects that are associated with trauma symptoms and HIV risk behavior; c) to determine whether there is evidence that the theoretical mediator variables, which include trauma-related stress symptoms, self-efficacy, communication skills, and social support mediate the intervention's effect on outcomes. There is evidence suggesting that HIV-positive men and women who experience traumatic stressors disproportionately engage in behaviors that put themselves and others at increase risk for HIV transmission. This will be one of the first randomized studies of the additive effects of trauma-focused treatment and an HIV-risk reduction intervention. Further, this study will likely identify key issues that will be relevant to investigate in future, larger-scale studies of HIV prevention efforts among people experiencing trauma-related stress.
