Child sexual abuse (CSA) is a devastating experience that has negative short and long-term consequences on the psychological and physical well-being of youth, leading to risky sexual behaviors that increase HIV risk. Most HIV prevention programs consist of education and behavioral interventions aimed at reducing sexual risk behaviors. Recent research suggests that many HIV prevention programs are not as effective for those with sexual abuse histories and emphasizes the need to address CSA in the context of HIV and violence prevention. Extensive research from the West shows a significant reduction in symptoms and risky sexual behaviors after implementation of an evidence-based trauma-focused treatment (TF-CBT) for sexually abused children. The urgency of the HIV crisis in sub-Saharan Africa and the increasing awareness of CSA demand attention to these critical and overlapping areas. CSA and HIV are rarely studied due to concerns about cultural factors and the difficulty of conducting research in low-resource countries. Cross- cultural researchers suggest a step-wise approach that incorporates qualitative methods and a feasibility study to increase the likelihood of successful implementation and treatment effectiveness. The primary goal of the proposed Mentored Patient-Oriented Research Career Development Award (K23) is integrate the areas of HIV prevention, trauma-focused treatments, and cross-cultural mental health into a training plan that prepares the Candidate to be an independent investigator of the effectiveness of child-focused mental health interventions in HlV-affected populations. Primary training goals include obtaining: 1) a Masters in Public Health, 2) specialized training in the socio-biologic issues of global HIV/AIDS, cross-cultural mental health assessment (qualitative and quantitative), and affective neuroscience as a framework, and 3) advanced training in TF-CBT for sexually abused children including its adaptation and implementation feasibility. The primary research goals include: 1) To develop culturally appropriate and locally valid measures of cognitive, affective and behavioral symptomatology of HlV-affected sexually-abused children in Zambia, 2) To adapt TF-CBT for HlV-affected sexually abused Zambian children (TF-CBT-AZ), and 3) To assess the acceptability and feasibility of implementing TF-CBT-AZ. Findings will be used in the Candidate's application for an R01.
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