Kathleen J. Sikkema - US grants

DESCRIPTION (adapted from the applicant's abstract): 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.

DESCRIPTION (APPLICANT'S ABSTRACT): HIV infections increasingly occur in persons with severe mental illness (SMI). Although descriptive studies have established high rates of HIV risk behavior among those with SMI, only a small body of research has shown that intensive cognitive-behavioral small group interventions can promote short-term change in HIV sexual risk practices. This application requests three years of support to evaluate the effectiveness of a community level intervention for people with SMI or those dually-diagnosed with SMI and substance abuse disorders (DD), who are formerly homeless, living in transitional housing programs (THPs). The intervention model integrates social cognitive theory (Bandura, 1986) and diffusion of innovation theory (Rogers, 1983). The community intervention will include three key components: 1) HIV risk reduction skills training group intervention appropriately tailored for SMI; 2) community norm change intervention mediated by popular opinion leaders living in THPs to created models, norms, and reinforcement supports for HIV risk reduction; and 3) THP staff training on HIV prevention approaches. Twelve THPs (320 residents across 6 demographically matched pairs) will be randomly assigned to the community-level intervention or the skills training group intervention only comparison condition. Assessments collected at baseline, post-group intervention, and 6- and 9-month follow-up points will be used to determine intervention outcome effects. It is hypothesized that, relative to participants in the group intervention-only THPS, participants in the community-level intervention THPs will exhibit at all follow-up points: a) lower levels of HIV sexual risk behavior; b) lower levels of alcohol and substance use behavior; and c) higher levels of HIV-related knowledge and normative perceptions, intentions, attitudes and beliefs concerning risk reduction and avoidance. If successful, this research will identify a community-level intervention for reducing and maintaining HIV risk reduction among formerly homeless persons with SMI or DD living in THPS. Since transitional housing is a common component of integrated systems of care for those with SMI or DD, the potential for broad dissemination of research findings throughout programs nationally is substantial.