Abstract
Child sexual abuse (CSA) is associated with HIV risk behaviors [Bensley, L., Van Eenwyk, J., and Simmons, K. W., 2003.] and more prevalent among women living with HIV than in the general population [Koenig, L. J., and Clark, H., 2004]. This randomized Phase~I clinical trial tested the impact of a culturally congruent psychoeducational intervention designed to reduce sexual risks and increase HIV medication adherence for HIV-positive women with CSA histories. An ethnically diverse sample of 147 women were randomized to two conditions: an 11-session Enhanced Sexual Health Intervention (ESHI) or an attention control. Results based on “intent to treat’’ analysesof pre–post changes are reported here. Additional analyses explored whether theobserved effects might depend on “intervention dose,’’ i.e., number of sessions attended. Women in the ESHI condition reported greater sexual risk reduction than women in the control condition. Although there were no differences between women in the ESHI and control groups on medication adherence, women in the ESHI condition who attended 8 or more sessions reported greater medication adherence at posttest than control women. The findings provide initial support for this culturally and gender-congruent psychoeducational intervention for HIV-positive women with CSA, and highlight the importance of addressing the effects of CSA on sexual risk reduction and medicationadherence in preventive interventions for women.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Amaro, H. (1995). Love, sex, and power: Considering women’s realities in HIV prevention. American Psychologist, 50(6), 437–447.
Bensley, L., van Eenwyk, J., and Simmons, K. W. (2003). Childhood family violence history and women’s risk for intimate partner violence and poor health. American Journal of Preventive Medicine, 25(1), 38–44.
Bensley, L. S., Eenwyk, J. V., and Simmons, K. W. (2000). Self-reported childhood sexual and physical abuse and adult HIV-risk behaviors and heavy drinking. American Journal of Preventive Medicine, 18(2), 151–158.
Boudewyn, A. C., and Liem, J. H. (1995). Childhood sexual abuse as a precursor to depression and self-destructive behavior in adulthood. Journal of Traumatic Stress, 8(3), 445–459.
Briere, J. (2004). Integrating HIV/AIDS prevention activities into psychotherapy for child sexual abuse survivors. In L. J. Koenig and L. S. Doll (Eds.), From child sexual abuse to adult sexual risk: Trauma, revictimization, and intervention (pp. 219–232). Washington, DC: American Psychological Association.
Briere, J., Henschel, D., and Smiljanich, K. (1992). Attitudes toward sexual abuse: Sex differences and construct validity. Journal of Research in Personality, 26(4), 398–406.
Briere, J. N. (1992). Child abuse trauma: Theory and treatment of the lasting effects (Vol. 2). Thousand Oaks, CA: Sage.
Campbell, R., Sefl, T., and Ahrens, C. E. (2004). The impact of rape on women’s sexual health risk behaviors. Health Psychology, 23(1), 67–74.
Carey, M. P., Maisto, S. A., Kalichman, S. C., Forsyth, A. D., Wright, E. M., and Johnson, B. T. (1997). Enhancing motivation to reduce the risk of HIV infection for economically disadvantaged urban women. Journal of Consulting and Clinical Psychology, 65(4), 531–541.
Center for Disease Control and Prevention. (2004). Recommendations for incorporating human immunodeficiency virus (HIV) prevention into the medical care of persons living with HIV. Clinical Infectious Diseases, 38, 104–121.
Chin, D., Wyatt, G. E., Carmona, J. V., Loeb, T. B., and Myers, H. F. (2004). Child sexual abuse and HIV: An integrative risk-reduction approach. In L. J. Koenig and L. S. Doll (Eds.), From child sexual abuse to adult sexual risk: Trauma, revictimization, and intervention (pp. 233–250). Washington, DC: American Psychological Association.
Cole, C. H., and Barney, E. E. (1987). Safeguards and the therapeutic window: A group treatment strategy for adult incest survivors. American Journal of Orthopsychiatry, 57(4), 601–609.
Darrow, W. W. (1996). Evaluating behavioral interventions for HIV prevention. Aids, 10(3), 346–348.
Deren, S., Davis, W. R., Beardsley, M., and Tortu, S. (1995). Outcomes of a risk-reduction intervention with high-risk populations: The Harlem AIDS project. AIDS Education and Prevention, 7(5), 379–390.
DiClemente, R. J., and Wingood, G. M. (1995). A randomized controlled trial of an HIV sexual risk-reduction intervention for young African-American women. Journal of the American Medical Association, 274(16), 1271–1276.
Ehrhardt, A. A., Exner, T. M., Hoffman, S., Silberman, I., Leu, C. S., Miller, S., and Levin, B. (2002). A gender-specific HIV/STD risk reduction intervention for women in a health care setting: Short- and long-term results of a randomized clinical trial. AIDS Care, 14(2), 147–161.
Exner, T. M., Seal, D. W., and Ehrhardt, A. A. (1997). A review of HIV interventions for at-risk women. AIDS and Behavior, 1(2), 93–124.
Farrington, D. P. (2003). Methodological quality standards for evaluation research. Annals of the American Academy of Political and Social Science, 587, 49–68.
Gold-Steinberg, S., and Buttenheim, M. C. (1993). “Telling one’s story” in an incest survivors group. International Journal of Group Psychotherapy, 43(2), 173–189.
Hays, R. D., Hayashi, T., and Stewart, A. L. (1989). A five-item measure of socially desirable response set. Educational and Psychological Measurement, 49(3), 629–636.
Kalichman, S. C., Rompa, D., Cage, M., DiFonzo, K., Simpson, D., Austin, J., Luke, W., Buckles, J., Kyomugisha, F., Benotsch, E., Pinkerton, S., and Graham, J. (2001). Effectiveness of an intervention to reduce HIV transmission risks in HIV-positive people. American Journal of Preventative Medicine, 21(2), 84–92.
Kalichman, S. C., Rompa, D., and Coley, B. (1996). Experimental component analysis of a behavioral HIV-AIDS prevention intervention for inner-city women. Journal of Consulting and Clinical Psychology, 64(4), 687–693.
Kelly, J. A., Murphy, D. A., Washington, C. D., and Wilson, T. S. (1994). The effects of HIV/AIDS intervention groups for high-risk women in urban clinics. American Journal of Public Health, 84(12), 1918–1922.
Koenig, L. J., and Clark, H. (2004). In L. J. Koenig and L. S. Doll (Eds.), From child sexual abuse to adult sexual risk: Trauma, revictimization, and intervention (pp. 69–92). Washington, DC: American Psychological Association.
Lauby, J. L., Smith, P. J., Stark, M., Person, B., and Adams, J. (2000). A community-level HIV prevention intervention for inner-city women: Results of the women and infants demonstration projects. American Journal of Public Health, 90(2), 216–222.
Longshore, D., Grills, C., and Annon, K. (1999). Effects of a culturally congruent intervention on cognitive factors related to drug use-recovery. Substance Use and Misuse, 34(9), 1223–1241.
Lucas, G. M., Gebo, K. A., Chaisson, R. E., and Moore, R. D. (2002). Longitudinal assessment of the effects of drug and alcohol abuse on HIV-1 treatment outcomes in an urban clinic. AIDS, 16(5), 767–774.
Pennebaker, J. W. (1997). Writing about emotional experiences as a therapeutic process. Psychological Science, 8(3), 162–166.
Roberts, K. J. (2002). Physician–patient relationships, patient satisfaction, and antiretroviral medication adherence among HIV-infected adults attending a public health clinic. AIDS Patient Care and STDs, 16(1), 43–50.
Roth, S., and Newman, E. (1995). The process of coping with sexual trauma. In G. S. Everly, Jr. and J. M. Lating (Eds.), Psychotraumatology: Key papers and core concepts in post-traumatic stress. Plenum series on stress and coping (pp. 321–339). New York: Plenum.
Rounsaville, B. J., Carroll, K. M., and Onken, L. S. (2001). A stage model of behavioral therapies research: Getting started and moving on from stage I. Clinical Psychology: Science and Practice, 8(2), 133–142.
Stall, R., Mills, T. C., Williamson, J., Hart, T., Greenwood, G., Paul, J., Pollack, L., Binson, D., Osmond, D., and Catania, J. A. (2003). Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. American Journal of Public Health, 93(6), 939–942.
Tjaden, P., and Thoennes, N. (2000). Prevalence and consequences of male-to-female and female-to-male intimate partner violence as measured by the National Violence Against Women Survey. Violence Against Women, 6(2), 142–161.
Wagner, G. J., and Ghosh-Dastidar, B. (2002). Electronic monitoring: Adherence assessment or intervention? HIV Clinical Trials, 3(1), 45–51.
Weeks, M. R., Schensul, J. J., Williams, S. S., and Singer, M. (1995). AIDS prevention for African-American and Latina women: Building culturally and gender-appropriate intervention. AIDS Education and Prevention, 7(3), 251–264.
Weinhardt, L. S., Carey, M. P., Johnson, B. T., and Bickham, N. L. (1999). Effects of HIV counseling and testing on sexual risk behavior: A meta-analytic review of published research, 1985–1997. American Journal of Public Health, 89(9), 1397–1405.
Wingood, G. M., and DiClemente, R. J. (1996). HIV sexual risk reduction interventions for women: A review. American Journal of Preventative Medicine, 12(3), 209–217.
Wingood, G. M., and DiClemente, R. J. (1997). The effects of an abusive primary partner on the condom use and sexual negotiation practices of African-American women. American Journal of Public Health, 87(6), 1016–1018.
Wyatt, G. E., Carmona, J. V., Loeb, T. B., Ayala, A., and Chin, D. (2002a). Sexual abuse. In G. M. Wingood and R. J. DiClemente (Eds.), Handbook of women’s sexual and reproductive health. Issues in women health (pp. 195–216). New York: Kluwer Academic/Plenum Publishers.
Wyatt, G. E., Guthrie, D., and Notgrass, C. M. (1992). Differential effects of women’s child sexual abuse and subsequent sexual revictimization. Journal of Consulting and Clinical Psychology, 60(2), 167–173.
Wyatt, G. E., Loeb, T. B., Solis, B., Carmona, J. V., and Romero, G. (1999a). The prevalence and circumstances of child sexual abuse: Changes across a decade. Child Abuse and Neglect, 23(1), 45–60.
Wyatt, G. E., Moe, A., and Guthrie, D. (1999b). The gynecological, reproductive, and sexual health of HIV-positive women. Cultural Diversity and Ethnic Minority Psychology, 5(3), 183–196.
Wyatt, G. E., Myers, H. F., Ashing-Giwa, K., and Durvasula, R. S. (1998). Socio-cultural factors affecting sexual risk-taking in African American men and women: Results from two empirical studies. In R. Staples (Ed.), The Black family: Essays and studies. Newbury Park, CA: Sage.
Wyatt, G. E., Myers, H. F., Williams, J. K., Kitchen, C. R., Loeb, T., Carmona, J. V., Wyatt, L. E., Chin, D., and Presley, N. (2002b). Does a history of trauma contribute to HIV risk for women of color? Implications for prevention and policy. American Journal of Public Health, 92(4), 660–665.
Zurbriggen, E. L., and Freyd, J. J. (2004). The link between child sexual abuse and risky sexual behavior: The role of dissociative tendencies, information-processing effects, and consensual sex decision mechanisms. In L. J. Koenig and L. S. Doll (Eds.), From child sexual abuse to adult sexual risk: Trauma, revictimization, and intervention (pp. 135–157). Washington, DC: American Psychological Association.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Wyatt, G.E., Longshore, D., Chin, D. et al. The Efficacy of an Integrated Risk Reduction Intervention for HIV-Positive Women With Child Sexual Abuse Histories. AIDS Behav 8, 453–462 (2004). https://doi.org/10.1007/s10461-004-7329-y
Issue Date:
DOI: https://doi.org/10.1007/s10461-004-7329-y