HIV This Week

Sikkema KJ, Wilson PA, Hansen NB, Kochman A, Neufeld S, Ghebremichael MS, KershawT. Effects of a coping intervention on transmission risk behavior among people living with HIV/AIDS and a history of childhood sexual abuse. J Acquir Immune Defic Syndr. 2008; 47(4):506-13.

Sikkema and colleagues examine the effect of a 15-session coping group intervention compared with a 15-session therapeutic support group intervention among HIV-positive men and women with a history of childhood sexual abuse on sexual transmission risk behaviour. In a randomized controlled behavioural intervention trial with 12-month follow-up, a diverse sample of 247 HIV-positive men and women with histories of childhood sexual abuse was randomized to 1 of 2 time-matched group intervention conditions. Sexual behaviour was assessed at baseline; immediately after the intervention; and at 4-, 8-, and 12-month follow up periods (5 assessments). Changes in frequency of unprotected anal and vaginal intercourse by intervention condition were examined using generalized linear mixed models for all partners, and specifically for HIV-negative or serostatus unknown partners. Participants in the HIV and trauma coping intervention condition decreased their frequency of unprotected sexual intercourse more than participants in the support intervention condition for all partners (P < 0.001; d = 0.38, 0.32, and 0.38 at the 4-, 8-, and 12-month follow-up periods, respectively) and for HIV-negative and serostatus unknown partners (P < 0.001; d = 0.48, 0.39, and 0.04 at the 4-, 8-, and 12-month follow-up periods, respectively). The authors conclude that a group intervention to address coping with HIV and childhood sexual abuse can be effective in reducing transmission risk behaviour among HIV-positive men and women with histories of sexual trauma.

Editors’ note: From one-third to two-thirds of people living with HIV in the USA report a history of having been sexually abused as children, more than double the estimated rates in the general population. The association between childhood sexual abuse and sexual risk behaviours is well documented. The participants randomised to the coping group intervention benefited from adaptive coping skills building for confronting the combined stress and emotional consequences of child sexual abuse and HIV. Focusing on psychological adjustment and development of adaptive coping skills had a significantly greater effect on safer sex practices than a therapeutic support group and probably had similar unmeasured effects on coping in other areas of life.