Intervention Description
Intervention Package Information
Evaluation Study and Results
References and Contact Information
Intervention Description
Target Population
HIV-positive adults with childhood sexual abuse (CSA) histories
Goals of Intervention
- Eliminate or reduce sexual
transmission risk behavior
- Improve coping with the combined
stressors of HIV infection and child
sexual abuse
- Increase positive change in
CSA-related trauma symptoms
Brief Description
Living in the Face of Trauma (LIFT)
is a group-level coping intervention for
HIV-positive persons who experienced
childhood sexual abuse. The intervention
consists of fifteen 90-minute sessions
delivered to same-gender groups (about
6-8 persons per group). The LIFT
intervention incorporates adaptive
coping, which includes problem-focused
strategies for changeable stressors and
emotion-focused strategies for
unchangeable stressors. These adaptive
coping strategies assist participants in
identifying and addressing individual
stressors related to HIV infection and
sexual trauma. Through discussions,
trigger identification, skills-building
exercises, goal setting, and social
support, participants learn problem
solving, communication skills,
risk-reduction skills, cognitive
reformation, and relaxation techniques
to improve coping and reduce HIV sexual
transmission risk behavior. |
Theoretic Basis
- Cognitive Theory of Stress and Coping
- Cognitive Behavioral Treatment Strategies for Sexual Trauma
Intervention Duration
Fifteen weekly 90-minute sessions delivered
over about 3.5 months
Intervention Settings
A local community health center
Deliverer
Three female therapists and one male
therapist: two clinical psychologists and
two clinical social workers
Delivery Methods
- Cognitive restructuring
- Exercises
- Goal setting
- Group discussion
- Relaxation techniques
- Role plays
- Social support
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Intervention Package Information
An intervention package is not available at this time. Please contact Dr.
Kathleen J. Sikkema, Department of Psychology and Neuroscience, Duke University,
9 Flowers Drive, Box 90086, Durham, NC27708, email:
kathleen.sikkema@duke.edu, for
details on intervention materials.
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Evaluation Study and Results
The original evaluation study was conducted in New York City between 2002 and 2004.
Key Intervention Effects
- Reduced unprotected sex acts with
all partners and with HIV-negative or
unknown serostatus partners
Study Sample
The baseline study sample of 247 HIV-positive men and women with CSA
histories is characterized by the following:
- 68% African American, 17%
Hispanic, 10% White, 5% Other
- 53% Female, 47% Male
- 60% gay or bisexual, 40%
heterosexual
- 47% MSM, 100% of men are MSM
- Mean age 42 years
- Mean education of 12 years
Recruitment Settings
AIDS service organizations and community health care clinics in New
York City
Eligibility Criteria
Men and women were eligible if they were 18
years or older, HIV-positive, and were
sexually abused as a child and/or adolescent
(i.e., any unwanted touching of a sexual
nature by an adult or someone at least 5
years older).
Assignment Method
HIV-positive
men and women (N=247) were randomly assigned
to 1 of 2 groups: LIFT intervention (n=124)
or HIV support group comparison (n=123)
Comparison Group
The HIV
support group provided a supportive
environment for participants to address
issues of HIV and CSA trauma. This
intervention consisted of 15 weekly
90-minute group sessions led by experienced
clinical therapists who were not trained on
the coping intervention model.
Relevant Outcomes Measured and Follow-up Time
Sex behaviors during past 4 months
(including frequency of unprotected vaginal
and anal intercourse with all partners and
frequency of unprotected vaginal and anal
intercourse with HIV-negative or unknown
serostatus partners) were measured at 2
weeks after the intervention and at 4-, 8-,
and 12-month follow-ups.
Participant Retention
- LIFT Intervention:
71% retained at 4 months
68% retained at 8 months
65% retained at 12 months
- HIV Support Group Comparison:
72% retained at 4 months
72% retained at 8 months
67% retained at 12 months
Significant Findings
- Across the three follow-up
assessments, LIFT intervention
participants reported significantly
fewer counts of unprotected vaginal and
anal intercourse with all partners (p <
.001) and with HIV-negative or unknown
serostatus partners (p < .001), compared
to comparison participants
- At the 4-month follow-up, the
LIFT intervention showed significant
effects in reducing unprotected sex with
all partners (p < .05) and unprotected
sex with HIV-negative and unknown serostatus partners (p < .05) among 168
participants who reported having vaginal
or anal intercourse during the study.
- Among 168 participants who reported
having vaginal or anal intercourse
during the study, the LIFT intervention
showed significant effects in reducing
unprotected sex with all partners (p <
.05) at the 8- and 12-month follow-ups
and unprotected sex with HIV-negative
and unknown serostatus partners (p <
.05) at the 8-month follow-up. (While
the above findings meet best evidence,
these findings meet the
promising-evidence criteria due to
retention rate <70%).
Considerations
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References and Contact Information
- Sikkema, K. J., Hansen, N. B., Kochman, A., Tarakeshwar, N., Neufeld, S.,
Meade, C. S., et al. (2007). Outcomes from a group intervention for coping
with HIV/AIDS and childhood sexual abuse: Reductions in traumatic stress.
AIDS and Behavior, 11, 49-60.
- Sikkema, K. J., Wilson, P. A., Hansen, N. B., Kochman, A., Neufeld, S.,
Ghebremichael, M. S., et al. (2008). Effects of a coping intervention on
transmission risk behavior among people living with HIV/AIDS and a history
of childhood sexual abuse. Journal of Acquired Immune Deficiency Syndromes,
47, 506-513.
Researcher: Dr. Kathleen J. Sikkema
Department of
Psychology and Neuroscience, Duke University
9 Flowers Drive, Box 90086
Durham, NC 27708
email:
kathleen.sikkema@duke.edu
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