Abstract
An overlooked sequela of HIV risk is trauma exposure, yet few HIV interventions address trauma exposure, mental health, and substance misuse. In a two-arm randomized controlled trial 73 Native American women were randomized to a culturally-adapted Cognitive Processing Therapy (CPT) or 6-weeks waitlist. Outcomes assessed: PTSD symptom severity, alcohol use frequency, substance abuse or dependence diagnosis, and high-risk sexual behavior defined as vaginal/anal intercourse (a) under the influence of alcohol and/or illicit substances, (b) with a partner who was concurrently sexually active with someone else, and/or (c) with more than one partner in the past 6 weeks. Among immediate intervention participants, compared to waitlist participants, there were large reductions in PTSD symptom severity, high-risk sexual behavior, and a medium-to-large reduction in the frequency of alcohol use. CPT appears to improve mental health and risk behaviors, suggesting that addressing PTSD may be one way of improving HIV-risk related outcomes.
Highlights
An important but overlooked sequela of trauma exposure is risk for HIV [1]
Our findings support the efficacy of Cognitive Processing Therapy (CPT), a manualized trauma-focused therapy, adapted for use with AIAN women for treatment of post-traumatic stress disorder (PTSD), substance use, and high risk sexual behavior
Among participants in the immediate intervention group, average PTSD symptom scores dropped by nearly half, whereas waitlist control participants maintained the same PTSD symptoms, on average, during their waitlist period
Summary
Trauma exposure increases risk for post-traumatic stress disorder (PTSD) and substance misuse. These negative outcomes are interrelated as PTSD frequently co-occurs with alcohol and drug dependence (> 50% and > 30% respectively) [2], and in turn the co-occurrence reduces self-care practices and elevates HIV sexual-risk behavior. PTSD interventions may reduce ongoing substance use and HIV sexual risk behaviors [13, 14]. Interventions designed for AIANs exposed to trauma may hold promise for reducing substance misuse and HIV sexual risk behaviors [24]. PTSD symptoms, high-risk sexual behavior, and substance use. Our study hypotheses were: (1) as compared to waitlist, improvements in PTSD, substance use, and HIV sexual-risk behavior will be greater at post intervention for those receiving immediate CPT; and (2) at 3 months post intervention, improvements in PTSD, substance use, and HIV sexual-risk behavior compared to pre-intervention will be greater for those receiving CPT compared to waitlist
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