HIV High-risk Behaviors Research Articles

Using Arrest Charge to Screen for Undiagnosed HIV Infection Among New Arrestees: A Study in Los Angeles County

Despite high documented HIV prevalence, few jail systems offer universal HIV screening, nor is this always feasible. The authors evaluated undiagnosed HIV infection and HIV risk history by arrest charge among 1,322 new arrestees to examine whether specific charges may help prioritize jail-based screening. Undiagnosed HIV prevalence was 2.7% and 1.0% among males and females, with 32% and 45% reporting recent STD diagnoses or high-risk behaviors for HIV. HIV risk history distinguished HIV-infected males but not females. Males with parole violation, sex, or theft charges had high undiagnosed HIV infection rates relative to other males. A weaker trend was observed for females with parole violation, drug, or violent charges. These charges represented 30% and 66% of males and females studied and 56% and 100% of their undiagnosed HIV infections, respectively. Using arrest charge to target screening may efficiently increase HIV diagnosis in jail inmates where universal HIV screening is not possible.

Intentional Condomless Anal Intercourse Among Latino MSM Who Meet Sexual Partners on the Internet

Data on intentional condomless anal intercourse in risky contexts, also known as "barebacking," among ethnic minority MSM, whose rates of HIV infection continue to rise, are extremely limited. In this study, 31 Latino MSM who seek barebacking partners via the Internet underwent in-depth interviews about bareback sex and its association to pleasure, substance use, HIV concerns, and cultural identity. Participants reported engaging in bareback sex owing to the physical and emotional pleasure they experience. They expressed concern about HIV infection and took steps to reduce risk of infection. Although a majority of participants reported using alcohol or drugs in the context of bareback sex, substance use did not appear to propel the behavior. Crystal methamphetamine use, prevalent only among our HIV-positive participants, was related to very high HIV risk behavior. In this sample, culture did not seem to play a large role in barebacking.

Psychiatric Aspects of HIV Spectrum Disease

The HIV/AIDS epidemic is not considered “under control” in the United States. An unacceptably high incident case rate has been sustained over the past decade. CDC now advocates for routine HIV antibody testing to be offered in all health care settings. The psychiatrist can play an important role in identifying HIV high risk behaviors, in presenting the option for HIV antibody testing, and in providing follow-up with counseling. The high risk for HIV infection among the severely mentally ill also directly involves the psychiatrist today in HIV/AIDS care. Anxiety, depressive spectrum, neurocognitive, and psychotic disorders present with symptom profiles and in settings that are specific to HIV infection and require the need for individually tailored psychiatric care. Guidelines for the psychiatrist treating HIV infected patients are available. It is incumbent upon the practicing psychiatrist to maintain familiarity with these guidelines and offer the capacity to treat the psychiatric disorders that occur in this patient population.

Applying Classification and Regression Tree Analysis to Identify Prisoners with High HIV Risk Behaviors

Among prisoners, past research has associated several factors with HIV risk behaviors, including illicit drug use, engaging in sex trade, older age (for drug-related risk), younger age (for sexrelated risk), low education, low income, type of offense, history of abuse, mental health disorders, vulnerability and low self-perceived efficacy. This study employs data collected through the Transitional Case Management study of the Criminal Justice Drug Abuse Treatment Studies collaborative to analyze characteristics of prisoners who engaged in high-risk behaviors prior to incarceration. For the first 787 participants of this study, we employed recursive partitioning techniques to better identify groups at varying levels of HIV risk behaviors. Those more likely to engage in risky needle use were White and either unemployed and less likely to justify their behavior, or employed with poor decision making capacity. Risky sexual behavior was associated with a general tendency toward risk-taking or a history of unstable housing. Those engaging in any type of HIV risk behavior were risk-takers in general and were aged 25 to 47 with a history of unstable housing. Recursive partitioning, a technique seldom used previously, offers a useful method for identifying subpopulations at elevated risk for HIV risk behaviors.

Comprehensive Textbook of AIDS Psychiatryedited by Mary Ann Cohen and Jack M. Gorman. New York, Oxford University Press, 2007, 656 pp., $98.50.

Back to table of contents Previous article Next article Book ForumFull AccessComprehensive Textbook of AIDS PsychiatryJOYCE SEIKO KOBAYASHI M.D.,JOYCE SEIKO KOBAYASHI M.D.Search for more papers by this author,Published Online:1 Nov 2008https://doi.org/10.1176/appi.ajp.2008.08050719AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The Comprehensive Textbook of AIDS Psychiatry will serve as a standard reference for psychiatrists and other mental health professionals providing care for HIV-positive individuals. This is a scholarly work informed by the experience of many pioneers in AIDS care and research, including Dr. Mary Ann Cohen, who first wrote about psychiatric care of people with AIDS when it was a deadly new epidemic without medical treatment. She and her colleagues return to chronicle the vast range of knowledge that has been gained through nearly three decades of research and experience in caring for people with AIDS. The scope of this text ranges from initial biopsychosocial assessment to end-of-life care. The reviews are all extensively researched, and the information is useful for both general practice and HIV specialty care. The clinician will learn to recognize HIV-related cognitive, motor, and psychiatric manifestations of HIV infection, reconsider the treatment of psychiatric disorders of patients who are infected with HIV, identify psychotherapeutic modalities appropriate for persons at various stages of HIV disease, and understand the particular concerns about medication adherence, provider “burnout,” and ethical dilemmas in the treatment of HIV-infected individuals. The chapter on substance use disorders emphasizes the role of specific substances in HIV transmission and high-risk behaviors, and the review of hepatitis C is essential knowledge for treating the nearly 30% of HIV-positive patients who are co-infected. For those interested in more specific comorbidities, there are chapters on HIV-associated renal disease and endocrinopathies, antiretroviral-related metabolic side effects, including lipodystrophies and cardiovascular disease, opportunistic infections associated with AIDS, and two excellent chapters on the neuropathological manifestations of HIV infection. The chapter by editor Jack Gorman and colleagues summarizes advances in psychoneuroimmunology.The drug-drug interactions between antiretroviral and psychotropic medications, such as the impact of ritonavir on levels of psychiatric medications through cytochrome P450 enzyme inhibition or the withdrawal symptoms that can be caused by enzyme induction when nevirapine is administered in conjunction with methadone, are thoroughly reviewed. There are also multiple reference tables summarizing these interactions, although these should be used cautiously and with the understanding that clinical effects can vary significantly between individuals. There is also a brief review of the mechanisms of action of antiretroviral medications, such as interference with viral transcription and replication, which includes protease inhibitors, reverse transcriptase inhibitors, and the newer fusion and integrase inhibitors. However, decisions about specific antiretroviral combination therapies by likely viral resistance based on genotype mutations are beyond the scope of this book.This text establishes a standard of excellence for the care of the individual HIV-positive patient by the individual psychiatrist within the context of the biopsychosocial model. There are also chapters on HIV and youth, serodiscordant couples, and the elderly from a developmental life cycle perspective. However, there is little analysis from a population perspective, such as the myriad issues faced by the population of HIV-positive women of reproductive age. The notable exceptions are a chapter on the homeless HIV-positive population and a provocative chapter suggesting that the disruption of already disadvantaged communities through the "engine" of incarceration in the nation"s prisons accounts for the disproportionate impact of HIV on racial and ethnic minorities. There are estimates that one in five HIV-positive individuals in this country passes through the correctional system, and the chapter proposes system interventions targeting this population. Disparities of care and problems in the health care system are discussed in a chapter on health services that includes an interesting historical perspective on syringe exchange programs as a community intervention.Finally, while there is a rich discussion of the role of psychiatric disorders in HIV transmission and high-risk behaviors in this book, there is little discussion of the role of the psychiatrist in HIV prevention. HIV psychiatry is a prime example of the need for a public mental health perspective that addresses populations as well as individual patients, explores sociocultural roots of illness as well as the medical and psychological, and targets interventions for communities as well as for individuals. Psychiatrists should be engaged in disease prevention as well as diagnosis and treatment.Denver, Colo.Book review accepted for publication May 2008 (doi: 10.1176/appi.ajp.2008.08050719). FiguresReferencesCited byDetailsCited ByNone Volume 165Issue 11 November, 2008Pages 1493-1493THE AMERICAN JOURNAL OF PSYCHIATRY November 2008 Volume 165 Number 11 Metrics PDF download History Published online 1 November 2008 Published in print 1 November 2008

Understanding Hope in the Face of an HIV Diagnosis and High-risk Behaviors

The purpose of this article is to: (a) explore and describe experiences of hope in the context of high-risk behaviors; and (b) identify sources of hope for participants dealing with an HIV diagnosis. Following qualitative case study methodology along with philosophical hermeneutics, 12 people diagnosed with HIV or AIDS were interviewed to understand their experiences of hope. Participants were selected based on self-report for continuing or increasing high-risk behaviors following diagnosis. Results include participant descriptions of hope as well as five higher order categories that highlight sources of hope following an HIV diagnosis. Implications for treatment of those newly diagnosed and engaged in high-risk behaviors are discussed.

Demographic Correlates of HIV Testing, High-Risk Behaviors, and Condom/STD Consultation Among a Multi-Ethnic Sample of Women

ABSTRACT Background: In the United States, HIV rates are disproportionately high among black women, with 78% of cases attributed to heterosexual transmission. This analysis examined HIV testing, high-risk behaviors and condom use consultation for the prevention of sexually transmitted diseases (STD) among a diverse sample of women. Methods: Secondary analyses were conducted using data from the 2004 Behavioral Risk Factor Surveillance System (BRFSS). This dataset included a sample of 43,550 (12% black, 79% white, and 9% Hispanic) women aged 18 to 49 years, living in the United States. Both bivariate and multivariate statistical analyses were conducted. Results: Multivariate logistic regression analyses revealed that ethnic group differences existed for past-year HIV test, high-risk behaviors, and condom use consultation even after we controlled for age, education, income, employment status, and region of residence. Black women were three times more likely than white women to report a past-year HIV test and Hispanic women were 50% more likely than white women and report a past-year HIV test. Women who reported receiving condom use consultations were most likely to be Hispanic, 30 to 34 years old, and residents of the northeast. Conclusions: Initiatives to promote HIV testing appeared to have affected HIV testing behaviors among black women. However, increased HIV testing among black women was not associated with an increased likelihood of condom use counseling by a healthcare professional. More emphasis on HIV counseling is warranted to assist with HIV risk reduction and to complement HIV testing initiatives.

Infecção pelo HIV entre gestantes atendidas nos centros de testagem e aconselhamento em Aids

To estimate HIV prevalence and identify high-risk sexual behavior for infection in pregnant women who were given prenatal assistance. Cross-sectional study based on attendance records of 8,002 pregnant women (25% of all municipalities) who lived in 27 municipalities in Southern Brazil in 2003 and had anti-HIV tests done in a testing and counseling center that performed prenatal assistance. Sociodemographic and behavioral data were gathered, as well as syphilis and HIV test results, during the individual counseling sessions registered in the data bank of the Sistema de Informações dos Centros de Testagem e Aconselhamento (Information System on Testing and Counseling Centers). Women who sought the centers for confirmation of previous serology or were referred to this service due to the presence of AIDS symptoms were excluded from the data base. A total of 0.5% of all the pregnant women analyzed (CI 95%=0.3;0.6) were HIV positive. The only variable associated with HIV seropositivity was schooling. The majority of them were basically exposed through unprotected sexual intercourse with the only partner they had a steady relationship with. Younger pregnant women who were single, unemployed and had lower level of education constituted the group with highest exposure. The Sistema de Informações dos Centros de Testagem e Aconselhamento turned out to be useful for the epidemiological surveillance of HIV infection and high-risk behavior among pregnant women and could also be useful as regards other populations.

A tale of three cities: persisting high HIV prevalence, risk behaviour and undiagnosed infection in community samples of men who have sex with men

To examine the geographical variations in HIV prevalence (diagnosed and undiagnosed), use of sexual health services, sexually transmitted infections and sexual behaviour in a community sample of men who have sex with men in three cities in England, specifically London, Brighton and Manchester. Cross-sectional surveys of men visiting gay community venues in three large cities in England. Men self-completed a questionnaire and provided an anonymous oral fluid sample for HIV antibody testing. HIV prevalence ranged from 8.6% to 13.7% in the three cities. Over one-third of HIV infection remained undiagnosed in all sites despite 69% of HIV-positive men reporting attending a genitourinary medicine clinic in the last year. Similar and high levels of risk behaviour were reported in all three cities. 18% of HIV-negative men and 37% of HIV-positive men reported unprotected anal intercourse with more than one partner in the last year. 20% of negative men and 41% of positive men reported an STI in the last year. Across all cities, despite widespread availability of anti-retroviral treatment and national policy to promote HIV testing, many HIV infections remain undiagnosed. Data from this community sample demonstrate high levels of risk behaviour and STI incidence, especially among those who are HIV positive. Renewed efforts are needed to increase diagnosis and to reduce risk behaviour to stem the continuing transmission of HIV.

Triple Jeopardy for HIV

SUMMARY Severely Mentally Ill (SMI) adults have disproportionately high HIV seroprevalence rates. Abuse of alcohol and other substances (AOD) and lifetime exposure to trauma by others are particularly potent risk factors, which, in combination with psychiatric disabilities, create triple jeopardy for HIV infection. This study examined the predictive utility of demographic characteristics; history of physical, emotional, or sexual abuse; extent of drug and alcohol abuse; knowledge about HIV/AIDS; sexual self-efficacy; and condom attitudes toward explaining the variance in a composite of HIV high-risk behavior among 188 SMI women and 158 SMI men. History of sexual abuse, engaging in sexual activities while high on substances, and lower cannabis use were the most significant predictors of HIV sexual risk behaviors. Given the triple jeopardy for HIV risk in this population, a triple barreled approach that simultaneously addresses multiple health risks within an integrated treatment setting is warranted.

Self-deception does not explain high-risk sexual behavior in the face of HIV/AIDS: A test from northern Kenya

Throughout sub-Saharan Africa, there is resistance to changing sexual behavior despite survey data indicating high levels of knowledge about HIV transmission patterns and high-risk behavior. Previous explanations for this paradox emphasize indigenous cultural models. An alternative explanation is that, due to a strong natural selection for sexual gratification, individuals evoke the evolved trait of self-deception to continue practicing high-risk sexual behavior. This alternative is tested using survey data from an Ariaal community in Marsabit District, northern Kenya. Results indicate that respondents make highly accurate self-assessments of HIV risk, negating the concept of self-deception in this study. These results are discussed within the larger context of the applicability of evolutionary theory to the AIDS pandemic.

HIV treatment optimism and high-risk sexual behaviour among gay men

HIV treatment optimism and high-risk sexual behaviour among gay men

HIV infection and high-risk behaviors in opioid dependent patients: The Indian context

Various risk behaviors promote the spread of HIV in drug addicts. Reflecting the substantial regional and geographic differences in the impact of HIV, its prevalence rates vary from country to country. In view of increasing reports of injection drug-uses (IDUs) from different parts of India, the study was aimed to examine and investigate the difference in prevalence rates of seropositivity between IDUs and non-IDUs in patients of drug dependence and to compare the pattern of risk behaviors due to sexual and drug use practice in IDUs and non-IDUs. A high HIV seroprevalence of 8.3% between IDUs and 1.8% in non-IDUs was found. The study findings suggest a trend towards drug-related risks being higher than sex-related risks in IDUs.

High HIV prevalence and risk behaviors in men who have sex with men in Chennai, India.

To estimate HIV and sexually transmitted disease (STD) prevalence and behavioral risk characteristics of men who have sex with men (MSM) in Chennai, India. A cross-sectional population-based random sample survey was conducted in 2001. Randomly selected residents of 30 slums in Chennai were interviewed for behavioral risk factors through face-to-face interviews. Sera and urine were examined for syphilis, HIV-1, gonorrhea, and chlamydia. Logistic regression analyses were used to assess associations between MSM status and HIV infection and to identify risk characteristics of MSM. Of 774 men, 46 reported (5.9%) sex with other men. MSM were more likely to be seropositive for HIV (odds ratio [OR] = 8.57; 95% confidence interval [CI]: 1.83, 40.23) and were more likely to have a history of STD (OR = 2.66; 95% CI: 1.18, 6.02) than non-MSM. Men who used illicit drugs in past 3 months (adjusted odds ratio [AOR] = 4.01; 95% CI: 1.92, 8.41), ever exchanged money for sex (AOR = 3.93; 95% CI: 1.97, 7.84), or were ever tested for HIV (AOR = 3.72; 95% CI: 1.34, 10.34) were significantly more likely to report sex with men. MSM in Chennai slums are at high risk for HIV. HIV prevention strategies aimed at changing unsafe drug and sexual practices should target the general population of men, with specific attention to areas with high rates of MSM.

Response to ‘High-risk sexual behaviour increases among London gay men between 1998 and 2001

With interest we read the paper on HIV optimism and sexual behaviour among gay men by Elford et al. [1] in a previous issue of AIDS. As all studies concerning the association between HIV optimism and high-risk sexual behaviour are currently based on cross-sectional data at one timepoint [2–5], their study, using cross-sectional data at four timepoints, contributes to an understanding of the changes over time. The authors concluded that it is unlikely that HIV optimism can explain the increase in high-risk sexual behaviour in London gyms. Although this might be true, the study is hampered by some methodological issues that might compromise their findings and raise concerns about the validity of such a conclusion. First, the authors report that they have changed the answering categories on the two optimism items from a five-point linear scale (`not at all'; ‘a bit'; ‘somewhat'; ‘quite a lot'; and ‘a lot') in the cross-sectional studies in 1998 and 1999, to a four-point scale (`strongly disagree'; ‘disagree'; ‘agree'; ‘strongly agree') in 2000 and 2001 [1]. Consequently, the definition of being ‘optimistic’ changed. In the first 2 years men were considered optimistic when they answered the two optimism items with ‘a bit', ‘somewhat', ‘quite a lot', or ‘a lot', whereas in the last 2 years they were considered optimistic when they answered ‘agree’ or ‘strongly agree'. Results show that the level of optimism decreased remarkably after the year 2000. Although the authors mentioned that the level of optimism is possibly slightly overestimated in the period before the year 2000 because of discontinuity in the measurement of HIV optimism, they argued that it is unlikely that the change has introduced a major source of bias. However, we feel that the discontinuity could generate an important bias, not only in the optimism levels but also in the levels of unprotected anal intercourse among optimistic and non-optimistic men. Consequently, the validity of the univariate and multivariate results as presented in this study is arguable. Second, men who filled in the questionnaire more than once were excluded in the multivariate analyses but not in the univariate analyses [1], resulting in different sample sizes used throughout the paper. This creates difficulties in the interpretation of the multivariate results. Are the adjusted effects of ‘year of survey’ and ‘optimism 1’ among HIV-negative individuals in the multivariate results really higher than the unadjusted effects, or is it a result of bias introduced by using a smaller sample in the multivariate analysis? Reanalysing the univariate results using the same sample size as in the multivariate analyses would facilitate a better understanding of the multivariate effects and the confounding role of the different covariates in the model. Finally, the behavioural dynamics in homosexual populations are known to be very complicated [6]. Some men change to risky behaviour, some men to more preventative behaviour, whereas other men do not change their behaviours at all. Looking at the population level, as was done in the study by Elford et al. [1], cannot reveal the complicated behavioural dynamics at an individual level. At an individual level, treatment-related optimism appears to be a factor that increases high-risk sexual behaviour [7], whereas this effect might not be noticed at the population level. Future studies, examining changes over time at an individual level, might give more insight into the role of HIV optimism in the total increase in high-risk sexual behaviour. In conclusion, we are not convinced by the report of Elford et al. [1] that HIV optimism is unlikely to explain the increase in high-risk sexual behaviour. We would like to emphasize that HIV optimism should still be addressed by prevention efforts, although we do agree that it is important to keep searching for other important factors that help to explain the increase in sexual risk behaviour, enabling the development of more effective prevention strategies.

HIV knowledge and risk behaviors among Pakistani and Afghani drug users in Quetta, Pakistan.

Situated on the Pakistan-Afghan border, Quetta is home to growing numbers of Afghan refugees. We studied HIV knowledge and risk behaviors among Pakistani and Afghani drug users between July 2001 and November 2001. Of 959 drug users, all were male and the majority used heroin. Most were Pakistani (84.8%), 14.9% were Afghani, and 0.3% were Iranian. Relative to Pakistani drug users, a higher proportion of Afghanis reported no formal education, homelessness, and unemployment ( p <.001). Afghanis were more likely to have used an opiate as their first illicit drug (16% vs. 7%, p <.001), to have ever injected (18.8% vs. 12.3%, p =.04), to report needle sharing (72.2% vs. 48.2%, p =.08), or to report a drug user in their family ( p =.08). None of sexually active Afghanis had ever used a condom compared with 5.0% of the Pakistanis ( p =.01). Only 4.3% of Afghans had ever heard of HIV/AIDS compared with 18.3% of Pakistanis ( p <.001). Extremely low levels of HIV/AIDS awareness and high HIV risk behaviors were evident among drug users in Quetta, among whom Afghanis were especially vulnerable. Interventions to prevent transition to injection, needle exchange, and drug treatment are urgently required to prevent blood-borne infections.

HIV treatments optimism among gay men: an international perspective.

To examine HIV optimism (i.e., optimism in the light of highly active antiretroviral therapy [HAART]) among gay men in four industrialized countries using a standard scale. Gay men were surveyed between January and December 2000 in Australia (Sydney and Melbourne, n = 3,120), Canada (Vancouver, n = 357), England (London, n = 690), and France (Paris, n = 1,715). Information was collected on HIV status, sexual behavior, and responses to a four-item HIV optimism scale. Possible responses to each item were as follows: strongly disagree, 1; disagree, 2; agree, 3; and strongly agree, 4. Agreement indicated optimism in the light of new HIV drug therapies. Total scores could range from a minimum of 4 (strongly disagree on all four items [i.e., not at all optimistic]) to a maximum of 16 (strongly agree on all four items [i.e., extremely optimistic]). In all cities, mean scores on the four-item scale were low (<7), indicating that for the most part men disagreed with the optimism statements. Mean scores were lowest in Paris (p <.001). There was no consistent relationship between mean optimism score and HIV status. In multivariate analysis, the association between mean optimism score and both city (p <.001) and HIV status (p =.05) was significant as was the interaction between city and HIV status (p =.02); the association between mean optimism score and age was not significant (p =.6). In London, Paris, and Sydney/Melbourne but not Vancouver, the mean optimism scores for men reporting high-risk sexual behavior were higher than scores for other men (p <.001). In the year 2000, only a few gay men in Australian, Canadian, and European cities were optimistic in the light of new HIV drug therapies. Although there was an association between HIV optimism and high-risk sexual behavior, causality could not be established. The lack of a consistent association between HIV optimism and HIV status across the cities suggests heterogeneity in gay men's response to HAART in different countries.

Learning the hard way

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Correlates of HIV Transmission Risk Factors and Considerations for Interventions in Homeless, Chemically Addicted and Mentally Ill Patients

A study was conducted to ascertain correlates of HIV high risk behaviors and attitudes toward HIV. A questionnaire was administered to 103 men living in a modified therapeutic community (TC) for homeless, chemically addicted and mentally ill men. The psychiatric diagnoses of the sample population included psychotic disorders (48%), depressive disorders (36%), and bipolar disorders (16%). Forty-two percent reported that their primary substance of abuse was cocaine and another 40% named alcohol as the substance to which they were most addicted. Two logistic regression analyses were conducted, one with needle sharing as the outcome measure and one with endorsement of the need for lifestyle changes to reduce risk of HIV transmission. Cocaine users were 3.4 times more likely to have shared needles than the rest of the sample. Patients who had a history of sexually transmitted diseases (STDs) were 17 times more likely to endorse the need for lifestyle changes. The level of HIV transmission knowledge was unrelated to HIV risk behaviors or attitudes.

Exposure therapy in the treatment of PTSD among cocaine-dependent individuals: description of procedures.

An estimated 30% to 50% of cocaine-dependent individuals meet criteria for lifetime PTSD. This comorbidity has detrimental effects on clinical presentation, and treatment course and outcome. Cocaine dependence is associated with increased rates of exposure to trauma, more severe symptoms, higher rates of treatment attrition and retraumatization, and greater vulnerability to PTSD when compared to other substance use disorders. These associations underscore the need for effective treatments that address issues particular to PTSD in a manner tolerable to cocaine-dependent individuals. This article describes a manualized psychotherapy developed specifically for individuals with PTSD and cocaine dependence. Concurrent Treatment of PTSD and Cocaine Dependence (CTPCD) provides coping skills training, cognitive restructuring techniques, and relapse prevention strategies to reduce cocaine use. In-vivo and imaginal exposure therapy techniques are incorporated to reduce PTSD symptom severity. Primary treatment goals include psychoeducation specific to the interrelationship between PTSD and cocaine dependence, and clinically meaningful reductions in cocaine use and PTSD symptomatology. Secondary goals include a reduction in HIV high-risk behaviors and improved functioning in associated areas, such as anger and negative affect management.