Development of a Novel HIV Risk Reduction Intervention for Abused Women

说明（由申请人提供）：艾滋病毒和性传播疾病是妇女面临的主要公共卫生问题。事实证明，儿童期性虐待增加了妇女患这些疾病的脆弱性。研究一致发现，CSA与性危险行为、性病和艾滋病毒感染有关。此外，与未受虐待的妇女相比，有CSA病史的妇女在传统的性风险降低干预措施后改善程度较低。因此，需要针对有CSA病史的妇女的独特需求进行性风险降低干预。本研究的目的是开发、完善和试点测试一种创新的、理论指导的性风险降低干预措施，用于有CSA病史的女性。我们将以先前的研究结果为基础，表明这种干预应该解决性行为风险的心理后果（即创伤性化、人际信任、内疚和无力感的创伤性动力学结构），以及性风险行为的典型前因（即知识、动机和行为技能）。为了为干预措施的制定提供信息，将招募25名报告有CSA病史的城市公共性病患者参加关键信息提供者访谈。在访谈结果的基础上，以理论和经验先例为指导，开发一种新的性风险降低干预措施。干预将根据从性病诊所招募的24名报告有CSA病史和性危险行为的妇女的反馈进行改进。最后，将对从诊所招募的60名报告有CSA病史和当前性危险行为的妇女进行干预试验。这些女性将完成一份电脑调查，评估童年性虐待、成人性风险行为、艾滋病相关信息、安全性行为动机、行为技能、创伤性化、人际信任、

DESCRIPTION (provided by applicant): HIV and sexually transmitted diseases (STDs) are major public health problems among women. Childhood sexual abuse (CSA) has been shown to increase women's vulnerability to these diseases. Studies have consistently found that CSA is associated with sexual risk behavior and with STD and HIV infection. In addition, compared to women who have not been abused, women with a history of CSA show less improvement following traditional sexual risk reduction interventions. Thus, sexual risk reduction intervention targeted to the unique needs of women with a history of CSA are needed. The purpose of the proposed research is to develop, refine, and pilot test an innovative, theoretically-guided sexual risk reduction intervention for women with a history of CSA. We will build on previous findings that suggest such an intervention should address the psychological consequences of CSA (i.e., the traumagenic dynamics constructs of traumatic sexualization, interpersonal trust, guilt, and powerlessness), as well as the typical antecedents of sexual risk behavior (i.e., knowledge, motivation, and behavioral skills). To inform intervention development, 25 women attending an urban, public STD who report a history of CSA will be recruited to participate in key informant interviews. Based on interview findings and guided by theory and empirical precedent, a novel sexual risk reduction intervention will be developed. The intervention will be refined based on feedback from 24 women recruited from the STD clinic who report a history of CSA and sexual risk behavior. Finally, the intervention will be pilot tested with 60 women recruited from the clinc who report a history of CSA and current sexual risk behavior. These women will complete a computerized survey to assess childhood sexual abuse, adult sexual risk behavior, HIV-related information, safer sex motivation, behavioral skills, traumatic sexualization, interpersonal trust, guilt, and powerlessness. Behavioral skills will also be assessed through role-plays and simulation scenarios. Women will be randomly assigned to the novel intervention or to a structurally equivalent intervention focused only on the psychological antecedents of sexual risk behavior. Three months after intervention completion, women will return to complete computerized interviews and behavioral skills assessments. The long-term goal of this research is to develop a feasible and effective sexual risk reduction intervention for women who have a history of CSA. If, as we anticipate, the intervention is successful in reducing sexual risk behavior, the proposed research will have addressed an important public health problem: reducing the disproportionately high rates of STDs and HIV among women who were sexually abused as children.