Development of a Novel HIV Risk Reduction Intervention for Abused Women

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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.