INTERVENTION FOR COPING WITH HIV AND TRAUMA

描述(改编自申请人的摘要)：流行率和不良反应 性虐待和精神创伤的情感后果是公认的。 尽管描述性研究已经确立了一段历史之间的关系 关于儿童性虐待和艾滋病毒危险行为，目前只有有限的研究集中在 关于艾滋病毒携带者中性虐待史的经历和影响 疾病。该应用程序需要四年的支持以评估其有效性 对艾滋病毒感染者进行二级预防干预 与性虐待有关的创伤应激障碍。该干预模式整合了 压力与应对的认知理论和应对不足的交易框架 终止性虐待结果。多时段小组干预将包括 五个关键组成部分：1)发展社会支持感 安全性和稳定性；2)与过去有关的情绪的识别和表达 创伤和当前艾滋病毒相关应激源；3)发展适应性应对技能 以及对创伤症状和艾滋病毒相关应激源的掌握；4)认知和 增强自我护理活动的行为技能，包括遵守艾滋病毒药物治疗的规定， 药物滥用治疗和减少性危险行为；以及，5)目标 制定、解决问题和寻求支持的技能发展，以维护 行为和情绪上的变化。240名感染艾滋病毒的男性和女性 经历与创伤相关的压力和精神痛苦将是随机的 分配到艾滋病毒和创伤应对小组或支持小组的比较 条件。在基线、干预后和4-、8-和 12个月的随访点将用于确定干预结果 效果。据推测，相对于感染艾滋病毒的参与者 在分配到比较条件下，艾滋病毒感染者中的艾滋病毒和 创伤应对干预将显示：(A)减少心理痛苦，因为 通过测量创伤应激，全球精神痛苦， 抑郁症和焦虑症；(B)制定和实施适应方法 应对艾滋病毒和创伤应激；(C)更高的生活质量评级； (D)减少药物使用和性危险行为；(E)增加治疗 遵守和利用保健服务；以及，(F)改善健康状况 如HIV症状学所示，CD4细胞和病毒载量计数。如果 如果成功，这项研究将确定一种艾滋病毒和创伤应对干预措施 心理健康障碍和疾病二级预防模式 艾滋病毒感染者的进展，这是医疗迫切需要的 以及为艾滋病毒感染者提供服务的心理健康计划。

DESCRIPTION (adapted from the applicant's abstract): The prevalence and adverse emotional consequences of sexual abuse and trauma are well established. Although descriptive studies have established the relationship between a history of child sexual abuse and HIV risk behavior, there has been limited research focused on the experience and impact of sexual abuse histories among people living with HIV disease. This application requests four years of support to evaluate the effectiveness of a secondary prevention intervention for people with HIV infection who are coping with traumatic stress related to sexual abuse. The intervention model integrates the cognitive theory of stress and coping and the transactional framework for under- standing sexual abuse outcomes. The multi-session group intervention will include five key components: 1) development of social support to establish a sense of safety and stability; 2) identification and expression of emotions related to past trauma and current HIV-related stressors; 3) development of adaptive coping skills and mastery over trauma symptoms and HIV-related stressors; 4) cognitive and behavioral skills to enhance self-care activities, including HIV medication adherence, substance abuse treatment, and reduction of sexual risk behaviors; and, 5) goal setting, problem-solving and support-seeking skills development for maintenance of behavioral and emotional changes. 240 men and women with HIV infection who are experiencing trauma-related stress and psychiatric distress will be randomly assigned to an HIV and trauma coping group or a support group comparison condition. Assessments collected at baseline, post-intervention, and 4-, 8- and 12- month follow-up points will be used to determine intervention outcome effects. It is hypothesized that, relative to HIV-infected participants assigned to the comparison condition, HIV infected participants in the HIV and trauma coping intervention will exhibit: (a) reduced psychological distress as assessed by measures of traumatic stress, global psychiatric distress, depression and anxiety; (b) development and implementation of adaptive ways of coping with HIV and traumatic stress; (c) higher ratings of quality-of-life; (d) decreased substance use and sexual risk behavior; (e) increased treatment adherence and health care services utilization; and, (f) improved health status as indicated by HIV symptomatology, CD4 cell and viral load counts. If successful, this research will identify an HIV and trauma coping intervention model for the secondary prevention of mental health disorders and disease progression among HIV-infected persons, which is urgently needed for medical and mental health programs that serve persons with HIV infection.