Development of a Novel HIV Risk Reduction Intervention for Abused Women

描述(申请人提供)：艾滋病毒和性传播疾病(性传播疾病)是妇女的主要公共卫生问题。儿童期性虐待(CSA)已被证明增加了妇女对这些疾病的脆弱性。研究一直发现，环孢素A与性危险行为以及性传播疾病和艾滋病毒感染有关。此外，与没有被虐待的女性相比，有CSA病史的女性在传统性风险降低干预后表现出较少的改善。因此，需要针对有CSA病史的女性的独特需求进行性风险降低干预。这项拟议研究的目的是为有CSA病史的女性开发、改进和试点测试一种创新的、理论指导的性风险降低干预措施。我们将基于以前的发现，即这种干预应该解决CSA的心理后果(即创伤性性化、人际信任、内疚和无能为力的创伤性动力学结构)，以及性风险行为的典型前置因素(即知识、动机和行为技能)。为了向干预发展提供信息，将招募25名报告CSA病史的参加城市公共STD的妇女参加关键线人访谈。根据访谈结果，在理论和经验先例的指导下，将开发一种新的性行为风险降低干预措施。干预措施将根据从性病诊所招募的24名女性的反馈进行改进，这些女性报告了CSA和性危险行为的病史。最后，干预措施将在60名从诊所招募的女性中进行试点测试，她们报告有CSA病史和当前的性风险行为。这些妇女将完成一项计算机化的调查，以评估儿童期性虐待、成人性危险行为、艾滋病毒相关信息、更安全的性动机、行为技能、创伤性性行为、人际信任 内疚和无能为力。行为技能也将通过角色扮演和模拟场景进行评估。女性将被随机分配到新的干预措施中，或者被分配到结构相同的干预措施中，只专注于性危险行为的心理前兆。干预完成三个月后，女性将返回完成计算机化面试和行为技能评估。这项研究的长期目标是为有CSA病史的女性开发一种可行而有效的性风险降低干预措施。如果像我们预期的那样，这项干预措施在减少性风险行为方面取得了成功，那么这项拟议中的研究将解决一个重要的公共卫生问题：降低儿童期性虐待女性中过高的性传播疾病和艾滋病毒感染率。

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.