Compendium of Evidence-Based Interventions and
Best Practices for HIV Prevention
Living in the Face of Trauma (LIFT)
HIV-positive adults with childhood sexual abuse (CSA) histories
Goals of Intervention
- Eliminate or reduce sexual transmission risk behavior
- Improve coping with the combined stressors of HIV infection and child sexual abuse
- Increase positive change in CSA-related trauma symptoms
Living in the Face of Trauma (LIFT) is a group-level coping intervention for HIV-positive persons who experienced childhood sexual abuse. The intervention consists of fifteen 90-minute sessions delivered to same-gender groups (about 6-8 persons per group). The LIFT intervention incorporates adaptive coping, which includes problem-focused strategies for changeable stressors and emotion-focused strategies for unchangeable stressors. These adaptive coping strategies assist participants in identifying and addressing individual stressors related to HIV infection and sexual trauma. Through discussions, trigger identification, skills-building exercises, goal setting, and social support, participants learn problem solving, communication skills, risk-reduction skills, cognitive reformation, and relaxation techniques to improve coping and reduce HIV sexual transmission risk behavior.
- Cognitive Theory of Stress and Coping
- Cognitive Behavioral Treatment Strategies for Sexual Trauma
Fifteen weekly 90-minute sessions delivered over about 3.5 months
A local community health center
Three female therapists and one male therapist: two clinical psychologists and two clinical social workers
- Cognitive restructuring
- Goal setting
- Group discussion
- Relaxation techniques
- Role plays
- Social support
An intervention package is not available at this time. Please contact Dr. Kathleen J. Sikkema, Department of Psychology and Neuroscience, Duke University, 9 Flowers Drive, Box 90086, Durham, NC27708, email: firstname.lastname@example.org, for details on intervention materials.
The original evaluation study was conducted in New York City between 2002 and 2004.
Key Intervention Effects
- Reduced unprotected sex acts with all partners and with HIV-negative or unknown serostatus partners
The baseline study sample of 247 HIV-positive men and women with CSA histories is characterized by the following:
- 68% African American, 17% Hispanic, 10% White, 5% Other
- 53% Female, 47% Male
- 60% gay or bisexual, 40% heterosexual
- 47% MSM, 100% of men are MSM
- Mean age 42 years
- Mean education of 12 years
AIDS service organizations and community health care clinics in New York City
Men and women were eligible if they were 18 years or older, HIV-positive, and were sexually abused as a child and/or adolescent (i.e., any unwanted touching of a sexual nature by an adult or someone at least 5 years older).
HIV-positive men and women (N=247) were randomly assigned to 1 of 2 groups: LIFT intervention (n=124) or HIV support group comparison (n=123)
The HIV support group provided a supportive environment for participants to address issues of HIV and CSA trauma. This intervention consisted of 15 weekly 90-minute group sessions led by experienced clinical therapists who were not trained on the coping intervention model.
Relevant Outcomes Measured and Follow-up Time
Sex behaviors during past 4 months (including frequency of unprotected vaginal and anal intercourse with all partners and frequency of unprotected vaginal and anal intercourse with HIV-negative or unknown serostatus partners) were measured at 2 weeks after the intervention and at 4-, 8-, and 12-month follow-ups.
- LIFT Intervention:
71% retained at 4 months
68% retained at 8 months
65% retained at 12 months
- HIV Support Group Comparison:
72% retained at 4 months
72% retained at 8 months
67% retained at 12 months
- Across the three follow-up assessments, LIFT intervention participants reported significantly fewer counts of unprotected vaginal and anal intercourse with all partners (p < .001) and with HIV-negative or unknown serostatus partners (p < .001), compared to comparison participants
- At the 4-month follow-up, the LIFT intervention showed significant effects in reducing unprotected sex with all partners (p < .05) and unprotected sex with HIV-negative and unknown serostatus partners (p < .05) among 168 participants who reported having vaginal or anal intercourse during the study.
- Among 168 participants who reported having vaginal or anal intercourse during the study, the LIFT intervention showed significant effects in reducing unprotected sex with all partners (p < .05) at the 8- and 12-month follow-ups and unprotected sex with HIV-negative and unknown serostatus partners (p < .05) at the 8-month follow-up. (While the above findings meet best evidence, these findings meet the GOOD-EVIDENCE criteria due to retention rate <70%).
- Sikkema, K. J., Hansen, N. B., Kochman, A., Tarakeshwar, N., Neufeld, S., Meade, C. S., et al. (2007). Outcomes from a group intervention for coping with HIV/AIDS and childhood sexual abuse: Reductions in traumatic stress. AIDS and Behavior, 11, 49-60.
- Sikkema, K. J., Wilson, P. A., Hansen, N. B., Kochman, A., Neufeld, S., Ghebremichael, M. S., et al. (2008). Effects of a coping intervention on transmission risk behavior among people living with HIV/AIDS and a history of childhood sexual abuse. Journal of Acquired Immune Deficiency Syndromes, 47, 506-513.
Researcher: Dr. Kathleen J. Sikkema
Department of Psychology and Neuroscience, Duke University
9 Flowers Drive, Box 90086
Durham, NC 27708