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Compendium of Evidence-Based HIV Behavioral Interventions

Living in the Face of Trauma (LIFT)

BEST-EVIDENCE

Intervention Description

Target Population
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

Brief Description

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.

Theoretic Basis

  • Cognitive Theory of Stress and Coping
  • Cognitive Behavioral Treatment Strategies for Sexual Trauma

Intervention Duration
Fifteen weekly 90-minute sessions delivered over about 3.5 months

Intervention Settings
A local community health center

Deliverer
Three female therapists and one male therapist: two clinical psychologists and two clinical social workers

Delivery Methods

  • Cognitive restructuring
  • Exercises
  • Goal setting
  • Group discussion
  • Relaxation techniques
  • Role plays
  • Social support

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Intervention Package Information

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: kathleen.sikkema@duke.edu, for details on intervention materials.

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Evaluation Study and Results

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

Study Sample
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

Recruitment Settings
AIDS service organizations and community health care clinics in New York City

Eligibility Criteria
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).

Assignment Method
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)

Comparison Group
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.

Participant Retention

  • 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

Significant Findings

  • 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%).

Considerations

  • None

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References and Contact Information

  • 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
email: kathleen.sikkema@duke.edu

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