Abstract
The association between sexual abuse and HIV risk is well documented, yet little empirical data exists on treatment approaches integrating the psychological impact of sexual abuse and HIV disease. This study examined the clinical significance of change on sexual-trauma-related stress following a coping group intervention study among 28 women and men with HIV-AIDS and a history of childhood sexual abuse. More than 75% of participants showed improvement on 1 or more subscales of the Trauma Symptom Inventory, with the majority of improvements within domains related to trauma symptoms and behavioral difficulties. Most observed gains were modest, but are considered meaningful in the context of stressors encountered by this disenfranchised sample, which was diverse with respect to race, sexual orientation, and psychiatric comorbidity. These preliminary findings support the need for the conduct of research trials to identify mental health and secondary prevention intervention models that can assist those with HIV–AIDS who have experienced childhood sexual abuse.
Similar content being viewed by others
REFERENCES
Allers, C. T., and Benjack, K. J. (1991). Connections between childhood abuse and HIV infection. Journal of Counseling and Development, 70, 309–313.
Allers, C. T., White, J. F., and Mullis, F. (1997). The treatment of dissociation in an HIV-infected, sexually abused adoles-cent male. Psychotherapy: Theory, Research, Practice, Training, 34, 201–206.
Armistead, L., and Forehand, R. (1995). For whom the bell tolls: Parenting decisions and challenges faced by mothers who are HIV positive. Clinical Psychology: Science and Practice, 2, 239–250.
Arnow, B. A., Hart, S., Scott, C., Robin, D., O'Connell, L., and Taylor, C. B. (1999). Childhood sexual abuse, psychological distress, and medical use among women. Psychosomatic Medicine, 61, 762–770.
Bedimo, A. L., Kissinger, P., and Bessinger, R. (1997). History of sexual abuse among HIV-infected women. International Journal of STD and AIDS, 8, 332–335.
Briere, J. (1995). Trauma Symptom Inventory professional manual. Odessa, FL: Psychological Assessment Resources.
Briere, J. (1996). A self-trauma model for treating adult survivors of severe child abuse. In J. Briere, L. Berliner, J. Myers, T. Reid, J. Carole, and C. T. Hendrix (Eds.), The APSAC hand-book on child maltreatment (pp. 140–157). Thousand Oaks, CA: Sage.
Cassese, J. (2000). New directions for research examining sexual trauma histories of gay men. In J. Cassese (Ed.), Gay men and childhood sexual trauma: Integrating the shattered self (pp. 183–193). Binghamton, NY: Harrington Park Press.
Classen, C., Koopman, C., Nevill-Manning, K., and Spiegel, D. (2001). A preliminary report comparing trauma-focused and present-focused group therapy against a wait-listed condition among childhood sexual abuse survivors with PTSD. Journal of Aggression, Maltreatment and Trauma. 4(2), 265–288.
Cohen, M. A., Alfonso, C. A., Hoffman, R. G., Milau, V., and Carrera, G. (2001). The impact of PTSD on treatment adherence in persons with HIV infection. General Hospital Psychiatry, 23, 294–296.
Comer, L. K., Henker, B., Kemeny, M., and Wyatt, G. (2000). Illness disclosure and mental health among women with HIV/AIDS. Journal of Community and Applied Social Psychology, 10, 449–464.
Cook, J. A., Cohen, M. H., Burke, J., Grey, D., Anastos, K., Kirstein, L., Palacio, H., Richardson, J., Wilson, T. E., and Young, M. (2002). Effects of depressive symptoms and mental health quality of life on use of highly active antiretroviral therapy among HIV-seropositive women. JAIDS: Journal of Acquired Immune Deficiency Syndromes, 30, 401–409.
Elliott, D. M., and Briere, J. (1992). Sexual abuse trauma among professional women: Validating the Trauma Symptom Checklist—40 (TSC-40). Child Abuse and Neglect, 16, 391–398.
Fallot, R. D., and Harris, M. (2002). The trauma recovery and empowerment model (TREM): Conceptual and practical issues in a group intervention for women. Community Mental Health Journal, 38, 475–485.
Finkelhor, D., Hotaling, G., Lewis, I. A., and Smith, C. (1990). Sexual abuse and in a national sample of adult men and women: Prevalence, characteristics, and risk factors. Child Abuse and Neglect, 14, 19–28.
Foa, E. B. (2000). Psychosocial treatment of posttraumatic stress disorder. Journal of Clinical Psychiatry, 61, 43–51.
Foa, E. B., and Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive–behavioral therapy for PTSD. New York: Guilford Press.
Folkman, S., Chesney, M., McKusick, L., Ironson, G., Johnson, D. S., and Coates, T. J. (1991). Translating coping theory into an intervention. In J. Eckenrode (Ed.), The Social context of stress (pp. 239–260). New York: Plenum.
Forehand, R., Steele, R., Armistead, L., Morse, E., Simon, P., and Clark, L. (1998). The Family Health Project: Psychosocial adjustment of children whose mothers are HIV infected. Journal of Consulting and Clinical Psychology, 66, 513–520.
Foy, D. W., Eriksson, C. B., and Trice, G. A. (2001). Introduction to group interventions for trauma survivors. Group Dynamics: Theory, Research, and Practice, 5, 246–251.
Gilbert, L., El-Bassel, N., Schilling, R. F., Wada, T., and Bennet, B. (2000). Partner violence and sexual HIV risk behaviors among women in methadone treatment. AIDS and Behavior, 4, 261–269.
Golding, J. M. (1999). Sexual assault history and long-term physical health problems: Evidence from clinical and population epidemiology. Current Directions in Psychological Science, 8, 191–194.
Gore Felton, C., and Koopman, C. (2002). Traumatic experiences: Harbinger of risk behavior among HIV-positive adults. Journal of Trauma and Dissociation, 3, 121–135.
Greenberg, J. B. (2001). Childhood sexual abuse and sexually transmitted diseases in adults: A review of implications for STD/HIV programs. International Journal of STD and AIDS, 12, 777–783.
Hansen, N. B., Lambert, M. J., and Forman, E. M. (2002). The psychotherapy dose–response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9, 329–343.
Hogben, M., Gange, S. J., Watts, D. H., Robison, E., Young, M., Richardson, J., Cohen, M., and DeHovitz, J. (2001). The effect of sexual and physical violence on risky sexual behavior and STDs among a cohort of HIV seropositive women. AIDS and Behavior, 5, 353–361.
Holmes, W. C. (1997). Association between a history of child-hood sexual abuse and subsequent, adolescent psychoactive substance use disorder in a sample of HIV seropostive men. Journal of Adolescent Health, 20, 414–419.
Howard, K. I., Moras, K., Brill, P. L., Martinovich, Z., and Lutz, W. (1996). Efficacy, effectiveness, and patient progress. American Psychologist, 51, 1059–1064.
Jacobson, N. S., and Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.
Jumper, S. A. (1995). A meta-analysis of the relationship of child sexual abuse to adult psychological adjustment. Child Abuse and Neglect, 19, 715–728.
Kalichman, S. C., Sikkema, K. J., DiFonzo, K., Luke, W., and Austin, J. (2002). Emotional adjustment in survivors of sexual assault living with HIV–AIDS. Journal of Traumatic Stress, 15, 289–296.
Lambert, M. J., Hansen, N. B., and Finch, A. E. (2001). Patient-focused research: Using patient outcome data to enhance treatment effects. Journal of Consulting and Clinical Psychology, 69, 159–172.
Lambert, M. J., Whipple, J. L., Hawkins, E. J., Vermeersch, D. A., Nielsen, S. L., and Smart, D. W. (2003). Is it time for clinicians to routinely track patient outcome? A meta-analysis. Clinical Psychology: Science and Practice, 10, 288–301.
Lazarus, R. S., and Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer-Verlag.
Lee, M., and Rotheram-Borus, M. (2001). Challenges associated with increased survival among parents living with HIV. American Journal of Public Health, 91, 1303–1309.
Liebschutz, J. M., Feinman, G., Sullivan, L., Stein, M., and Samet, J. (2000). Physical and sexual abuse in women infected with the human immunodeficiency virus: Increased illness and health care utilization. Archives of Internal Medicine, 160, 1659–1664.
Lunnen, K. M., and Ogles, B. A. (1998). A multiperspective, multivariable evaluation of reliable change. Journal of Consulting and Clinical Psychology, 66, 400–410.
Marcenko, M. O., Kemp, S. P., and Larson, N. C. (2001). Childhood experiences of abuse, later substance use, and parenting outcomes among low-income mothers. American Journal of Orthopsychiatry, 70, 316–326.
McCauley, J., Kern, D. E., Kolodner, K., and Dill, L. (1997). Clinical characteristics of women with a history of childhood abuse: Unhealed wounds. JAMA, 277, 1362–1368.
Miller, M., and Paone, D. (1998). Social network characteristics as mediators in the relationship between sexual abuse and HIV risk. Social Science and Medicine, 47, 765–777.
Morey, L. C. (1991). Personality Assessment Inventory: Professional manual. Odessa, FL: Psychological Assessment Resources, Inc.
Neumann, D. A., Housekamp, B. M., Pollack, V. E., and Briere, J. (1996). The long-term sequelae of childhood sexual abuse in women: A meta-analytic review. Child Maltreatment, 1, 6–16.
Parillo, K. M., Freeman, R. C., Collier, K., and Young, P. (2001). Association between early sexual abuse and adult HIV-risky sexual behaviors among community-recruited women. Child Abuse and Neglect, 25, 335–346.
Rotheram-Borus, M. J., Mahler, K. A., Koopman, C., and Langabeer, K. (1996). Sexual abuse history and associated multiple risk behavior in adolescent runaways. American Journal of Orthopsychiatry, 66, 390–400.
Schiff, M., El-Bassel, N., Engstrom, M., and Gilbert, L. (2002). Psychological distress and intimate sexual abuse among women in methadone maintenance treatment programs. Social Service Review, 76(2), 302–320.
Shalev, A. Y. (1997). Discussion: Treatment of prolonged post-traumatic stress disorder—Learning from experience. Journal of Traumatic Stress, 10, 415–423.
Sikkema, K. J., Hansen, N. B., Kochman, A., Tate, D. C., and DiFranceisco, W. (2004). Outcomes from a randomized controlled trial of a group intervention for HIV positive men and women coping with AIDS-related loss and bereavement. Death Studies, 28, 187–209.
Sikkema, K. J., Kochman, A., DiFranceisco, W., Kelly, J. A., and Hoffman, R. G. (2003). AIDS-related grief and coping with loss among HIV-positive men and women. Journal of Behavioral Medicine, 26, 165–181.
Spaccarelli, S. (1994). Stress, appraisal, and coping in child sexual abuse: A theoretical and empirical review. Psychological Bulletin, 116, 340–362.
Thompson, K. M., Crosby, R. D., Wonderlich, S. A., Mitchell, J. E., Redlin, J., Demuth, G., Smyth, J., and Haseltine, B. (2003). Psychopathology and sexual trauma in childhood and adult-hood. Journal of Traumatic Stress, 16, 35–38.
Tingey, R. C., Lambert, M. J., Burlingame, G. M., and Hansen, N. B. (1996). Assessing clinical significance: Proposed extensions to method. Psychotherapy Research, 6, 109–123.
van der Kolk, B. A. (1993). Group psychotherapy with posttrau-matic stress disorders. In H. I. Kaplan and B. J. Sadock (Eds.),. Comprehensive textbook of group psychotherapy (pp. 550–560). Baltimore: Williams & Wilkins.
Wilsnack, S. C., Vogeltanz, N. D., Klassen, A. D., and Harris, T. R. (1997). Childhood sexual abuse and women's substance abuse: National survey findings. Journal of Studies on Alcohol, 58, 264–271.
Wingood, G. M., and DiClemente, R. J. (1997). Child sexual abuse, HIV sexual risk, and gender relations of African-American women. American Journal of Preventive Medicine, 13, 380–384.
Wingood, G. M., DiClemente, R. J., and Raj, A. (2000). Adverse consequences of intimate partner abuse among women in non-urban domestic violence shelters. American Journal of Preventive Medicine, 19, 270–275.
Wyatt, G., Axelrod, J., Chin, D., Carmona, J. V., and Loeb, T. B. (2000). Examining patterns of vulnerability to domestic violence among African American women. Violence Against Women, 6, 495–514.
Wyatt, G., Myers, H., Williams, J. K., Kitchen, C. R., Loeb, T., Carmona, J. V., Wyatt, L. E., Chin, D., and Presley, N. (2002). Does a history of trauma contribute to HIV risk for women of color? Implications for prevention and policy. American Journal of Public Health, 92, 660–665.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sikkema, K.J., Hansen, N.B., Tarakeshwar, N. et al. The Clinical Significance of Change in Trauma-Related Symptoms Following a Pilot Group Intervention for Coping with HIV–AIDS and Childhood Sexual Trauma. AIDS Behav 8, 277–291 (2004). https://doi.org/10.1023/B:AIBE.0000044075.12845.75
Issue Date:
DOI: https://doi.org/10.1023/B:AIBE.0000044075.12845.75