Cognitive Behavioral Therapy for HIV Prevention and to Reduce Posttraumatic Symptoms in MSM with Histories of Childhood Sexual Abuse: Results of a RCT
1. Abstracts based on Formal Research WorkGail H Ironson4, Katie Biello3, 5, Michael S Boroughs3, 6, Brett M Goshe1, 2, 3, Samantha M McKetchnie2, 3, Jillian C Shipherd7, 8, 9, Steven A Safren2, 3, 4
1 Harvard Medical School
2 Massachusetts General Hospital
3 The Fenway Institute, Fenway Health
4 University of Miami
5 Brown University, Fenway Health
6 Windsor University
7 LGBTQ+ Health Program, Veterans Health Administration
8 National Center for PTSD, VA Boston Healthcare System
9 Boston University School of Medicine,
Abstract
Background: Childhood sexual abuse (CSA) disproportionately impacts men who have sex with men (MSM) and is associated with higher rates of condomless anal sex and poorer engagement in the PrEP treatment cascade. Additionally, MSM with early sexual trauma may experience post-traumatic distress, particularly in adult sexual situations, which can interfere with their ability to protect their sexual health. As such MSM with CSA histories have unique vulnerabilities for HIV infection that are not addressed by traditional sex education and STI risk reductions interventions. This study sought to address this gap by evaluating Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC) a tailored intervention specifically designed to reduce sexual risk for HIV acquisition and posttraumatic distress among MSM with CSA histories.
Methods: HIV-uninfected MSM with histories of CSA (n=190) and episodes of condomless anal or vaginal intercourse with a HIV serodiscordant partner in the past three months were enrolled in a two-arm randomized controlled trial to test a tailored psychosocial intervention designed to reduce the frequency of condomless sex acts and posttraumatic symptoms. The treatment, 10 individual sessions of Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC), was compared to a time-matched comparison condition that provided supportive psychotherapy. Participants completed a baseline assessment and 3-, 6-, 9-, and 12-month follow-up assessments. The study was conducted in Boston and Miami in the United States. In addition to sociodemographics, participants completed self-report assessments 1) sexual risk for HIV acquisition number of condomless, anal and vaginal intercourse acts (accounting for self-reported PREP use and adherence) with HIV serodiscordant partners), 2) Frequency of CSA-related trauma symptoms (via the Davidson Trauma Scale), 3) PrEP use, and 4) PrEP adherence. Linear mixed effects models were used to examine both acute (3-months post-randomization) and follow-up (3-, 6-, 9-, and 12-month) intervention effects on both sexual risk and trauma symptom frequency.
Results: For the acute intervention effects, both conditions saw decreases in sexual risk from baseline to 3-month follow-up (b = -0.48, 95% CI = -0.87, -0.10; p = 0.01), but there were no significant differences between conditions after controlling for baseline sexual risk or baseline PTSD diagnosis. Both conditions also saw reductions in trauma symptom severity from baseline to 3-month (b = -0.31, 95% CI = -0.49, -0.14; p < 0.001), though the CBT-TSC group demonstrated larger improvements in the acute intervention period (b = -0.39, 95% CI: = -0.63, -0.16; p = 0.01) than the supportive psychotherapy comparison condition. This intervention effect was stronger for those with a baseline PTSD diagnosis (overall model = b=-.44, 95% CI = -.72, -.17; p = 0.002; CBT-TSC condition = b = -.64, 95% CI = -1.02, -.26; p = .001). For the follow-up intervention effects, sexual risk continued to decrease over time for both conditions, and the CBT-TSC group maintained reductions in trauma symptom frequency between the 3- and 12-month follow-ups.
Conclusions: Findings from this two-arm randomized controlled trial indicate that CBT-TSC is an effective treatment for trauma-related distress among MSM with CSA histories and may decrease behaviors that are associated with HIV infections.