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Research Project

A Pilot RCT of Expressive Writing with HIV-Positive Methamphetamine Users

It is well established that HIV-positive persons who use stimulants such as methamphetamine are at increased risk for transmitting medication-resistant strains HIV. Mental health co-morbidities such as symptoms of post-traumatic stress disorder and HIV-specific traumatic stress may substantially contribute to increased stimulant use among HIV-positive persons. Consequently, adjuvant mental health interventions designed to address traumatic stress could ultimately improve substance abuse treatment outcomes and reduce transmission risk behavior among HIV-positive methamphetamine-using men. In particular, expressive writing is a self-administered, exposure-based intervention to address trauma that could be easily disseminated to substance abuse treatment programs without placing significant additional burden on staff for training or intervention delivery. Over the past 20 years, numerous randomized controlled trials (RCTs) have examined the efficacy of self-administered expressive writing interventions where participants are asked write about traumatic events for 15-30 minutesover 1-5 days. Findings from meta-analyses observed that expressive writing interventions improve psychological adjustment, physiological functioning, and self-reported physical health in various populations. However, to our knowledge no published research has examined the efficacy of expressive writing with active drug users. The proposed formative clinical research will examine the safety, feasibility, and potential clinical utility of delivering a self-administered, expressive writing intervention to HIV-positive methamphetamine-using men. In order to evaluate expressive writing, we will conduct a pilot RCT with 90 HIV-positive methamphetamine-using men. In addition to providing data on safety and feasibility, this RCT will provide an opportunity to examine the potential clinical utility of expressive writing with respect to measures of psychological adjustment (primary outcome) as well as substance use and HIV transmission risk behavior (secondary outcomes). Establishing that expressive writing is safe, feasible, and potentially efficacious with this population represents a crucial first step to inform a planned clinical research program. Subsequent clinical research will examine whether expressive writing can serve as an efficacious adjuvant to substance abuse treatment with HIV-positive methamphetamine-using men. Improving the effectiveness of substance abuse treatment for HIV-positive methamphetamine-using men would alleviate human suffering and could ultimately reduce HIV transmission rates.

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Disclosure assistance (PCRS)

After more than 20 years of the HIV epidemic, with advances in treatment and increases in understanding and acceptance of HIV, getting an HIV+ diagnosis still can be a traumatic experience. HIV+ persons must come to terms with their own infection and be concerned with possible infection in past and future partners. Talking to partners about HIV is especially hard because even though it is a manageable disease, HIV still is not curable. Disclosure assistance services (also known as partner counseling and referral services or PCRS) are an array of voluntary and confidential services available to persons living with HIV and their exposed sex and/or needle-sharing partner(s). Disclosure assistance is cost effective and can play a critical role in identifying those individuals most at risk for HIV infection, and linking those who are infected to early medical care and treatment. Most HIV+ persons make the decision to disclose or not disclose to their partners on their own. But HIV+ persons may want support for telling their partners about HIV, whether by encouragement for self-disclosure or by having someone who is well-trained carefully and confidentially notify a partner for them. In one study, persons who received disclosure assistance were over three times more likely to have informed a partner of their risk. In the past few years, HIV counseling and testing programs across the US have shifted their emphasis from testing anyone, to finding and testing persons at greatest risk for HIV infection. At general HIV testing sites, around 1% of clients tested are found to be HIV+, whereas 8-39% of clients tested through disclosure assistance are found to be HIV+.

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Consejería y prueba de VIH

La consejería y prueba (C&P) del VIH es un componente importante en la gama de servicios de prevención y tratamiento del VIH. Ya que la visita para la C&P incluye una evaluación individual integral de riesgo, ésta ofrece la mejor oportunidad para remitir al cliente a otros servicios más intensivos. Por otra parte, la C&P es una de las entradas a los servicios de prevención y a otros servicios. La consejería breve y enfocada en el cliente que la C&P proporciona puede incrementar el uso de condones y evitar la propagación de las enfermedades de transmisión sexual (ETS). Conocer la condición de VIH, ya sea VIH- o VIH+, es clave para evitar la transmisión del VIH y para obtener consejería y atención médica. Se calcula que la cuarta parte de las personas VIH+ en los EE.UU. no saben que están infectadas. Una encuesta entre hombres jóvenes que tienen sexo con hombres (HSH) encontró que el 14% de los jóvenes negros HSH eran VIH+. El 93% de éstos desconocían estar infectados y el 71% afirmaron que era poco probable que fueran VIH+. Hace poco los Centros para el Control y Prevención de Enfermedades (CDC, siglas en inglés) anunciaron una iniciativa para expandir la C&P en EE.UU. Su plan estratégico del año 2005 pretende reducir en un 50% el número de personas que ignoran su condición de VIH. Si se cumple esta meta para el año 2010, se calcula que se prevendrán unas 130,000 nuevas infecciones de VIH, ahorrándose así más de $18 mil millones.

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Black women

Black women and men in the US are hard hit by HIV, and have been since the beginning of the epidemic. In 2006, Black women accounted for 61% of new HIV cases among women, but make up only 12% of US female population. The rate of HIV diagnoses for Black women is 15 times the rate for White women. Black women also have high rates of sexually transmitted diseases (STDs), which can facilitate transmission of HIV. Among Black women in 2006, the rate of chlamydia was 7 times higher, gonorrhea 14 times higher, and syphilis 16 times higher than the rate among White women. These numbers and statistics, however, don’t show the richness and diversity of Black women’s lives. Black women can be White collar and working class, Christians and Muslims. They live in inner-city and suburban neighborhoods, are the descendants of slaves and recent Caribbean immigrants. They work, go to school, raise families, fall in love. HIV among Black women is not simply about individual behavior, but a complex system of social, cultural, economic, geographic, religious and political factors that combine to affect health.

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Childhood sexual abuse (CSA)

Childhood sexual abuse may be defined in many ways, but this fact sheet refers to unwanted sexual body contact prior to age 18, the age of consent to engage in sex. CSA is a painful experience on many levels that can have a profound and devastating effect on later physiological, psychosocial and emotional development. CSA experiences can vary with respect to duration (multiple experiences with the same perpetrator), degree of force/coercion or degree of physical intrusion (from fondling to digital penetration to attempted or completed oral, anal or vaginal sex). The identity of the perpetrator–ranging from a stranger to a trusted figure or family member–may also impact the long-term consequences for individuals. To distinguish CSA from exploratory sexual experimentation, the contact should be unwanted/coerced or there should be a clear power difference between the victim and perpetrator, often defined as the perpetrator being at least 5 years older than the victim. Many more children are sexually abused than are reported to authorities. Estimates of the prevalence of CSA in the US are about 33% for females under the age of 18 and 10% in males under 18 years of age. Men are significantly less likely than women to report CSA when it occurs. CSA is more likely to occur in families under duress. Children are at risk for CSA in families that experience stress, poverty, violence and substance abuse and whose parents and relatives have histories of CSA.