Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.
Harvard Medical School, Boston, MA, USA.
AIDS Behav. 2019 Sep;23(9):2421-2431. doi: 10.1007/s10461-019-02482-z.
To address childhood sexual abuse (CSA) related distress and HIV risk in men who have sex with men (MSM) using cognitive-behavioral therapy for trauma and self-care (CBT-TSC), which is a novel intervention integrating HIV risk reduction with modified cognitive and behavioral therapy strategies for post-traumatic stress. We compared CBT-TSC to HIV voluntary counseling and testing (VCT)-only in an initial 2-arm RCT in 43 HIV-negative MSM at with a history of CSA and HIV risk. Serodiscordant condomless anal/vaginal sex (CAS; CAS with HIV-postive or HIV unknown status partners) and posttraumatic stress disorder (PTSD) symptoms (Davidson Trauma Scale: total score and avoidance, intrusions, hyperarousal subscales) were outcomes immediately post-treatment, and at 6- and 9-month follow-up. At post-treatment, CBT-TSC had decreased odds (approximately 60%) of any CAS and greater reductions in CAS compared to VCT-only. Additionally, the CBT-TSC condition experienced greater reductions in total PTSD and avoidance symptoms. At the follow-up visits, CBT-TSC condition had significant reductions in the odds of any CAS and reductions in CAS. However, for PTSD symptoms, only the avoidance subscale remained significantly different compared to VCT-only. CBT-TSC is a potentially efficacious approach to address HIV risk in MSM with a CSA history, with replication and extension in a larger trial needed. This proof-of-concept trial is the first to integrate the treatment of a commonly occurring mental-health syndemic problem in MSM with a health psychology approach to self-care in MSM.Trial Registration Clinicaltrials.gov NCT01266122.
为了解决男男性行为者（MSM）中与儿童期性虐待（CSA）相关的困扰和 HIV 风险，我们使用创伤和自我保健认知行为疗法（CBT-TSC），这是一种将 HIV 风险降低与创伤后认知和行为治疗策略相结合的新干预措施。我们将 CBT-TSC 与 HIV 自愿咨询和检测（VCT）仅在一项初始的 2 臂 RCT 中进行了比较，该 RCT 纳入了 43 名 HIV 阴性、有 CSA 史和 HIV 风险的 MSM。血清不一致的无保护肛交/阴道交（CAS；与 HIV 阳性或 HIV 未知状态的伴侣发生的 CAS）和创伤后应激障碍（PTSD）症状（Davidson 创伤量表：总分和回避、侵入、警觉过度子量表）是治疗后即刻、6 个月和 9 个月随访时的结局。治疗后，CBT-TSC 发生任何 CAS 的几率降低（约 60%），与 VCT 相比，CAS 的减少更大。此外，CBT-TSC 组 PTSD 总分和回避症状的减少更为明显。在随访时，CBT-TSC 组发生任何 CAS 的几率降低，CAS 减少。然而，对于 PTSD 症状，只有回避子量表与 VCT 相比仍有显著差异。CBT-TSC 是一种针对有 CSA 史的 MSM 解决 HIV 风险的潜在有效方法，需要在更大的试验中复制和扩展。这项概念验证试验是首次将 MSM 中常见的精神健康综合征问题的治疗与 MSM 中的健康心理学自我保健方法相结合。试验注册Clinicaltrials.gov NCT01266122。
