A Randomized Comparison Trial Testing Two Culturally Adapted HIV Prevention Approaches for Native Americans Reducing Trauma Symptoms Versus Substance Misuse.

We compared two counseling approaches aimed at preventing HIV: Narrative Exposure Therapy (NET) targeting posttraumatic stress disorder (PTSD) and Motivational Interviewing with CBT-skills training (MIST), addressing substance misuse. We recruited 125 participants aged 16 + rural American Indians. Participants were screened for current sexual activity, probable PTSD, and substance misuse, then randomly assigned to either NET or MIST. Interventions were culturally adapted and up to 6 sessions delivered by local counselors. Primary outcomes included PTSD severity, number of sexual partners, frequency of sex, sex while using substances, and overall substance use. Both treatments reduced PTSD severity, risky sexual behavior, number of sexual partners, sexual encounters with unknown HIV serostatus partners, and substance use symptoms at follow-up. However, NET showed greater effectiveness than MIST, specifically in reducing risky sexual behaviors and substance use. Results suggest that interventions addressing either PTSD symptoms or substance misuse can effectively reduce HIV sexual risk behaviors.