title: A sexual risk and stress reduction intervention designed for HIV-positive bisexual African American men with childhood sexual abuse histories.
abstract: OBJECTIVE
  HIV transmission risk is high among men who have sex with men and women (MSMW), and it is further heightened by a history of childhood sexual abuse (CSA) and current traumatic stress or depression. Yet, traumatic stress is rarely addressed in HIV interventions. We tested a stress-focused sexual risk reduction intervention for African American MSMW with CSA histories.
  
  
  METHODS
  This randomized controlled trial compared a stress-focused sexual risk reduction intervention with a general health promotion intervention. Sexual risk behaviors, psychological symptoms, stress biomarkers (urinary cortisol and catecholamines), and neopterin (an indicator of HIV progression) were assessed at baseline and at 3- and 6-month follow-ups.
  
  
  RESULTS
  Both interventions decreased and sustained reductions in sexual risk and psychological symptoms. The stress-focused intervention was more efficacious than the general health promotion intervention in decreasing unprotected anal insertive sex and reducing depression symptoms. Despite randomization, baseline group differences in CSA severity, psychological symptoms, and biomarkers were found and linked to subsequent intervention outcomes.
  
  
  CONCLUSIONS
  Although interventions designed specifically for HIV-positive African American MSMW can lead to improvements in health outcomes, future research is needed to examine factors that influence intervention effects.
authors.affiliation: University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 38-260, Los Angeles, CA 90024-1759, USA. keoniwmd@aol.com
authors.forename: John K
authors.initials: JK
authors.lastname: Williams
authors.forename: Dorie A
authors.initials: DA
authors.lastname: Glover
authors.forename: Gail E
authors.initials: GE
authors.lastname: Wyatt
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kisler
authors.forename: Honghu
authors.initials: H
authors.lastname: Liu
authors.forename: Muyu
authors.initials: M
authors.lastname: Zhang
mesh_terms: D054523:Adult Survivors of Child Abuse / Q000523:psychology*; D001741:Black or African American / Q000523:psychology*; D000704:Analysis of Variance; D015415:Biomarkers / Q000652:urine; D001727:Bisexuality; D002395:Catecholamines / Q000652:urine; D016009:Chi-Square Distribution; D015658:HIV Infections / Q000523:psychology* / Q000635:transmission*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D008297:Male; D008875:Middle Aged; D019798:Neopterin / Q000652:urine; D040242:Risk Reduction Behavior; D012725:Sexual Behavior; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D002395:Catecholamines; D019798:Neopterin; D006854:Hydrocortisone