Annals of Behavioral Medicine

, Volume 45, Issue 3, pp 318–328 | Cite as

The Impact of Substance Use, Sexual Trauma, and Intimate Partner Violence on Sexual Risk Intervention Outcomes in Couples: A Randomized Trial

  • Deborah L. Jones
  • Deborah Kashy
  • Olga M. Villar-Loubet
  • Ryan Cook
  • Stephen M. Weiss
Original Article



Few HIV prevention interventions focus on sexual risk reduction as mutual process determined by couple members, though risk behaviors are inter-dependent.


This trial examined the impact of substance use, history of sexual trauma, and intimate partner violence on sexual risk associated with participation in a risk reduction intervention.


HIV seroconcordant and serodiscordant multicultural couples in Miami, Florida (n = 216) were randomized to group (n = 112) or individual (n = 104) couple-based interventions.


Group intervention participants increased condom use in couples in which women had a history of sexual trauma [F(2,221) = 3.39, p = 0.036] and by partners of alcohol users. History of sexual trauma was a determinant of conflict resolution, predicting negative communication and intimate partner violence.


Results emphasize the need for group sexual risk reduction interventions targeting sexual trauma, partner violence, and substance use among HIV seroconcordant and serodiscordant couples.


Couples Behavioral intervention HIV Multicultural Sexual trauma Substance use Intimate partner violence 



This study was supported by grants from the National Institutes of Health, nos. K18DA031463 and R01MH63630. The authors and investigators would like to acknowledge the NOW2 study team, Arnetta Phillips, Jacqueline Gonzalez, Laura Bruscantini, Eliot Lopez, Jennifer Casani, and the men and women participating, without whom this study would not have been possible.

Conflict of Interest Statement

The authors report no real or perceived vested interests that relate to this article (including relationships with pharmaceutical companies, biomedical device manufacturers, grantors, or other entities whose products or services are related to topics covered in this manuscript) that could be construed as a conflict of interest.


  1. 1.
    Brown-Peterside P, Ren L, Chiasson MA, Koblin BA. Double trouble: Violent and non-violent traumas among women at sexual risk of HIV infection. Women Health. 2002; 36: 51–64. doi:  10.1300/J013v36n03_04 PubMedCrossRefGoogle Scholar
  2. 2.
    Kalichman SC, Sikkema KJ, DiFonzo K, Luke W, Austin J. Emotional Adjustment in Survivors of Sexual Assault Living With HIV-AIDS. J Trauma Stress. 2002; 15: 289–296. doi:  10.1023/A:1016247727498 PubMedCrossRefGoogle Scholar
  3. 3.
    Markowitz SM, O’Cleirigh C, Hendriksen ES, Bullis JR, Stein M, Safren SA. Childhood sexual abuse and health risk behaviors in patients with HIV and a history of injection drug use. AIDS Behav. 2011; 15: 1554–60.PubMedCrossRefGoogle Scholar
  4. 4.
    Wegman HL, Stetler CA. Meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood. Psychosom Med. 2009; 71: 805–12.PubMedCrossRefGoogle Scholar
  5. 5.
    Sachs-Ericsson N, Cromer K, Hernandez A, Kendall-Tackett K. A review of childhood abuse, health, and pain-related problems: The role of psychiatric disorders and current life stress. J Trauma Dissociation. 2009; 10: 170–88. doi:  10.1080/15299730802624585 PubMedCrossRefGoogle Scholar
  6. 6.
    Wilson DR. Stress Management for Adult Survivors of Childhood Sexual Abuse: A Holistic Inquiry. Western J Nursing Research. 2009; 20(10): 1–25. doi: 10.1177/0193945909343703 Google Scholar
  7. 7.
    Liebschutz J, Savetsky JB, Saitz R, Horton NJ, Lloyd-Travaglini C, Samet JH. The relationship between sexual and physical abuse and substance abuse consequences. J Substance Abuse Treat. 2002; 22: 121–128. doi:  10.1016/S0740-5472(02)00220-9 CrossRefGoogle Scholar
  8. 8.
    Mehrabadi A, Craib KJ, Patterson K, et al. Cedar Project Partnership. The Cedar Project: A comparison of HIV-related vulnerabilities amongst young Aboriginal women surviving drug use and sex work in two Canadian cities. Int J Drug Policy. 2008; 19: 159–68. doi:  10.1016/j.drugpo.2007.07.005 PubMedCrossRefGoogle Scholar
  9. 9.
    Myers HF, Wyatt GE, Loeb TB, et al. Severity of Child Sexual Abuse, Post-Traumatic Stress and Risky Sexual Behaviors Among HIV-Positive Women. AIDS Behav. 2006; 10: 191–199. doi:  10.1007/s10461-005-9054-6 PubMedCrossRefGoogle Scholar
  10. 10.
    El-Bassel N, Gilbert L, Witte S, Wu E, Chang M. Intimate Partner Violence and HIV Among Drug-Involved Women: Contexts Linking These Two Epidemics—Challenges and Implications for Prevention and Treatment. Subst. Use Misuse. 2011; 46: 295–306. doi:  10.3109/10826084.2011.523296 PubMedCrossRefGoogle Scholar
  11. 11.
    Meade CS, Kershaw TS, Hansen NB, Sikkema KJ. Long-term correlates of childhood abuse among adults with severe mental illness: Adult victimization, substance abuse, and HIV sexual risk behavior. AIDS Behav. 2009; 13: 207–216. doi: 10.1007/s10461-007-9326-4 PubMedCrossRefGoogle Scholar
  12. 12.
    Stockman JK, Campbell JC, Celentano DD. Sexual violence and HIV risk behaviors among a nationally representative sample of heterosexual American women: The importance of sexual coercion. J Acquir Immune Defic Syndr. 2010; 53: 136–43. doi:  10.1097/QAI.0b013e3181b3a8cc PubMedCrossRefGoogle Scholar
  13. 13.
    Van Roode T, Dickson N, Herbison P, Paul C. Child sexual abuse and persistence of risky sexual behaviors and negative sexual outcomes over adulthood: Findings from a birth cohort. Child Abuse Neglect. 2009; 33: 161–172. doi:  10.1016/j.chiabu.2008.09.006 PubMedCrossRefGoogle Scholar
  14. 14.
    Wilson HW, Widom CS. Sexually transmitted diseases among adults who had been abused and neglected as children: A 30-year prospective study. Am J Pub Health. 2009; 99 Suppl. 1: S197-203. doi:  10.2105/AJPH.2007.131599 CrossRefGoogle Scholar
  15. 15.
    Pence BW. The impact of mental health and traumatic life experiences on antiretroviral treatment outcomes for people living with HIV/AIDS. J Antimicrob Chemother. 2009; 63: 636–40.PubMedCrossRefGoogle Scholar
  16. 16.
    Hien DA, Campbell ANC, Killeen T, et al. The Impact of Trauma-Focused Group Therapy upon HIV Sexual Risk Behaviors in the NIDA Clinical Trials Network “Women and Trauma” Multi-Site Study. AIDS Behav. 2010; 14: 421–430. doi: 10.1007/s10461-009-9573-7 PubMedCrossRefGoogle Scholar
  17. 17.
    Wyatt GE, Myers HF, Williams JK, et al. Does a history of trauma contribute to HIV risk for women of color? Implications for prevention and policy. Am J Public Health. 2002; 92: 660–5. doi: 10.2105/AJPH.92.4.660 PubMedCrossRefGoogle Scholar
  18. 18.
    Medrano MA, Desmond DP, Zule WA, Hatch JP. Histories of childhood trauma and the effects on risky HIV behaviors in a sample of women drug users. Am J Drug Alcohol Abuse. 1999; 25: 539–606. doi:  10.1081/ADA-100101881 Google Scholar
  19. 19.
    Wilson HW, Widom CS. Pathways from childhood abuse and neglect to HIV-risk sexual behavior in middle adulthood. J Consult Clin Psychol. 2011; 79: 236–246. doi:  10.1037/a0022915 PubMedCrossRefGoogle Scholar
  20. 20.
    Elze DE, Auslander W, McMillan C, Edmond T, Thompson R. Untangling the impact of sexual abuse on HIV risk behaviors among youths in foster care (abstract). AIDS Educ Prev. 2001; 13: 377–389. doi:  10.1521/aeap.13.4.377.21427 PubMedCrossRefGoogle Scholar
  21. 21.
    Wyatt GE, Longshore D, Chin D, et al. The efficacy of an integrated risk reduction intervention for HIV-positive women with child sexual abuse histories. AIDS & Behav. 2004; 8: 453–474. doi: 10.1007/s10461-004-7329-y CrossRefGoogle Scholar
  22. 22.
    Senn TE, Carey MP, Vanable PA. Childhood and adolescent sexual abuse and subsequent sexual risk behavior: Evidence from controlled studies, methodological critique, and suggestions for research. Clin Psychol Rev. 2008; 28: 711–735. doi:  10.1016/j.cpr.2007.10.002 PubMedCrossRefGoogle Scholar
  23. 23.
    Johnson SD, Cottler LB, Ben Abdallah A, O’Leary CC. History of sexual trauma and recent HIV-risk behaviors of community-recruited substance using women. AIDS Behav. 2011; 15: 172–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Eaton LA, West TV, Kenny DA. HIV Transmission Risk among HIV Seroconcordant and Serodiscordant Couples: Dyadic Processes of Partner Selection. AIDS Behav. 2009; 13: 185–195. doi: 10.1007/s10461-008-9480-3 PubMedCrossRefGoogle Scholar
  25. 25.
    Puffer ES, Kochman A, Hansen NB, Sikkema KJ. An evidence-based group coping intervention for women living with HIV and history of childhood sexual abuse. Int J Group Psychother. 2011; 61: 98–126. doi:  10.1521/ijgp.2011.61.1.98 PubMedCrossRefGoogle Scholar
  26. 26.
    Burton J, Darbes LA, Operario D. Couples-focused behavioral interventions for prevention of HIV: Systematic review of the state of evidence. AIDS Behav. 2010; 14: 1–10. doi: 10.1007/s10461-008-9471-4 PubMedCrossRefGoogle Scholar
  27. 27.
    Sales JM, Lang DL, DiClemente RJ, et al. The Mediating Role of Partner Communication Frequency on Condom Use Among African American Adolescent Females Participating in an HIV Prevention Intervention. Health Psychol. 2012; 1: 63–69. doi:  10.1037/a0025073 CrossRefGoogle Scholar
  28. 28.
    Sikkema KJ, Wilson PA, Hansen NB, Kochman A, Neufeld S, Ghebremichael MS. Effects of coping intervention on transmission risk behavior among people living with HIV/AIDS and a history of childhood sexual abuse. J Acquir Immune Defic Syndr. 2008; 14: 506–13. doi:  10.1097/QAI.0b013e318160d727 CrossRefGoogle Scholar
  29. 29.
    El-Bassel N, Witte SS, Gilbert L, et al. The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples. Am J Public Health. 2003; 93: 963–969.PubMedCrossRefGoogle Scholar
  30. 30.
    Albarracin D, Johnson BT, Fishbein M, Muellerleile PA. Theories of reasoned action and planned behavior as models of condom use: A meta-analysis. Psychol Bull. 2001; 127: 142–61.PubMedCrossRefGoogle Scholar
  31. 31.
    Ajzen I. The theory of planned behavior. Organ Behav Hum Dec. 1991; 50: 179–211.CrossRefGoogle Scholar
  32. 32.
    Florida Department of Health. HIV Counseling and Testing Annual Report, 2004. Accessed August 20, 2012.
  33. 33.
    Straus MA. Measuring Intrafamily Conflict and Violence: The Conflict Tactics Scales. J Marriage Family. 1979; 41: 75–88.CrossRefGoogle Scholar
  34. 34.
    Meyer-Bahlberg HFL, Ehrhardt AA, Exner TM, et al. Sexual Risk Behavior Assessment Schedule: Adult (SERBAS-A-DF-4) Manual. 1990.Google Scholar
  35. 35.
    Kalichman SC, Cain D, Weinhardt L, et al. Experimental components analysis of brief theory-based HIV/AIDS risk-reduction counseling for sexually transmitted infection patients. Health Psychol. 2005; 24: 198–208.PubMedCrossRefGoogle Scholar
  36. 36.
    Kenny DA, Kashy DA, & Cook WL. Dyadic data analysis. New York: Guilford Press; 2006.Google Scholar
  37. 37.
    Rugpao S, Koonlertkit S, Pinjaroen S, et al. Patterns of male condom use and risky sexual behaviors in Thai couples receiving ongoing HIV risk reduction counseling. Abstract presented at: XV International AIDS Conference; 11–16 July 2004; Bangkok (abstract no. ThPeC7408).Google Scholar
  38. 38.
    Sikkema KJ, Hansen NB, Kochman A, et al. Outcomes from a group intervention for coping with HIV/AIDS and childhood sexual abuse: Reductions in traumatic stress. AIDS Behav. 2007; 11: 49–60. doi:  10.1007/s10461-006-9149-8 PubMedCrossRefGoogle Scholar
  39. 39.
    Sikkema KJ, Hansen NB, Meade CS, Kochman A, Fox AM. Psychosocial Predictors of Sexual HIV Transmission Risk Behavior among HIV-Positive Adults with a Sexual Abuse History in Childhood. Arch Sex Behav. 2009; 38: 121–134. doi: 10.1007/s10508-007-9238-4 PubMedCrossRefGoogle Scholar
  40. 40.
    Harman JJ, Amico KR. The relationship-oriented information-motivation-behavioral skills model: A multilevel structural equation model among dyads. AIDS Behav. 2009; 13: 173–84.PubMedCrossRefGoogle Scholar
  41. 41.
    Orengo-Aguayo R, Perez-Jimenez D. Impact of relationship dynamics and gender roles in the protection of HIV discordant heterosexual couples: An exploratory study in the Puerto Rican context. P R Health Sci J. 2009; 28: 30–9.PubMedGoogle Scholar
  42. 42.
    Perez-Jimenez, D, Seal DW, Serrano-Garcia I. Barriers and facilitators of HIV prevention with heterosexual Latino couples: Beliefs of four stakeholder groups. Cultur Divers Ethnic Minor Psychol. 2009; 15: 11–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Persson A. Sero-silence and sero-sharing: Managing HIV in serodiscordant heterosexual relationships. AIDS Care. 2008; 20: 503–506.PubMedCrossRefGoogle Scholar
  44. 44.
    Montgomery CM, Lees S, Stadler J, et al. The role of partnership dynamics in determining the acceptability of condoms and microbicides. AIDS Care. 2008; 20: 733–740.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2012

Authors and Affiliations

  • Deborah L. Jones
    • 1
  • Deborah Kashy
    • 2
  • Olga M. Villar-Loubet
    • 1
  • Ryan Cook
    • 1
  • Stephen M. Weiss
    • 1
  1. 1.Department of Psychiatry and Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Department of PsychologyMichigan State UniversityLansingUSA

Personalised recommendations