DOLESCENTS ARE ACKNOWLedged as a population at increased risk of human immunodeficiency virus (HIV) infection. 1-5 Among adolescents, African American girls are a subgroup at particularly high risk of HIV infection. A seroepidemiologic study of Job Corps applicants reported that HIV prevalence among African American adolescent girls was significantly higher than among their white or Hispanic female peers (4.9 vs 0.7 and 0.6 per 1000, respectively) and exceeds that of white, Hispanic, and African American male adolescents (0.8, 1.5, and 3.2 per 1000, respectively). African American adolescent girls in the South had the highest prevalence (6.4 per 1000) relative to adolescents from other geographic regions. 6 Recent meta-analyses and reviews indicate that theoretically derived and empirically based HIV interventions can Author Affiliations are listed at the end of this article.
Background
Posttraumatic stress disorder is a major public health concern with long term sequelae. There are no accepted interventions delivered in the immediate aftermath of trauma. This study tested an early intervention aimed at modifying the memory to prevent the development of PTSD prior to memory consolidation.
Methods
Patients (N=137) were randomly assigned to receive 3 sessions of an early intervention beginning in the emergency department (ED) compared to an assessment only control group. Posttraumatic stress reactions (PTSR) were assessed at 4 and 12 weeks post-injury and depression at baseline and week 4. The intervention consisted of modified prolonged exposure including imaginal exposure to the trauma memory, processing of traumatic material, and in vivo and imaginal exposure homework.
Results
Patients were assessed an average of 11.79 hours post-trauma. Intervention participants reported significantly lower PTSR than the assessment group at 4 weeks post-injury, p < 0.01, and at 12 weeks post-injury, p < 0.05, and significantly lower depressive symptoms at Week 4 than the assessment group, p < 0.05. In a subgroup analysis the intervention was the most effective at reducing PTSD in rape victims at Week 4 (p=.004) and Week 12 (p=.05).
Conclusions
These findings suggest that the modified prolonged exposure intervention initiated within hours of the trauma in the ED is successful at reducing PTSR and depression symptoms one and three months after trauma exposure and is safe and feasible. This is the first behavioral intervention delivered immediately post-trauma that has been shown to be effective at reducing PTSR.
To evaluate the efficacy of an intervention to reduce incident sexually transmitted disease (STD) and enhance STD/human immunodeficiency virus (HIV)preventive behaviors and psychosocial mediators. Design: A randomized controlled trial of an HIV prevention program.
This is the first trial to demonstrate reductions in risky sexual behavior and incident bacterial STDs and to enhance HIV-preventive psychosocial and structural factors among women living with HIV.
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