Development of a trauma-informed substance use and sexual risk reduction intervention for young South African women

Abstract

PurposeTo develop a trauma-informed substance use and sexual risk reduction intervention for young South African women at risk of HIV.Patients and methodsGuided by the ADAPT-ITT framework for intervention development, we selected four focus groups (n=26) to assess the service needs and preferences of trauma-exposed young women (aged 18–25 years) who use substances. We used findings to develop a needs-based and contextually appropriate intervention. In addition four focus groups (n=30) were selected to explore potential service users’ views of this intervention and recommendations for improving acceptability and appeal. Expert stakeholders were also consulted.ResultsYoung women described therapeutic, self-care, and social support needs for coping with traumatic experiences and reducing substance- and sexual-related risks for HIV and further trauma. To address these needs, we expanded the Women’s Health Co-Operative (WHC; an evidence-based HIV prevention program) to include trauma-related psychoeducation; cognitive-behavioral strategies for coping with the emotional impact of trauma, stress, and substance use craving; social support strategies; and self-care components to help young women create a life with purpose. This novel and expanded six-session group-based intervention is called the trauma-informed WHC. Focus group participants and expert stakeholders viewed the trauma-informed WHC as highly relevant and acceptable. They provided recommendations for modifications to the intervention structure and reformatting of intervention materials to enhance the intervention’s appeal and the feasibility of reaching and retaining young women in the program.ConclusionEngaging women as potential service users in the process of developing a trauma-informed substance use and sexual risk reduction intervention helped identify service needs not commonly addressed in trauma-informed substance use interventions but critical for recovery and local relevance. It also enhanced the acceptability and appeal of the intervention. While potentially acceptable, the trauma-informed WHC requires feasibility testing before establishing its efficacy in a larger trial.

"Ek het uiteindelik op straat beland; dis ʼn harde lewe": Uitdagings van kwesbare vroue wat alkohol of dwelms misbruik

“…Ongelukkig lei hierdie ongesonde en gevaarlike gedrag dikwels tot hoë-risiko seksuele gedrag, wat tot HIV as gevolg van inkonsekwente kondoomgebruik kan lei. Volgens Myers et al (2018) het al die deelnemers alkohol of dwelms misbruik om trauma van die verlede te hanteer asook om van hul huidige probleme te probeer ontsnap. Baie vroue het genoem dat hulle sodoende hul skuldgevoelens, verleentheid en ander negatiewe emosies probeer hanteer.…”

“…Baie vroue het genoem dat hulle sodoende hul skuldgevoelens, verleentheid en ander negatiewe emosies probeer hanteer. Dit is interessant dat deelnemers aan Myers et al (2018) se studie erken het dat die misbruik van dwelms bygedra het tot ander uitdagings in hulle lewens. Die bogenoemde outeurs het bygevoeg dat ʼn hele aantal vroue bereid was tot prostitusie, want "jy doen wat jy moet doen om dwelms te kry".…”

“…Baie vroue meld nie aan as hulle ʼn middelgebruikstoornis ontwikkel nie, vanweë die moontlike stigma wat daaraan gekoppel is. Verskeie vroue voel ook vasgevang in hul huise, gemeenskappe en kultuur en om hulp te soek, is dikwels nie ʼn opsie nie (Baird et al 2014;Myers et al 2018). Ander navorsers (Fries et al 2014;Gous 2018) bevind ook dat finansiële probleme stresvlakke verhoog wat weer kan lei tot middelgebruikstoornisse.…”

“…Gibbs et al (2018) voeg by dat daar dikwels by dergelike vroue ʼn verband te bespeur is tussen alkohol-of dwelmmisbruik en posttraumatiese stresversteuring en depressie. Die bykomende las van armoede dra ook by tot ʼn komplekse situasie waar vroue hulle telkens tot alkohol of dwelms wend in ʼn poging om te ontsnap van ʼn allesoorweldigende stresvolle situasie (Baird et al 2014;Myers et al 2018).…”

“…Die waglyste is gewoonlik lank, tot twee jaar en langer, en die meeste behandelingsentrums bied nie dienste aan vroue nie. In die Wes-Kaap is daar slegs een staatsinrigting wat rehabilitasie aan dergelike vroue bied en daar is slegs twee semi-gesubsidieerde behandelingsentrums (Myers et al 2018).…”