Reductions in traumatic stress following a coping intervention were mediated by decreases in avoidant coping for people living with HIV/AIDS and childhood sexual abuse.

Childhood sexual abuse (CSA) is among the most common traumatic experiences encountered in the United States, with as many as one in three women and one in six men having a history of CSA (Briere & Elliott, 2003; Finkelhor, Hotaling, Lewis, & Smith, 1990). The negative impacts of CSA are well documented and include mental disorders, substance abuse, sexual dysfunction, physical health problems and relationship difficulties (Briere & Elliott, 2003; Irish, Kobayashi, & Delahanty, 2010; Jumper, 1995; Neumann, Houskamp, Pollock, & Briere, 1996; Wyatt et al., 2002). CSA has also been associated with HIV risk behaviors, such as unprotected sex and multiple partners (Arriola, Louden, Doldren, & Fortenberry, 2005; Mimiaga et al., 2009). The psychological difficulties that often arise from CSA, such as helplessness, low self-esteem, dissociation, denial, avoidance, and self-destructiveness, have been linked to HIV risk behavior, and likely mediate the relationship between CSA and HIV infection (Becker, Rankin, & Rickel, 1998; Briere, 2004; Mimiaga et al., 2009; Rotheram-Borus, Mahler, Koopman, & Langabeer, 1996). Further, CSA survivors are less responsive to HIV risk reduction interventions (Belcher et al., 1998; Kalichman, Carey, & Johnson, 1996; Mimiaga et al., 2009). Given these psychological and behavioral sequelae of CSA, it is perhaps not surprising that the reported rates of CSA among HIV-infected persons are between 33% and 53% (Henny, Kidder, Stall, & Wolitski, 2007; Kalichman, Sikkema, DiFonzo, Luke, & Austin, 2002; Markowitz et al., 2011; Welles et al., 2009; Whetten et al., 2006). CSA among HIV-infected individuals is a public health concern because it is associated with engagement in unprotected intercourse and substance abuse (Holmes, 1997; Kalichman et al., 2002; Markowitz et al., 2011; O’Leary, Purcell, Remien, & Gomez, 2003; Welles et al., 2009). Despite the growing recognition of the need for HIV prevention and mental health interventions to take into account the experience of CSA (Chin, Wyatt, Carmona, Loeb, & Myers, 2004; Greenberg, 2001; Parillo, Freeman, Collier, & Young, 2001; Sikkema et al., 2004), few interventions have been developed specifically for HIV-infected persons with CSA (Sikkema et al., 2007; Sikkema et al., 2004; Williams et al., 2008; Wyatt et al., 2004)