Lessons Learned: Overcoming Challenges to Developing HIV Interventions for Black MSMW with Child Sexual Abuse Histories

Issues: Trauma, especially in the form of childhood sexual abuse (CSA), has been associated with psychological distress and HIV risk behaviors among men who have sex with men (MSM). However, HIV interventions rarely address issues of trauma among MSM, let alone among Black men who have sex with men and women (MSMW) despites its potential contribution to the HIV epidemic. Description: We developed the Enhanced Sexual Health Intervention for Men, a six-session, culturally congruent intervention aimed at reducing CSA-driven symptoms of depression and posttraumatic stress disorder, as well as HIV risk behaviors and tested it against an attention matched health promotion control. The sample consisted of 88 participants who were non-gay identifying behaviorally bisexual HIV-positive Black men with histories of CSA. Lessons: Recruitment and retention of participants who were not open about their sexuality and who may be stigmatized by their HIV status and sexual abuse histories were significant barriers. Maintaining collaborations with fiscally challenged community based organizations who often served as the first point of contact for this population, was also difficult. Finally, despite randomization, some psychological factors were more prevalent within the control condition, impacting ability to analyze intervention effectiveness. Recommendations: Interventions that focus on multiple outcomes, especially prior trauma histories, are needed. This is especially true among highly affected and stigmatized populations, such as HIV-positive Black MSMW with CSA histories. Further, stratifying participants by trauma history and psychological symptoms prior to randomization is an important consideration as demographics alone may not reflect the heterogeneity among individuals.