As a clinical psychologist, Kathleen Sikkema has spent her career developing and evaluating mental health interventions to improve the wellbeing of people living with HIV. One key focus of her work has been tackling the intersection between HIV and sexual trauma. According to Sikkema, these two experiences often co-occur and lead to poorer health outcomes.
“Experiencing sexual trauma, either in childhood or adulthood, can have serious impacts for individuals who are living with HIV,” said Sikkema. “Sexual trauma often leads to mental health distress, particularly traumatic stress. It can also have other consequences such as poor retention in HIV care, abuse of alcohol and drugs, and sexual risk behavior that can result in transmission of the virus to others.”
Several years ago, Sikkema completed a US-based randomized controlled trial of a group intervention called Living in the Face of Trauma (LIFT). Sikkema developed LIFT for HIV-positive women and men with sexual trauma histories. The goal of the intervention was to help participants better appraise stressors and apply adaptive coping strategies, thereby disrupting avoidant coping and ultimately reducing traumatic stress and related health risks. LIFT was found to be effective in reducing trauma symptoms, substance use, and sexual risk behavior among participants. As a result, it has been recognized by the CDC as a "best evidence intervention" and in the SAMHSA National Registry of Evidence-based Programs and Practices (NREPP).
Now, Sikkema is taking her experience with LIFT to South Africa. In a new study funded by the National Institute for Mental Health, Sikkema and her colleagues plan to develop and pilot test a coping intervention for South African women who are starting antiretroviral (ARV) treatment and have experienced sexual trauma in their lifetimes. The hypothesis is that by addressing the psychological sequelae of sexual trauma, women will be more likely to remain engaged in HIV care and adhere to their medications over the long term. The study is being conducted in collaboration with John Joska and Dan Stein at the University of Cape Town in South Africa, a priority location for DGHI. Sikkema is working together with DGHI faculty member Melissa Watt, DGHI Global Health Doctoral Scholar Karmel Choi, and DGHI research staff member Alexis Dennis.
This new endeavor in South Africa builds upon Sikkema’s previous community-based research in Cape Town, which documented high rates of traumatic experiences among South African women. Sikkema hopes that this new study will further the lessons from LIFT to address the unique needs of South African women.
“In the first year and a half of this study, we will be doing a large amount of qualitative work to better understand the experiences and needs of this patient population, to develop an intervention feasible for delivery in this setting, and to tailor some of what worked in our LIFT intervention for the South African context,” said Sikkema. “We will then do a small trial of the study with 60 women, to determine whether the intervention has meaningful impacts that would justify a larger trial. Given the very high rates of sexual trauma in South Africa, and what we know about the impact of sexual trauma, we feel this study is immensely important as we think about strategies to increase HIV care engagement.”
In a recent visit to Cape Town, Sikkema, Watt and Choi met with their University of Cape Town collaborators and visited local HIV clinics. Clinic staff they met with agreed wholeheartedly about the need to address women’s trauma histories in those settings. Data collection for the study will begin later this year.