CBT to Reduce Substance Abuse, PTSD in Transgender Women With HIV
Transgender women have the highest prevalence of HIV of any group and have extremely high rates of trauma exposure.
A 12-week cognitive-behavioral therapy (CBT) program led to reductions in measures of post-traumatic stress disorder (PTSD), alcoholism, and drug abuse in transgender women with HIV, according to research published in the Journal of Psychoactive Drugs.1
Rates of HIV in women have risen substantially, with women now representing 23% of people with HIV in the United States.2 A significant number of studies have found elevated rates of exposure to trauma — such as physical, emotional, or sexual abuse — and PTSD in HIV-positive individuals. Previous findings show that the rate of PTSD in women with HIV is 30.7% compared with 9.7% in the general population.3 A history of trauma is associated with a higher risk of HIV exposure and worse outcomes in people with HIV.
Male-to-female transgender women have the highest prevalence of any group (27.7%) and have extremely high rates of trauma exposure — for example, up to 69% for sexual abuse and 65% for physical abuse.4,5 Rates of substance abuse are also increased in people with HIV and are associated with worse health outcomes.
“Despite the high rate of co-occurring PTSD and SUD, and evidence that treatment is more effective if it addresses both conditions,” few programs have been designed to target both, wrote the current investigators.6 A CBT program called Seeking Safety, which addresses both disorders, has been linked with improvement in symptoms in many different populations. However, the program has not been evaluated in people with HIV or transgender women.
The present study investigated the effects of Seeking Safety in 7 transgender women (74.4% blacks; mean age, 42.3) with HIV and a history of trauma and substance abuse. Treatment consisted of 12 weekly 2-hour sessions. Before treatment and 2 weeks post-treatment, participants completed the following assessments: the PTSD CheckList-Civilian Version (PCL-C); the Short Version Michigan Alcohol Screening Test (MAST-22); and the Drug Abuse Screening Test (DAST-20). Participants also provided feedback after each session.
The findings show reductions in all 3 scores: 17.5% on the PCL-C, 23.9% on the MAST-22, and 68.8% on the DAST-20. Participant feedback indicates that essential components of the program were social support and the all-transgender group composition. Additional research is needed to further investigate the benefits and long-term impact of Seeking Safety in this patient population.
- Empson S, Cuca YP, Cocohoba J, Dawson-Rose C, Davis K, Machtinger EL. Seeking Safety group therapy for co-occurring substance use disorder and PTSD among transgender women living with HIV: a pilot study. J Psychoactive Drugs. 2017;19:1-8. doi:10.1080/02791072.2017.1320733
- Centers for Disease Control and Prevention (CDC). HIV among women. 2016. www.cdc.gov/hiv/group/gender/women. Accessed June 29, 2017.
- Machtinger EL, Wilson TC, Haberer JE, Weiss DS. Psychological trauma and PTSD in HIVpositive women: A meta-analysis. AIDS and Behavior. 2012;16(8):2091-2100. doi:10.1007/s10461-011-0127-4
- Herbst JH, Jacobs ED, Finlayson TJ, et al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: A systematic review. AIDS and Behavior. 2008;12(1):1-17. doi:10.1007/s10461-007-9299-3
- Kenagy GP. Transgender health: Findings from two needs assessment studies in Philadelphia. Health & Social Work. 2005;30(1):19-26. doi:10.1093/hsw/30.1.19
- Najavits LM, Hien D. Helping vulnerable populations: A comprehensive review of the treatment outcome literature on substance use disorder and PTSD. Journal of Clinical Psychology. 2013;69(5):433-479. doi:10.1002/ jclp.21980.