3 - (SYM 63) Cognitive Behavioral Therapy for Trauma and Self-care (CBT-TSC): Results of an RCT to Reduce Condomless Anal Sex and Posttraumatic Symptoms Among MSM Who Have Histories of Childhood Sexual Abuse

Background: Childhood sexual abuse (CSA) disproportionately impacts MSM, is associated with higher rates of condomless anal sex, and poorer engagement in the PrEP treatment cascade. MSM with early sexual trauma may experience posttraumatic distress, particularly in adult sexual situations, which can interfere with their ability to protect their sexual health. As such, MSM with CSA histories have unique vulnerabilities for HIV infection that are not addressed by traditional safer sex counseling. This study sought to address this gap by evaluating Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC) a tailored intervention specifically designed to reduce condomless sex and posttraumatic distress.

Methods: HIV-uninfected MSM (n=190) with histories of CSA and recent episodes of condomless intercourse with HIV serodiscordant partners received two sessions of sexual health counseling and were randomized to CBT-TSC (8 individual sessions) or to time-matched supportive psychotherapy. Participants completed baseline and 3, 6, 9, and 12 month assessments including diagnostic assessment of PTSD, CSA-related trauma symptoms, recent sexual behavior, and PrEP use and adherence. The study was conducted in Boston and Miami. Mixed effects models were used to examine acute and follow-up intervention effects on sexual risk and trauma symptom frequency.

Results: Both conditions saw decreases in condomless sex acts from baseline to 3-month follow-up (b = -0.48, 95% CI = -0.87, -0.10; p = 0.01), but there were no significant differences between conditions, controlling for baseline sexual risk and baseline PTSD diagnosis. Both conditions also saw reductions in trauma symptom severity from baseline to 3-month (b = -0.31, 95% CI = -0.49, -0.14; p < 0.001), however, the CBT-TSC group demonstrated larger improvements during the acute intervention period (b = -0.39, 95% CI: = -0.63, -0.16; p = 0.01) than the supportive psychotherapy condition. Reductions in trauma symptom severity for CBT-TSC maintained during the follow-up period. These intervention effects were stronger for those with PTSD diagnosis at baseline.

Conclusions: Findings from this RCT suggest that CBT-TSC is an effective treatment for trauma-related distress among MSM with CSA histories and that both CBT-TSC and supportive psychotherapy are associated with reductions in risk behavior for HIV acquisition. Integrating mental health treatment into sexual health interventions may support the public health by off-setting new infections and improving the mental health of MSM.