Studies indicate the frequent co-occurrence of trauma histories and substance use disorders in women, which may increase HIV sexual risk behaviors. Researchers studied the impact of 2 group therapy interventions to reduce unprotected sexual occasions (USO) among women with co-occurring posttraumatic stress disorder (PTSD) and substance use disorders: Seeking Safety (SS), a cognitive behavioral intervention addressing substance use and PTSD symptoms, and Women's Health Education (WHE), a psycho-educational intervention focused on health, nutrition, and sexual behavior including sessions on HIV risk and transmission. A total of 346 women from 6 community-based drug treatment programs participating in the NIDA Clinical Trials Network were randomized to receive 1 of the 2 interventions. Forty-six percent of the total sample reported at least one USO in the 30 days prior to intake. Most had experienced physical or sexual violence in their lifetime (94% and 90%, respectively), and all met DSM-IV criteria for either full (80%) or subthreshold (20%) PTSD.

• Women in the SS group with the highest sexual risk at baseline (at least 12 USO per month) had significantly fewer USO at 12-month follow-up compared with women with the highest baseline sexual risk in the WHE group (4.97 versus 8.60 USO per month, respectively).
• There was no difference in USO between groups at 12 months among women with the lowest baseline sexual risk (≤2 USO per month).

Comments by Norma Finkelstein, PhD
Findings from this randomized controlled trial show that SS, which emphasizes coping skills and reducing unsafe behavior and treats PTSD and substance misuse concurrently, may be more effective than traditional sexual risk reduction interventions in high-risk women with co-occurring PTSD and addictive disorders. Addressing trauma and improving women's coping and behavior skills may also prove effective in HIV education services. It would be interesting to know whether SS combined with HIV-specific education would have further reduced USO among high-risk women in this study.