Wednesday, August 7, 2013

Sex, Relationships, and HIV: Interview with Gail Wyatt, Ph.D.

[Episode 83] In today's Social Work Podcast I speak with Dr. Gail Wyatt, pioneering sex researcher, award winning teacher, mentor, and researcher, and the first African-American woman to be licensed as a psychologist in the state of California. I spoke with Dr. Wyatt in April 2010 when she was at Temple University giving a talk about her research with African American HIV serodiscordant couples. Serodiscordant couples are those in which one partner is HIV positive and the other is HIV negative. Dr. Wyatt and her co-investigators had just concluded an 8-years investigation of a couples therapy intervention that they hoped would reduce HIV/STD risk behaviors in African American HIV serodiscordant couples. They called the intervention Eban which is "a traditional African concept meaning 'fence,' a symbol of safety, security, and love within one's family and relationship space" (El-Bassel et al., 2010, p. 1596) The Eban intervention combined components of social cognitive theory, historical and cultural beliefs about family and community preservation, and an Afrocentric paradigm. If you want to read more about the Eban intervention or the results of this clinical trial I’ve posted the links to those and related articles on the Social Work Podcast website. So, you’re probably wondering, after 8 years did it work? Yes. At the end of 8 years, and 535 couples later, the couples that were part of the Eban intervention used condoms more frequently and more consistently and reported fewer sexual acts without condoms than the couples in the health promotion comparison group. And I have no doubt that when the researchers finished running those analyses, they went "Phew! Thank Goodness!"

For today's interview, Dr. Wyatt and I talked a bit about the research, but mostly we talked about two of the techniques that were used in the clinical trial. The first was a way of having couples plan and enjoy safe sex. The second had to do with addressing past histories of abuse within the context of a consensual sexual relationship.  It was at this point that the conversation moved away from couples therapy into a conversation about healthy sexual behaviors. Dr. Wyatt made the point that most health and mental health providers ask about a client's "age of first sexual contact" without distinguishing between consensual and non-consensual sexual contact. She pointed out that adolescents sometimes do not distinguish between the two. She encouraged providers to be more precise in their questions, and to find out if their clients are current victims of sexual abuse. We about how to include adolescent clients in mandated abuse reporting calls if current abuse is uncovered, and how to address the issue of sex among adolescents who are victims of past or current sexual abuse. And, as usual, I asked Dr. Wyatt if she could provide some resources for people who were interested in learning more, and she was happy to oblige.

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Bio
(from: UCLA Health)
Academic and Clinic titles:

Professor, Dept. of Psychiatry & Biobehavioral Sciences
UCLA Semel Institute for Neuroscience and Human Behavior
Director, UCLA Sexual Health Program
Director, Center for Culture, Trauma and Mental Health Disparities
Associate Director, UCLA AIDS Institute


Dr. Wyatt is a clinical psychologist, sex therapist and professor in the Department of Psychiatry and Biobehavioral Sciences at UCLA. She was an NIMH Research Scientist Career Development Awardee for 17 years. Her research examines the consensual and abusive sexual relationships of women and men, the effects of these experiences on their psychological well-being, and the cultural context of risks for sexually-transmitted diseases and HIV. She has conducted national and international research since 1980, funded by the National Institutes of Mental Health, the National Institute of Drug Abuse, state and private foundations. The recipient of numerous awards, Dr. Wyatt has to her credit more than 110 journal articles and book chapters, and has co-edited or written five books, including Stolen Women: Reclaiming our Sexuality, Taking Back Our Lives and No More Clueless Sex: 10 Secrets to a Sex Life That Works for Both of You. Dr. Wyatt is an Associate Director of the UCLA AIDS Institute and coordinates a core of behavioral scientists who consult with other researchers to recruit underserved populations and conduct research that effectively incorporates socio-cultural factors into HIV/AIDS research. Dr. Wyatt has received numerous awards and honors for her scientific accomplishments, mentoring, and teaching. She has also testified before the United States Congress eight times on issues related to health policy. She was the first African-American woman to be licensed as a psychologist in the state of California.

Transcript

Introduction

Jonathan Singer: In today's Social Work Podcast I speak with Dr. Gail Wyatt, pioneering sex researcher, award winning teacher, mentor, and researcher, and the first African-American woman to be licensed as a psychologist in the state of California. I spoke with Dr. Wyatt in April 2010 when she was at Temple University giving a talk about her research with African American HIV serodiscordant couples. Serodiscordant couples are those in which one partner is HIV positive and the other is HIV negative. Dr. Wyatt and her co-investigators had just concluded an 8-years investigation of a couples therapy intervention that they hoped would reduce HIV/STD risk behaviors in African American HIV serodiscordant couples. They called the intervention Eban which is "a traditional African concept meaning “fence,” a symbol of safety, security, and love within one’s family and relationship space" (El-Bassel et al., 2010, p. 1596) The Eban intervention combined components of social cognitive theory, historical and cultural beliefs about family and community preservation, and an Afrocentric paradigm. If you want to read more about the Eban intervention or the results of this clinical trial I’ve posted the links to those and related articles on the Social Work Podcast website. So, you’re probably wondering, after 8 years did it work? Yes. At the end of 8 years, and 535 couples later, the couples that were part of the Eban intervention used condoms more frequently and more consistently and reported fewer sexual acts without condoms than the couples in the health promotion comparison group. And I have no doubt that when the researchers finished running those analyses, they went "Phew! Thank Goodness!"

For today's interview, Dr. Wyatt and I talked a bit about the research, but mostly we talked about two of the techniques that were used in the clinical trial. The first was a way of having couples plan and enjoy safe sex. The second had to do with addressing past histories of abuse within the context of a consensual sexual relationship.  It was at this point that the conversation moved away from couples therapy into a conversation about healthy sexual behaviors. Dr. Wyatt made the point that most health and mental health providers ask about a client’s "age of first sexual contact" without distinguishing between consensual and non-consensual sexual contact. She pointed out that adolescents sometimes do not distinguish between the two. She encouraged providers to be more precise in their questions, and to find out if their clients are current victims of sexual abuse. We about how to include adolescent clients in mandated abuse reporting calls if current abuse is uncovered, and how to address the issue of sex among adolescents who are victims of past or current sexual abuse. And, as usual, I asked Dr. Wyatt if she could provide some resources for people who were interested in learning more, and she was happy to oblige.

And now, without further ado, on to episode 83 of the Social Work Podcast, "Sex, Relationships, and HIV: Interview with Gail Wyatt, Ph.D."

Interview

(forthcoming)


References and Resources

El-Bassel, N., Jemmott, J. B., Landis, J. R., Pequegnat, W., Wingood, G. M., Wyatt, G. E., … NIMH Multisite HIV/STD Prevention Trial for African American Couples Group. (2010). National Institute of Mental Health Multisite Eban HIV/STD Prevention Intervention for African American HIV Serodiscordant Couples: a cluster randomized trial. Archives of Internal Medicine, 170, 1594–1601. doi:10.1001/archinternmed.2010.261
BACKGROUND: Human immunodeficiency virus (HIV) has disproportionately affected African Americans. Couple-level interventions may be a promising intervention strategy. METHODS: To determine if a behavioral intervention can reduce HIV/sexually transmitted disease (STD) risk behaviors among African American HIV serodiscordant couples, a cluster randomized controlled trial (Eban) was conducted in Atlanta, Georgia; Los Angeles, California; New York, New York; and Philadelphia, Pennsylvania; with African American HIV serodiscordant heterosexual couples who were eligible if both partners were at least 18 years old and reported unprotected intercourse in the previous 90 days and awareness of each other’s serostatus. One thousand seventy participants were enrolled (mean age, 43 years; 40% of male participants were HIV positive). Couples were randomized to 1 of 2 interventions: couple-focused Eban HIV/STD risk-reduction intervention or attention-matched individual-focused health promotion comparison. The primary outcomes were the proportion of condom-protected intercourse acts and cumulative incidence of STDs (chlamydia, gonorrhea, or trichomonas). Data were collected preintervention and postintervention, and at 6- and 12-month follow-ups. RESULTS: Data were analyzed for 535 randomized couples: 260 in the intervention group and 275 in the comparison group; 81.9% were retained at the 12-month follow-up. Generalized estimating equation analyses revealed that the proportion of condom-protected intercourse acts was larger among couples in the intervention group (0.77) than in the comparison group (0.47; risk ratio, 1.24; 95% confidence interval [CI], 1.09 to 1.41; P = .006) when adjusted for the baseline criterion measure. The adjusted percentage of couples using condoms consistently was higher in the intervention group (63%) than in the comparison group (48%; risk ratio, 1.45; 95% CI, 1.24 to 1.70; P <.001). The adjusted mean number of (log)unprotected intercourse acts was lower in the intervention group than in the comparison group (mean difference, -1.52; 95% CI, -2.07 to -0.98; P < .001). The cumulative STD incidence over the 12-month follow-up did not differ between couples in the intervention and comparison groups. The overall HIV seroconversion at the 12-month follow-up was 5 (2 in the intervention group, 3 in the comparison group) of 535 individuals, which translates to 935 per 100,000 population. CONCLUSION: To our knowledge, this is the first randomized controlled intervention trial to report significant reductions in HIV/STD risk behaviors among African American HIV serodiscordant couples. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00644163.
Loeb, T. B., Gaines, T., Wyatt, G. E., Zhang, M., & Liu, H. (2011). Associations between child sexual abuse and negative sexual experiences and revictimization among women: does measuring severity matter? Child Abuse & Neglect, 35, 946–955. doi:10.1016/j.chiabu.2011.06.003. Free Article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262588/
ABSTRACT:  Women with histories of child sexual abuse (CSA) are more likely than those without such experiences to report a variety of negative sexual outcomes. This study examines the explanatory power of a CSA summed composite versus dichotomous (presence/absence) measurement in predicting a comprehensive negative sexual behavior outcome. Study participants were obtained from a community based sample examining women’s sexual decision-making. The continuous CSA measurement reflects cumulative histories of CSA through a composite score capturing abuse specific characteristics. Using a cross-validation approach, the sample (n=835) was randomly split and the explanatory power of each measure was examined through a series of multiple linear regressions comparing model fit indexes and performing a formal likelihood ratio test of one model against another. All CSA measures explained a similar percentage of variance but overall the CSA summed composite explained the data significantly better in terms predicting negative sexual experiences and revictimization than a binary measure as demonstrated with the likelihood ratio test. The results were replicated by cross-validating the predictive power of the CSA composite score between the split samples. Consistency of CSA regression estimates for the summed composite between training and validation samples were also confirmed. Given the superiority of the CSA summed composites over the binary variable, we recommend using this measure when examining associations between CSA histories and negative sexual experiences and revictimization.
Williams, J. K., Glover, D. A., Wyatt, G. E., Kisler, K., Liu, H., & Zhang, M. (2013). A Sexual Risk and Stress Reduction Intervention Designed for HIV-Positive Bisexual African American Men With Childhood Sexual Abuse Histories. American Journal of Public Health, 103, 1476–1484. doi:10.2105/AJPH.2012.301121
ABSTRACT: Objectives. HIV transmission risk is high among men who have sex with men and women (MSMW), and it is further heightened by a history of childhood sexual abuse (CSA) and current traumatic stress or depression. Yet, traumatic stress is rarely addressed in HIV interventions. We tested a stress-focused sexual risk reduction intervention for African American MSMW with CSA histories. Methods. This randomized controlled trial compared a stress-focused sexual risk reduction intervention with a general health promotion intervention. Sexual risk behaviors, psychological symptoms, stress biomarkers (urinary cortisol and catecholamines), and neopterin (an indicator of HIV progression) were assessed at baseline and at 3- and 6-month follow-ups. Results. Both interventions decreased and sustained reductions in sexual risk and psychological symptoms. The stress-focused intervention was more efficacious than the general health promotion intervention in decreasing unprotected anal insertive sex and reducing depression symptoms. Despite randomization, baseline group differences in CSA severity, psychological symptoms, and biomarkers were found and linked to subsequent intervention outcomes. Conclusions. Although interventions designed specifically for HIV-positive African American MSMW can lead to improvements in health outcomes, future research is needed to examine factors that influence intervention effects.
NIMH Multisite HIV/STD Prevention Trial for African American Couples Group. (2008). Eban health promotion intervention: conceptual basis and procedures. Journal of Acquired Immune Deficiency Syndromes (1999), 49 Suppl 1, S28–34. doi:10.1097/QAI.0b013e3181842548 Free Article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2814167/
OBJECTIVE: This article concerns the health promotion intervention that served as the comparison condition in Project Eban, the NIMH Multisite HIV/STD Prevention Trial for African American Couples. Considerable research has documented the high rates of chronic diseases, including heart disease, cancer, stroke, and diabetes, among African Americans. Many of these diseases are tied to behavioral risk factors-the things that people do or do not do, their diet, the amount of exercise they get, and their substance use practices. DESIGN: The Eban Health Promotion Intervention was designed to increase healthful behaviors, including physical activity, healthful dietary practices, ceasing cigarette smoking and alcohol abuse, practicing early detection and screening behaviors, and improving medication adherence. As a comparison condition, the Eban Health Promotion Intervention was designed to be structurally similar to the Eban HIV/STD Risk Reduction Intervention. METHODS: This article describes the intervention and how it was developed, integrating social cognitive theory with information collected in formative research to ensure that the intervention was appropriate for African Americans affected by HIV. CONCLUSION: Project Eban not only tests the efficacy of an HIV/STD risk reduction intervention for African American serodiscordant couples, but also tests the efficacy of an intervention addressing many of the other health problems common in this population.
Williams, J. K., Wyatt, G. E., & Wingood, G. (2010). The four Cs of HIV prevention with African Americans: crisis, condoms, culture, and community. Current HIV/AIDS reports, 7(4), 185–193. doi:10.1007/s11904-010-0058-0. Free Article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938440/
ABSTRACT: HIV/AIDS continues to be a devastating epidemic with African American communities carrying the brunt of the impact. Despite extensive biobehavioral research, current strategies have not resulted in significantly decreasing HIV/AIDS cases among African Americans. The next generation of HIV prevention and risk reduction interventions must move beyond basic sex education and condom use and availability. Successful interventions targeting African Americans must optimize strategies that integrate socio-cultural factors and address institutional and historical barriers that hinder or support HIV risk reduction behaviors. Community-based participatory research to decrease the HIV/AIDS disparity by building community capacity and infrastructure and advocating for and distributing equitably, power and resources, must be promoted. Recommendations for paradigm shifts in using innovative theories and conceptual frameworks and for training researchers, clinicians, grant and journal reviewers, and community members are made so that culturally congruent interventions may be tested and implemented at the community level.
Wyatt, G. E. (2009). Enhancing cultural and contextual intervention strategies to reduce HIV/AIDS among African Americans. American Journal of Public Health, 99, 1941–1945. doi:10.2105/AJPH.2008.152181 Free Article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759808/
ABSTRACT: I describe 4 protective strategies that African Americans employ that may challenge current HIV prevention efforts: (1) an adaptive duality that protects identity, (2) personal control influenced by external factors, (3) long-established indirect communication patterns, and (4) a mistrust of “outsiders.” I propose the Sexual Health Model as a conceptual framework for HIV prevention interventions because it incorporates established adaptive coping strategies into new HIV-related protective skills. The Sexual Health Model promotes interconnectedness, sexual ownership, and body awareness, 3 concepts that represent the context of the African American historical and cultural experience and that enhance rather than contradict future prevention efforts.

Wyatt, G. E., G√≥mez, C. A., Hamilton, A. B., Valencia-Garcia, D., Gant, L. M., & Graham, C. E. (2013). The intersection of gender and ethnicity in HIV risk, interventions, and prevention: new frontiers for psychology. The American Psychologist, 68, 247–260. doi:10.1037/a0032744
ABSTRACT: This article articulates a contextualized understanding of gender and ethnicity as interacting social determinants of HIV risk and acquisition, with special focus on African Americans and Hispanics/Latinos--2 ethnic groups currently at most risk for HIV/AIDS acquisition in the United States. First, sex and gender are defined. Second, a conceptual model of gender, ethnicity, and HIV risk and resilience is presented. Third, a historical backdrop of gender and ethnic disparities is provided, with attention to key moments in history when notions of the intersections between gender, ethnicity, and HIV have taken important shifts. Finally, new frontiers in psychology are presented, with recommendations as to how psychology as a discipline can better incorporate considerations of gender and ethnicity as not only HIV risk factors but also as potential avenues of resilience in ethnic families and communities. Throughout the article, we promulgate the notion of a syndemic intersectional approach, which provides a critical framework for understanding and building the conditions that create and sustain overall community health by locating gendered lived experiences and expectations within the layered conceptual model ranging from the biological self to broader societal structures that define and constrain personal decisions, behaviors, actions, resources, and consequences. For ethnic individuals and populations, health disparities, stress and depression, substance abuse, and violence and trauma are of considerable concern, especially with regard to HIV risk, infection, and treatment. The conceptual model poses new frontiers for psychology in HIV policy, research, interventions, and training.
Wyatt, G. E., Loeb, T. B., Williams, J. K., Zhang, M., & Davis, T. D. (2012). A case study of sexual abuse and psychological correlates among an HIV-serodiscordant couple. Couple and Family Psychology: Research and Practice, 1, 146–159. doi:10.1037/a0028773  Free Article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731162/
ABSTRACT: Childhood sexual abuse (CSA), adult sexual abuse (ASA), and intimate partner violence (IVP) are documented risk factors for HIV infection and are often implicated in the presentation of mental health disorders in both males and females, including those who are vulnerable to HIV infection (African Americans; trauma survivors). As such, these issues may contribute to health-related challenges among couples, particularly if the individuals are impacted by histories of trauma and HIV. Presented here is a case study of one couple with self-reported histories of CSA and clinically significant symptoms of posttraumatic stress disorder (PTSD) and depression. This couple was selected from a larger National Institute of Mental Health (NIMH)-funded study of 535 African-American HIV-serodiscordant heterosexual couples (see El Bassel et al., 2010). The study couple completed eight sessions of an HIV sexual risk reduction intervention program to increase condom use. Although the couple reported an initial increase in condom use at the immediate post intervention assessment, condom use decreased to baseline assessment levels at the 12-month post intervention assessment. The decrease in HIV-transmission protective behaviors over time (i.e., condom use), in part, may be attributable to the clinically significant psychological distress symptoms of PTSD and depression that were maintained from baseline, throughout the trial, and at follow-up assessments. We propose that the success of sexual risk reduction interventions may be attenuated and compromised over time by the presence of sexual trauma histories and the residual mental health issues. We discuss clinical implications for health care professionals in their work with couples, especially those from racially diverse groups.

Wyatt, G. E., Williams, J. K., Gupta, A., & Malebranche, D. (2012). Are cultural values and beliefs included in U.S. based HIV interventions? Preventive Medicine, 55(5), 362–370. doi:10.1016/j.ypmed.2011.08.021
OBJECTIVE: To determine the extent to which current United States based human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) prevention and risk reduction interventions address and include aspects of cultural beliefs in definitions, curricula, measures and related theories that may contradict current safer sex messages.
METHOD: A comprehensive literature review was conducted to determine which published human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) prevention and risk reduction interventions incorporated aspects of cultural beliefs.
RESULTS: This review of 166 human immunodeficiency virus (HIV) prevention and risk reduction interventions, published between 1988 and 2010, identified 34 interventions that varied in cultural definitions and the integration of cultural concepts.
CONCLUSION: human immunodeficiency virus (HIV) interventions need to move beyond targeting specific populations based upon race/ethnicity, gender, sexual, drug and/or risk behaviors and incorporate cultural beliefs and experiences pertinent to an individual’s risk. Theory based interventions that incorporate cultural beliefs within a contextual framework are needed if prevention and risk reduction messages are to reach targeted at risk populations. Implications for the lack of uniformity of cultural definitions, measures and related theories are discussed and recommendations are made to ensure that cultural beliefs are acknowledged for their potential conflict with safer sex skills and practices.
Effects of caffeine on the Body



APA (6th ed) citation for this podcast:

Singer, J. B. (Producer). (2013, August 7). #83 - Sex, relationships, and HIV: Interview with Gail Wyatt, Ph.D. [Audio Podcast]. Social Work Podcast. Retrieved from http://www.socialworkpodcast.com/2013/08/gail-wyatt.html

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