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A Randomized Comparison Trial Testing Two Culturally Adapted HIV Prevention Approaches for Native Americans Reducing
C R Pearson1, D Huh2, M Bedard-Gilligan3
1Indigenous Wellness Research Institute, School of Social Work, University of Washington, Box 354900, Seattle, WA, 98105-6299, USA. pearsonc@uw.edu.
AIDS and Behavior
|June 16, 2025
Summary
Narrative Exposure Therapy (NET) and MIST interventions effectively reduced HIV sexual risk behaviors in rural American Indians. NET demonstrated superior results in decreasing risky sexual behaviors and substance misuse compared to MIST.
Area of Science:
- Public Health
- Mental Health
- Addiction Medicine
Background:
- HIV prevention remains a critical public health challenge, particularly among vulnerable populations.
- Co-occurring posttraumatic stress disorder (PTSD) and substance misuse are significant risk factors for HIV sexual risk behaviors.
- Culturally adapted interventions are essential for effective engagement and outcomes in diverse communities.
Purpose of the Study:
- To compare the effectiveness of two culturally adapted counseling approaches, Narrative Exposure Therapy (NET) and Motivational Interviewing with CBT-skills training (MIST), in reducing HIV sexual risk behaviors.
- To assess the impact of interventions targeting PTSD symptoms versus substance misuse on HIV risk behaviors.
- To evaluate outcomes in a sample of rural American Indian adolescents and adults.
Main Methods:
- A randomized controlled trial involving 125 participants (aged 16+) from rural American Indian communities.
- Participants were screened for PTSD and substance misuse and randomly assigned to either NET or MIST.
- Both interventions comprised up to 6 culturally adapted sessions delivered by local counselors, with outcomes assessed at follow-up.
Main Results:
- Both NET and MIST significantly reduced PTSD severity, risky sexual behavior, number of sexual partners, sexual encounters with unknown HIV serostatus partners, and substance use symptoms.
- Narrative Exposure Therapy (NET) was more effective than MIST in reducing risky sexual behaviors and substance use.
- Interventions addressing either PTSD or substance misuse demonstrated efficacy in mitigating HIV sexual risk behaviors.
Conclusions:
- Culturally adapted interventions targeting PTSD symptoms or substance misuse can effectively reduce HIV sexual risk behaviors in rural American Indian populations.
- Narrative Exposure Therapy shows particular promise for simultaneously addressing PTSD and reducing associated HIV risk behaviors.
- These findings underscore the importance of integrated mental health and substance use interventions for comprehensive HIV prevention strategies.
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