Healing Through Expressive Writing and Alcohol Intervention for Women Living with HIV

Alcohol use and trauma substantially impact women with HIV (WWH). Approximately 22-47% of WWH report drinking at unhealthy levels, and up to 60% report symptoms of traumatic stress – both of which are associated with negative consequences on the HIV care continuum. As two of the most prevalent, unaddressed, and comorbid psychiatric issues in this population there is an urgent need for scalable and efficacious combined interventions for WWH. Unhealthy alcohol use and traumatic stress in WWH are usually treated separately, despite calls for combined interventions that address both. Although combined interventions have been studied in veterans in primary care – they are lacking for WWH, who are in high need. We hypothesize that a brief alcohol intervention could be combined with an expressive writing intervention to create a scalable, intervention that could reduce unhealthy levels of alcohol use and symptoms of traumatic stress and be feasibly incorporated into HIV care. The overall objective of this application is therefore to conduct a randomized clinical trial designed to determine the efficacy of a brief, remotely delivered, combined intervention for unhealthy alcohol use and traumatic stress among WWH. The Healing through Expressive Writing and Brief Alcohol (HEAL) Intervention involves a brief alcohol intervention previously shown to significantly reduce unhealthy alcohol use among WWH, followed by an evidence-based brief expressive writing intervention for reducing traumatic stress symptoms and tailored to WWH. We will use the collaboration in CALIBER to accomplish the following specific aims: tailor an expressive writing intervention for syndemic alcohol use and traumatic stress in WWH (Aim 1) and determine the efficacy of a combined brief alcohol and expressive writing intervention for WWH (Aim 2). We will accomplish these aims by conducting qualitative interviews with 25 WWH with unhealthy alcohol use and traumatic stress to determine how to tailor an evidence-based expressive writing intervention to focus on the synergistic associations among HIV, alcohol, and trauma. We will then randomly assign 250 WWH who drink at unhealthy levels and report elevated symptoms of traumatic stress to (1) a brief alcohol intervention developed for WWH followed by the expressive writing intervention from Aim 1 (BI + EW), or a BI-only waitlist control. Traumatic stress and alcohol use will be assessed via self- report and biomarkers of stress (cortisol) and alcohol use (phosphatidylethanol) at baseline, post-treatment, and again 6-months later. We hypothesize that: reductions in alcohol use and traumatic stress will be greater in the BI+EW group than in the BI-only group at all follow-up timepoints. The proposed aims will address a significant unmet need for an effective and highly implementable combined intervention for unhealthy alcohol use and traumatic stress in WWH—significantly improving mental health and HIV-related outcomes in women.