Cognitive Behavioral Therapy for Trauma and Self-Care to Treat Posttraumatic Stress Symptoms and Support HIV Care Engagement Among Men With HIV Who Have Sex With Men: A Case Series

There is a strong need for clinical interventions that improve engagement in HIV care among men who have sex with men (MSM) with HIV who have histories of trauma. Cognitive behavioral therapy (CBT) has substantial support for treating posttraumatic stress among people with HIV and among HIV-negative MSM. In this population, posttraumatic responses can include both general avoidance of distress related to the trauma but also specific avoidance of HIV-related stimuli that can reduce engagement in HIV care. The present paper introduces an application of Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC), which integrates CBT strategies to address posttraumatic stress symptoms with the Life-Steps framework, an evidence-based, single-session problem-solving intervention that increases adherence to antiretroviral therapies. Other CBT components include psychoeducation and the reduction of specific trauma symptoms, including avoidance and negative self-beliefs that can act as barriers to care engagement. The intervention is presented via four individual case studies. These cases demonstrate the ways in which CBT-TSC can be used to support mental health and self-care among MSM with HIV who have histories of trauma and are facing barriers to full participation in HIV care.