Elsevier

Women's Health Issues

Volume 29, Issue 5, September–October 2019, Pages 376-384
Women's Health Issues

Trauma and HIV
The Association of Trauma with the Physical, Behavioral, and Social Health of Women Living with HIV: Pathways to Guide Trauma-informed Health Care Interventions

https://doi.org/10.1016/j.whi.2019.06.001Get rights and content

Abstract

Background

Trauma is increasingly recognized as a near-universal experience among women living with HIV (WLHIV) and a key contributor to HIV acquisition, morbidity, and mortality.

Methods

We present data from the baseline analysis of a planned intervention trial of the impact of trauma-informed health care on physical, behavioral, and social health outcomes of WLHIV in one clinic, with a particular focus on quality of life and viral suppression. Data were collected through interviewer-administered surveys and electronic health record data abstraction.

Results

Among 104 WLHIV, 97.1% of participants reported having experienced lifetime trauma, and participants had experienced on average 4.2 out of 10 Adverse Childhood Experiences. WLHIV with more lifetime trauma were significantly more likely to report post-traumatic stress disorder, depression, and anxiety symptoms; significantly more likely to report potentially harmful alcohol and drug use; and had a significantly poorer quality of life. In addition, women who had experienced more lifetime trauma were significantly less likely to report being on and adhering to HIV medications, although trauma was not significantly associated with having an undetectable HIV viral load.

Conclusions

These data suggest that trauma is associated with much of the morbidity and mortality experienced by WLHIV. The results of this study support the implementation and study of trauma-informed approaches to health care for WLHIV.

Section snippets

Methods

Quantitative patient data were collected in Fall (2015), before any TIHC changes in the clinic. Data were also collected from clinic staff in a parallel study about the impact of working with a highly traumatized population (Dawson-Rose, Cuca, Shumway, Davis, & Machtinger, 2019). The study was approved by the University of California, San Francisco Institutional Review Board.

Results

Participants in the study were 104 WLHIV (Table 1). Four participants identified as transgender or intersex; they were included in all analyses as the intervention being evaluated is clinic-wide and the four women represent an important portion of the clinic’s patient population. The participants’ mean age was 52 years and almost 80% were women of color. Approximately one-half had a high school education or less, only 20% were working for pay, and 61% reported food insecurity in the past year.

Discussion

In this sample of WLHIV, we found near-universal reports of lifetime trauma, including childhood and adult trauma, as well as a significant minority who reported incidents of abuse and threats in the past 30 days. These findings support the growing body of literature documenting high rates of trauma and PTSD among WLHIV (Machtinger et al., 2012a, Machtinger et al., 2012b Weber et al., 2012), and uniquely add to it by documenting high mean ACE scores in a population of WLHIV for the first time.

Implications for Practice and/or Policy

The data presented here support the implementation of trauma-informed approaches to health care for WLHIV (Machtinger et al., 2015, Machtinger et al., 2019). TIHC acknowledges and addresses recent and past trauma and PTSD, and has the promise to lead to improved physical, behavioral, and social health outcomes for patients.

Conclusions

We found significant associations between lifetime trauma and quality of life, ART medication adherence, substance use, mental health symptoms, and HIV-related stigma. The results of this baseline study as well as the forthcoming prospective study will contribute to an emerging body of literature informing models of TIHC.

Acknowledgments

Our team would like to acknowledge all of the study participants, as well as Esther Chavez for her assistance with outreach and recruitment. We also acknowledge Emily Huang for data management, and our data collection team: Patricia Ambrose, Natalie Ingraham, Vishalli Loomba, Kate Mitchell, and Sheba Vincent.

Yvette P. Cuca, PhD, MPH, MIA, is a Research Specialist and Project Director at the UCSF School of Nursing. Her work focuses on sexual and reproductive health and rights for women living with HIV.

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    Yvette P. Cuca, PhD, MPH, MIA, is a Research Specialist and Project Director at the UCSF School of Nursing. Her work focuses on sexual and reproductive health and rights for women living with HIV.

    Martha Shumway, PhD, is Associate Professor in the UCSF Department of Psychiatry. Her work focuses on measurement, research methodology, and the effectiveness of mental health services.

    Edward L. Machtinger, MD, is a Professor of Medicine and Director of the Women’s HIV Program at UCSF. His research focuses on the impact of trauma among women living with HIV and on developing and evaluating models of trauma-informed health care.

    Katy Davis, PhD, LCSW, is the Director of Trauma-Informed Care at the UCSF Women’s HIV Program. Her research focuses on the roles of attachment and stigma in intimate partner violence.

    Naina Khanna, BS, is Executive Director of Positive Women’s Network – USA. Her research interests include the sexual rights of women with HIV, and the ways women with HIV negotiate access to power and decision making.

    Jennifer Cocohoba, PharmD, is Professor of Clinical Pharmacy at the UCSF School of Pharmacy and a Pharmacist in the UCSF Women’s HIV Program clinic. Her research focuses on pharmacy-based interventions to improve adherence to HIV treatments.

    Carol Dawson-Rose, RN, PhD, is Professor of Nursing at the UCSF School of Nursing. Her research focuses on implementing behavioral health interventions in HIV primary care settings.

    Funding Statement: We acknowledge support from the UCSF National Center of Excellence in Women’s Health; the Mose J. and Sylvia Dilman Firestone Charitable Trust; and the HIV/AIDS Nursing Care and Prevention program (T32 NR007081). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

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    © 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc.