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

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, mental, and social health outcomes of WLHIV in one clinic, with 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 (ACEs). WLHIV with more lifetime trauma were significantly more likely to report PTSD, depression, and anxiety symptoms; significantly more likely to report potentially harmful alcohol and drug use; and had 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.1 Conclusion: These data suggest that trauma is associated with much of the morbidity and mortality experienced by women living with HIV. The results of this study support the implementation and study of trauma-informed approaches to healthcare for WLHIV.

“I just keep quiet about it and act as if everything is alright” – The cascade from trauma to disengagement among adolescents living with HIV in western Kenya

“…Strategies are needed to provide trauma-informed care to ALHIV [15,[46][47][48][49][50]. Key targets for intervention may centre on preventing, addressing, or mitigating each of the contributing impacts of trauma, stigma, lacking social support and mental health disorders.…”

Factors Associated with Pain Treatment Satisfaction Among Patients with Chronic Non-Cancer Pain and Substance Use

“…69 HIV providers may also feel more comfortable treating substance use disorders, have longer-term relationships with patients, and be more likely to identify as patient allies or practice trauma- informed care, potentially leading to higher pain treatment satisfaction. 70,71 Future studies should also explore what factors and lessons from HIV care can be extended to non-HIV settings to improve pain treatment satisfaction for all patients living with CNCP. The association of cannabis use for pain treatment with higher satisfaction is intriguing, especially as UDS being positive for cannabis was not significantly associated with treatment satisfaction.…”

Help-Seeking to Cope With Experiences of Violence Among Women Living With HIV in Canada

“…Violence has significant impacts on the lives and health of women ( Coker, 2007 ) including depression ( Logie et al, 2019 ), impeding engagement in sustained HIV care and antiretroviral therapy (ART) adherence ( Carter et al, 2017 ; Hatcher et al, 2015 ; Schafer et al, 2012 ; Zunner et al, 2015 ), deterring active participation in social and health advocacy ( Cho et al, 2020 ; Schafer et al, 2012 ), and a synergistic relationship between violence, poly-substance use ( Carter et al, 2017 ), and posttraumatic stress disorder (PTSD; Cuca et al, 2019 ). While this relationship between violence and HIV has been acknowledged and integrated in both community and national action plans ( Khan, 2011 ; Women’s Coalition, 2014 ), there is a lack of research that investigates how women cope with experiences of violence, including where women seek help, and the perceived helpfulness of such supports.…”