Trauma and HIV| Volume 29, ISSUE 5, P385-391, September 2019

Providing Primary Care for HIV in the Context of Trauma: Experiences of the Health Care Team



      Trauma-informed health care for women living with human immunodeficiency virus (HIV) attends not only to HIV treatment, but also to the many common physical and emotional health consequences of trauma. One principle of providing trauma-informed care is the acknowledgement that working with a population that has experienced extensive trauma affects the team members who care for them in the clinic, as well as the interactions between those team members.


      To understand the needs of one primary health care team, we conducted in-depth interviews with 21 providers, staff, and collaborators who provide care to patients within the clinic. We used symbolic interaction and grounded theory methods to examine how interactions unfold within the clinic and how they are influenced by trauma.


      The clinic team serves a highly traumatized and vulnerable population. Within this context, interactions between clinic staff unfold and trauma surfaces, and power dynamics play out along the lines of professional hierarchy. Although power differences cause tension within the clinic, professional hierarchy also serves as an important division of labor in times of medical crises.


      Clinic power dynamics may be influenced to improve the care environment for patients, and to realize a more effective and satisfying trauma-informed health care clinic for both patients and staff.
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      Carol Dawson-Rose, RN, PhD, is a professor of nursing at the UCSF School of Nursing. Her research focuses on implementing behavioral health interventions in HIV primary care settings.


      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 an associate professor in the UCSF Department of Psychiatry. Her work focuses on measurement, research methodology, and the effectiveness of mental health services.


      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.


      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.