Trauma and HIV| Volume 29, ISSUE 5, P376-384, September 2019

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



      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.


      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.


      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.


      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.
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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.