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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- A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization.Drug and Alcohol Dependence. 2010; 112: 178-193
- Relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS.AIDS Patient Care and STDS. 2000; 14: 189-197
- The effect of prandial glucose regulation with repaglinide on treatment satisfaction, wellbeing and health status in patients with pharmacotherapy-naïve type 2 diabetes: A placebo-controlled, multicentre study.Quality of Life Research. 2003; 12: 413-425
- The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation.Journal of Traumatic Stress. 2015; 28: 489-498
- AUDIT-C as a brief screen for alcohol misuse in primary care.Alcoholism Clinical & Experimental Research. 2007; 31: 1208-1217
- The syndemic illness of HIV and trauma: Implications for a trauma-informed model of care.Psychosomatics. 2015; 56: 107-118
- The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol use disorders identification test.Archives of Internal Medicine. 1998; 158: 1789-1795
- Future Research Needs for the Integration of Mental Health/Substance Abuse and Primary Care: Identification of Future Research Needs from Evidence.(Available:)https://effectivehealthcare.ahrq.gov/topics/mental-health-substance-abuse/research/Date: 2010Date accessed: March 24, 2014
- Development and validation of a brief self-report measure of trauma exposure: The Trauma History Screen.Psychological Assessment. 2011; 23: 463-477
- The Adverse Childhood Experiences (ACE) Study.(Available:)www.cdc.gov/violenceprevention/acestudy/Date: 2014Date accessed: October 25, 2015
- HIV and Women.(Available:)www.cdc.gov/hiv/pdf/group/gender/women/cdc-hiv-women.pdfDate: 2018Date accessed: July 25, 2018
- Understanding the HIV Care Continuum.(Available:)www.cdc.gov/hiv/pdf/library/factsheets/cdc-hiv-care-continuum.pdfDate: 2018Date accessed: September 9, 2018
- Using interactive web-based screening, brief intervention and referral to treatment in an urban, safety-net HIV clinic.AIDS and Behavior. 2015; 19: 186-193
- Changes in specific substance involvement scores among SBIRT recipients in an HIV primary care setting.Addiction Science & Clinical Practice. 2017; 12: 34
- Women and Wellness-Staying Healthy Beyond UDVL.in: Paper presented at the 22nd Annual United. States Conference on AIDS, Orlando, FL2018
- Providing HIV primary care in the context of trauma: The impact of professional hierarchies on the care team.Women's Health Issues. 2019; 29: 385-391
- Physical and sexual violence predictors: 20 years of the Women's Interagency HIV Study cohort.American Journal of Preventive Medicine. 2016; 51: 731-742
- Adverse childhood experiences and personal alcohol abuse as an adult.Addictive Behaviors. 2002; 27: 713-725
- Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The Adverse Childhood Experiences study.Pediatrics. 2003; 111: 564-572
- Seeking Safety Group Therapy for co-occurring substance use disorder and PTSD among transgender women living with HIV: A pilot study.Journal of Psychoactive Drugs. 2017; 49: 344-351
- Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.American Journal of Preventive Medicine. 1998; 14: 245-258
- Trends in mortality and causes of death among women with HIV in the US: A ten-year study.Journal of Acquired Immune Deficiency Syndromes. 2009; 51: 399
- Predictors of resilience and posttraumatic growth among people living with HIV: A longitudinal study.AIDS and Behavior. 2017; 2 1: 3260-3270
- A confirmatory factor analysis of an abbreviated social support instrument: The MOS-SSS.Research on Social Work Practice. 2008; 18: 231-237
- Development and validity of a 2-item screen to identify families at risk for food insecurity.Pediatrics. 2010; 126: e26-e32
- Intimate partner violence and engagement in HIV care and treatment among women: A systematic review and meta-analysis.AIDS. 2015; 29: 2183-2194
- Gender differences in causes of death among persons with HIV/AIDS in San Francisco, California, 1996-2013.International Journal of STD and AIDS. 2018; 29: 135-146
- Validation of the Alcohol, Smoking And Substance Involvement Screening Test (ASSIST).Addiction. 2008; 103: 1039-1047
- Clinical Preventive Services for Women: Closing the Gaps.(Available:)www.nap.edu/openbook.php?record_id=13181Date: 2011Date accessed: December 18, 2018
- The PHQ-9: Validity of a brief depression severity measure.Journal of General Internal Medicine. 2001; 16: 606-613
- A review of recent literature on trauma among individuals living with HIV.Current HIV/AIDS Reports. 2015; 12: 397-405
- Buffering effects of general and medication-specific social support on the association between substance use and HIV medication adherence.AIDS Patient Care and STDs. 2011; 25: 181-189
- Measuring depression outcome with a brief self-report instrument: Sensitivity to change of the Patient Health Questionnaire (PHQ-9).Journal of Affective Disorders. 2004; 81: 61-66
- Optimal recall period and response task for self-reported HIV medication adherence.AIDS and Behavior. 2008; 12: 86-94
- Highly active antiretroviral therapy in a large urban clinic: Risk factors for virologic failure and adverse drug reactions.Annals of Internal Medicine. 1999; 131: 81-87
- Recent trauma is associated with antiretroviral failure and HIV transmission risk behavior among HIV-positive women and female-identified transgenders.AIDS and Behavior. 2012; 16: 2160-2170
- Psychological trauma and PTSD in HIV-positive women: A meta-analysis.AIDS and Behavior. 2012; 16: 2091-2100
- From treatment to healing: The promise of trauma-informed primary care.Women’s Health Issues. 2015; 25: 193-197
- From treatment to healing: Inquiry and response to recent and past trauma in adult health care.Women’s Health Issues. 2019; 29: 97-101
- Reductions in alcohol and cocaine use following a group coping intervention for HIV-positive adults with childhood sexual abuse histories.Addiction. 2010; 105: 1942-1951
- Improving engagement in HIV care: What can we do?.Topics in HIV Medicine. 2008; 16: 156-161
- Screening women for intimate partner violence: A systematic review to update the U.S. Preventive Services Task Force recommendation.Annals of Internal Medicine. 2012; 156 (W-279, W-280, W-281, W-282): 796-808
- 1998 (Available:)https://www.psykiatri-regionh.dk/who-5/Documents/WHO5_English.pdfDate accessed: July 3, 2019Mental Health at Frederiksborg General Hospital. (ND). WHO (Five) Well-Being Index.
- An evidence-based group coping intervention for women living with HIV and history of childhood sexual abuse.International Journal of Group Psychotherapy. 2011; 61: 98-126
- The relationships of childhood trauma and adulthood prescription pain reliever misuse and injection drug use.Drug and Alcohol Dependence. 2016; 169: 190-198
- A consumer-constructed scale to measure empowerment among users of mental health services.Psychiatric Services. 1997; 48: 1042-1047
- Development and psychometric assessment of a multidimensional measure of internalized HIV stigma in a sample of HIV-positive adults.AIDS and Behavior. 2008; 12: 748-758
- Interventions to improve psychological functioning and health outcomes of HIV-infected individuals with a history of trauma or PTSD.Current HIV/AIDS Reports. 2012; 9: 344-350
- The MOS Social Support Survey.Social Science and Medicine. 1991; 32: 705-714
- The clinical implications of high rates of intimate partner violence against HIV-positive women.Journal of Acquired Immune Deficiency Syndrome. 2013; 64: 32-38
- Effects of a coping intervention on transmission risk behavior among people living with HIV/AIDS and a history of childhood sexual abuse.Journal of Acquired Immune Deficiency Syndromes. 2008; 47: 506-513
- Syndemics and public health: Reconceptualizing disease in bio-social context.Medical Anthropology Quarterly. 2003; 17: 423-441
- Drug use questionnaire (DAST-20).Addiction Research Foundation, Toronto1982
- A brief measure for assessing generalized anxiety disorder: The GAD-7.Archives of Internal Medicine. 2006; 166: 1092-1097
- Stata Statistical Software: Release. 14. Author, College Station, TX2015
- Internal construct validity of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS): A Rasch analysis using data from the Scottish Health Education Population Survey.Health Qual Life Outcomes. 2009; 7: 15
- SAMHSA's Concept of Trauma and Guidance for a Trauma-informed Approach.(Available:)http://store.samhsa.gov/shin/content/SMA14-4884/SMA14-4884.pdfDate: 2014Date accessed: March 1, 2015
- Substance abuse, violence, and HIV/AIDS (SAVA) syndemic effects on viral suppression among HIV positive women of color.AIDS Patient Care and STDS. 2015; 29: S42-S48
- West China Hospital set of measures in Chinese to evaluate back pain treatment.Pain Medicine. 2010; 11: 637-647
- The relationship of post-traumatic stress disorder and depression to antiretroviral medication adherence in persons with HIV.AIDS Patient Care and STDS. 2008; 22: 313-321
- The PTSD Checklist for DSM-5 (PCL-5).(Available:)www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.aspDate: 2013Date accessed: July 25, 2018
- Prevalence and predictors of PTSD in a large cohort of women with and at risk for HIV. Paper presented at the American Public Health Association annual meeting, San Francisco, CA. Oral abstract 272385.(Available:)https://apha.confex.com/apha/140am/webprogram/Paper272385.htmlDate: 2012Date accessed: July 3, 2019
- Global burden of disease attributable to mental and substance use disorders: Findings from the Global Burden of Disease Study 2010.Lancet. 2013; 382: 1575-1586
- The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Development, reliability and feasibility.Addiction. 2002; 97: 1183-1194
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.
Published online: July 11, 2019
Accepted: June 7, 2019
Received in revised form: April 25, 2019
Received: January 15, 2019
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.
© 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc.