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Treating and Preventing HIV with Trauma-Informed Care

In addition to dealing with the demands of HIV, a substantial proportion of infected individuals are living with the fallout of trauma. As defined by the Substance Abuse and Mental Health Services Administration, trauma is an event or circumstance that adversely affects an individual, causing lasting effects to a person’s mental, physical, social, emotional, or spiritual well-being. Estimates are that 30% of all people in the US with HIV were subjected to physical or sexual abuse before age 13. Among women with HIV, studies reveal that anywhere from 68% to 95% have been subjected to intimate partner violence, while anywhere from 68% to 77% of HIV-infected men have experienced the same. Transgender HIV-infected individuals seem to have some of the highest incidences of trauma; one report notes that approximately 93% of them are the victims of intimate partner violence at some point.
While HIV-infected individuals are more likely than others to have experienced trauma, many people without HIV who’ve experienced trauma are at risk of contracting HIV due to psychiatric conditions such as anxiety, depression, and post-traumatic stress disorder that may lead them to partake in risky behaviors such as drug abuse and unprotected sex. Approximately 51% to 81% of adults in high-income countries such as the US have experienced at least one traumatic event in their lives and plenty of people have endured multiple traumas that may take a toll on their psyches.
Due to the fact that it’s so vital to understand the role that trauma plays in mental and physical health, a team of researchers from Emory University’s Rollins School of Public Health conducted a survey designed to examine recent studies highlighting interventions—such as community workshops, couples counseling, or individual therapy sessions focused on mitigating risky behavior—that were conducted specifically with a focus of trauma in mind.
The researchers found eight interventions, mostly outside of the US, that met their criteria. The interventions were quite diverse, including one designed for sex workers, one aimed at helping HIV-positive African-American men who have sex with both men and women, one for heterosexual couples in which the male partner struggles with alcohol, two aimed at any person who has been the victim of intimate-partner violence, and three focused on helping women exclusively. They took place in locations as varied as Uganda, India, and South Africa, where violence against women has been a particular problem, as has HIV.
Noteworthy among the researchers’ discoveries is that all of the recent interventions conducted outside of the US, and most of the ones in the US, focused on trauma-informed HIV prevention. As for recent trauma-based care initiatives to help people already infected with HIV, only one was found. Another finding that stood out was the complete absence of HIV-prevention interventions designed to assist men or transgender individuals who had been victims of violence.
“That doesn’t mean that there aren’t interventions [for this population] that are currently being examined,” said Jessica Sales, PhD, associate professor at Rollins School of Public Health and a lead author of the study, noting that awareness of transgender individuals and the issues they face is increasing.
Although Dr. Sales and her team felt that the interventions were largely successful in helping the populations for which they were intended, she noted that they focused mainly on childhood abuse or intimate partner violence and neglected other possible sources of trauma, such as witnessing violence or experiencing war or natural disaster. She added, “Some have advocated for trauma-informed HIV care, particularly for women, but our findings indicate that such an approach is warranted for HIV prevention and treatment for all populations with high co-occurring epidemics of HIV and trauma.” This includes men who have sex with men and transgender individuals as well.
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