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 people living with HIV in the US have been 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 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% have experienced partner violence at some point as well.

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. In countries with higher incomes such as the US, approximately 51% to 81% of adults have, at least once, experienced a traumatic event and plenty of people have endured a number of 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 with a specific focus on trauma.

The researchers found eight interventions, that had been conducted 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. These interventions took place in locations ranging from Uganda and India to South Africa, where violence against women has become a prevalent 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, had been 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 proved 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.”

Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.