Studies have demonstrated that trauma is a major factor contributing to HIV infections in women in the U.S., but it is only recently that researchers have begun to explore how trauma is associated with the lives of women already living with the virus. In this study, researchers analyzed the impact of trauma on health outcomes and transmission risk behaviors in HIV-positive women, including transgender women.
Researchers examined clinical and behavioral data collected from 113 non-transgender and transgender women with HIV in San Francisco. They found that trauma was highly associated with both treatment failure (which includes adherence to medication and developing resistance to it) and behaviors that increase the likelihood of HIV transmission.
Compared to participants who did not report recent trauma, women who experienced recent trauma were over four times more likely to experience treatment failure. In addition, they were over three times more likely to report having had sex with someone without knowing their HIV status and to not use condoms during those sexual encounters.
This study is the first to identify a significant association between trauma and HIV-related health behaviors and outcomes among women in the U.S., and the magnitude of this relationship is striking. Its results reflect the need to incorporate discussions about traumatic experience into HIV prevention and care, and for providers to demonstrate competence in addressing violence and other forms of trauma when working with women living with or affected by HIV. The results also reflect the complexity of issues like disclosure, which are often dealt with without regard to surrounding social and behavioral factors.