In this research study, the authors examined the relationship between recent experiences of trauma, antiretroviral (ART) failure, and HIV transmission risk behavior among self-identified women in a clinical prevention-with-positives program in San Francisco. Researchers used demographic, behavioral, and medical data obtained through interviews with program harm reduction counselors and medical records. Their data analysis was limited to quantitative methods. Given the limited sample and scope of the study, care must be taken in generalizing the findings to other HIV positive populations.
Results indicate that biological and transgender women experiencing trauma within the previous 30 days had four times the odds of ART failure (described as having a detectable viral load despite being on medication) and three times the odds of transmission risk behavior (specifically, sex without condoms with HIV-negative partners or partners whose status is unknown). Interestingly, while ART failure is strongly associated with recent trauma, it is not related to self-reported adherence.
The study has a number of limitations and certainly seems to raise more questions than it answers. However, the implications of the results are important. For those working in direct service, screening for recent trauma can prove a simple predictor of poor health outcomes, allowing for more effective allocation of existing resources. Interventions addressing and preventing trauma among HIV-positive women are crucial to effective prevention and positive health outcomes. On a broader scale, this research provides further support for advocates of structural interventions reducing the experience of physical, emotional, and sexual violence against girls, women, and transgender women.