Impact of Sexual Trauma on HIV Care Engagement: Perspectives of Female Patients with Trauma Histories in Cape Town, South Africa

Abstract

South African women have disproportionately high rates of both sexual trauma and HIV. To understand how sexual trauma impacts HIV care engagement, we conducted in-depth qualitative interviews with 15 HIV-infected women with sexual trauma histories, recruited from a public clinic in Cape Town. Interviews explored trauma narratives, coping behaviors and care engagement, and transcripts were analyzed using a constant comparison method. Participants reported multiple and complex traumas across their lifetimes. Sexual trauma hindered HIV care engagement, especially immediately following HIV diagnosis, and there were indications that sexual trauma may interfere with future care engagement, via traumatic stress symptoms including avoidance. Disclosure of sexual trauma was limited; no women had disclosed to an HIV provider. Routine screening for sexual trauma in HIV care settings may help to identify individuals at risk of poor care engagement. Efficacious treatments are needed to address the psychological and behavioral sequelae of trauma.

Being HIV positive and staying on antiretroviral therapy in Africa: A qualitative systematic review and theoretical model

“…Competing maternal and marital responsibilities make it difficult for them to put their health first [54, 97, 109]. Poor women are often economically dependent on their partners and frequently disempowered in the household: they may not be able to make health care decisions on their own [61, 65, 107, 108], and are vulnerable to discrimination and abuse [54, 57, 65, 68, 69, 78, 100, 107–110]. HIV disclosure [81, 108] and infertility [85, 97, 108] may put women at risk of discrimination, social isolation and put them and their children’s survival at risk.…”

“…Accepting HIV is difficult: Accepting HIV is hard and influenced by an individual’s perception of their own risk for infection prior to testing [79, 97]. A HIV-positive diagnosis is often met with shock [61, 65, 67, 74, 79, 97, 110], and many, at first, deny results and seek out repeat confirmatory tests at different health facilities [46, 61, 69, 74, 79, 80]. People struggle to reconcile how their lives, relationships and reproductive desires may have to change as a result of being HIV-positive [91, 97].…”

Young South African Women on Antiretroviral Therapy Perceptions of a Psychological Counselling Program to Reduce Heavy Drinking and Depression

“…Although heavy drinking and common mental disorders (CMDs) are highly prevalent barriers to ART adherence among PLWH in South Africa [10][11][12][13][14][15][16][17], they are rarely addressed as part of HIV treatment [18]. Routine screening for heavy drinking and CMDs does not occur and often goes undetected in these services.…”

Prevalence of physical and sexual violence and psychological abuse among adolescents and young adults living with HIV in Zambia

“…Given that AYA were sampled from purposively-selected clinics in an urban area and had been on ART for at least 6 months, our findings may not be generalizable to AYA who are living in rural areas or not accessing HIV care/on ART. Results may underestimate the prevalence of violence since those who have experienced violence tend to be less likely to engage in HIV care than those who do not [53,54]. We did not ask youth if the violence they experienced was due to their HIV status-nor did we ask about, and therefore cannot discuss, the sexual orientation of the youth or the sex of the romantic partner perpetrating violence, though sexual minorities may be at higher risk of violence than heterosexuals [55].…”