Trauma-Informed HIV Prevention and Treatment

Abstract

The high prevalence of trauma and its negative impact on health and health-promoting behaviors underscore the need for multi-level interventions to address trauma and its associated sequelae to improve physical and mental well-being in both HIV-infected and HIV-uninfected populations. Growing global awareness of the intersection of trauma and HIV has resulted in development and testing of interventions to address trauma in the context of HIV treatment and HIV prevention in the U.S. and globally. Despite increasing recognition of the widespread nature of trauma and the importance of trauma to HIV transmission around the globe, several gaps remain. Through a survey of the literature, we identified 8 studies (published in the past 5 years) describing interventions to address the effects of trauma on HIV-related outcomes. In particular, this study focused on the levels of intervention, populations the interventions were designed to benefit, and types of trauma addressed in the interventions in the context of both HIV prevention and treatment. Remarkably absent from the HIV prevention interventions reviewed were interventions designed to address violence experienced by men or transgender individuals, in the U.S. or globally. Given the pervasive nature of trauma experienced generally, but especially among individuals at heightened risk for HIV, future HIV prevention interventions universally should consider becoming trauma-informed. Widespread acknowledgement of the pervasive impact of gender-based violence on HIV outcomes among women has led to multiple calls for trauma-informed care (TIC) approaches to improve the effectiveness of HIV services for HIV infected women. TIC approaches may be relevant for and should also be tested among men and all groups with high co-occurring epidemics of HIV and trauma (e.g., men who have sex with men (MSM), transgendered populations, injection drug users, sex workers), regardless of type of trauma experience.

Trauma-Informed Decision-Making Among Providers and Victims of Intimate Partner Violence During HIV Testing: A Qualitative Study

“…Increased recognition of the intersection between HIV and IPV has led to numerous calls to improve the delivery of HIV services to be more responsive to those with a history of trauma (Sales, Swartzendruber, & Phillips, 2016). Results from our study highlight aspects of the testing process that may be unique for victims of IPV and have implications for improving the quality of HIV testing in this population.…”

“…Experiences of trauma, such as IPV, can have numerous impacts on HIV risk, testing decisions, and paths for recovery (Draucker et al, 2015; Rountree, 2010; Sales et al, 2016). Providers in our study indicated that there was a need for improved awareness in both clients and providers that the experience of IPV increased an individual’s risk for acquiring HIV.…”

Global estimate of the prevalence of post-traumatic stress disorder among adults living with HIV: a systematic review and meta-analysis

“…To minimise selection bias, we reviewed the articles included in the meta-analysis to ensure they met eligibility criteria. Gender and sexual orientation were considered because of underlying differences in the epidemics of HIV and trauma 30–32. Specifically, populations were grouped as women and men, and samples of HIV-infected men were further classified into men who have sex with men (MSM) and non-MSM males.…”

Social Ecological Factors of Sexual Subjectivity and Contraceptive Use and Access Among Young Women in the Northwest Territories, Canada

“…Alcohol use was also a way to evade interpersonal relational accountability and was used by LG hunters to take advantage of young women. Alcohol and its role in increasing risk for unprotected sex is well documented among youth populations (Kiene, Barta, Tennen, & Armeli, 2009;Leston, Jessen, & Simons, 2012;Sales, Swartzendruber, & Phillips, 2016;Senior, Helmer, Chenhall, & Burbank, 2014;Shrier, Kim Harris, Sternberg, & Beardslee, 2001), as is the cultural norm of pressure on young women to engage in sexual activity, particularly if alcohol or other drugs are involved (Senior et al, 2014). However, this is the first study to document the role of alcohol in the context of LG hunters among NWT youth.…”