Trauma Fuels HIV Cases

Trauma and post-traumatic stress disorder (PTSD) appear closely linked with both HIV risk and poor treatment outcomes, two new studies suggest. Simultaneously addressing trauma and HIV will better serve female patients, according to lead research Dr. Edward Machtinger, who heads the University of California-San Francisco's Women's HIV Program.

Machtinger's study analyzed 29 previous reports and found: HIV-positive women are two to six times more likely to have suffered trauma or PTSD; 30 percent of HIV-positive women have PTSD; more than 60 percent of HIV-positive women have been sexually abused (compared to 12 percent of women overall); and 55 percent of women with HIV have experienced domestic violence (compared to 25 percent of women overall).

A second study, conducted on 113 patients in the Women's HIV Program, found that recently traumatized women were four times more likely to have detectable levels of the virus in their blood, indicating that their drug regimens were not working.

The study also noted those women were almost four times more likely to have unsafe sex with someone who was HIV-negative or of unknown serostatus.

"It appears to us that trauma fuels the HIV epidemic among women," said Machtinger.

Medical professionals say the effects of physical and sexual abuse of HIV-positive women -- which can include depression, low self-esteem, and restricted access to care and medications -- all affect outcomes. For these women, mental health care can be as essential as medical treatment.

"We can't just say here's the prescription and I'll see you in six months," said Dr. Deborah Cohan, director of the Bay Area Perinatal AIDS Center at San Francisco General Hospital. "Their lives are much more complicated than that."

The studies, "Psychological Trauma and PTSD in HIV-Positive Women: A Meta-Analysis" and "Recent Trauma Is Associated with Antiretroviral Failure and HIV Transmission Risk Behavior Among HIV-Positive Women and Female-Identified Transgenders," were published early online in AIDS and Behavior (2012;doi:10.1007/s10461-011-0127 and doi:10.1007/s10461-012-0158).

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