June 4, 2012
Back in March, President Barack Obama announced a working group to address how gender-based violence affects women's vulnerability to HIV/AIDS. Obama's memorandum on the inter-agency team doesn't specifically address trauma, but trauma and how people cope (or are unable to cope) with traumatic experiences are a key part of what he's talking about.
First, let's unpack what "trauma" is. In simple terms, when a person experiences a traumatic event, he or she sometimes cannot heal from or move past the experience, whether consciously or subconsciously. According to the Justice Resource Institute's renowned Trauma Center, common responses to trauma include a tendency to isolate oneself and feel detached from others, emotional numbing, difficulty trusting, difficulty concentrating or remembering, and feelings of shame or self-blame. It's easy to see how any one of these conditions could interfere with a person's ability to negotiate safer sex, use condoms, or access and stay in care if he or she becomes HIV positive.
This is why simply telling a person to "get over it" won't help him or her move past trauma -- the individual needs acknowledgement and support to help change those mental patterns.
Fittingly, findings from two studies dealing with trauma and the HIV epidemic came on the heels of Obama's announcement. Researchers from the University of California, San Francisco (UCSF) and Harvard Medical School found that trauma -- experiences of physical or sexual violence, among other forms of psychological disruption -- is a key driver of the HIV epidemic among women in the U.S.
In the first-ever study to show a significant link between recent trauma and HIV-related health struggles, Edward Machtinger, M.D., director of the Women's HIV Program at UCSF and the lead researcher on both these studies, spoke with 113 non-transgender and trans-identified women in his clinic. He found that those who'd experienced trauma recently had a startlingly higher likelihood of having their HIV med regimens fail than those who hadn't. These women were also more than three times as likely to have had unprotected sex with partners who were HIV negative or whose HIV status was unknown.
In the second report, Machtinger reviewed 29 past studies and found that women living with HIV were two to six times more likely to have experienced traumatic events and post-traumatic stress disorder (PTSD) than women in the general population. One of the most troubling findings was that 60 percent of HIV-positive women reported having been sexually abused at some point in their lifetime -- more than five times the percentage among women in the general population who reported sexual abuse.
Machtinger believes these studies prove that providers need to know more about trauma, in order to better support their patients' drug adherence and overall health. "We have to learn to ask about trauma," he says; "This is actually an amazing opportunity to have a significant impact on the HIV/AIDS epidemic, especially among minority women."
Again, let's be clear: According to these studies, it's not just a handful of women living with HIV who have experienced or been affected by some form of violence. This is most women living with HIV. HIV services that don't take into account the impact of trauma on women's lives are selling most HIV-positive women short on their care.
While the connection between gender-based violence and poor HIV health outcomes may have just made the news, it is by no means new. HIV-positive women and their advocates and providers have witnessed and spoken out about this link for years.
In late February, the Presidential Advisory Council on HIV/AIDS (PACHA) held the first meeting in its 17-year history that focused on women and girls. In the course of each presentation at that meeting, all of the presenters -- each a longtime veteran of women's HIV care, prevention and/or advocacy -- stressed the impact of experiences of violence on women living with or vulnerable to HIV, from childhood sexual abuse to the partner violence that may help keep condoms out of an intimate relationship.
Dr. Laurie Dill, medical director of Medical AIDS Outreach of Alabama, stated that she was unable to conduct a study of experiences of violence among women living with HIV. The reason? They couldn't find enough female clients who hadn't experienced violence to build a control group for the study.
In her presentation, noted sex therapist Dr. Gail Wyatt pointed out that HIV prevention messages generally assume that sex is consensual, and that the effects of violence have little to do with HIV transmission. It's apparent that these messages need to be adapted to assume the opposite.
Unaddressed trauma is clearly a pervasive, if silent, public health concern -- too many women, and men, have to maneuver through a life freighted with the long-term effects of violence and abuse without assistance.
So, knowing all of this, the question then becomes what is going to be done to address this issue?
Recent developments are cause for cautious optimism. The president's working group puts a policy agenda to the call to integrate HIV services with violence prevention and trauma services -- vital concerns that have been voiced by female community leaders for decades. And just weeks ago, PACHA passed a resolution that brings these women-centered goals a huge step closer to being implemented.
However, we won't soon forget that the PACHA meeting that birthed the president's working group, and this recent resolution, was PACHA's first to focus on gender -- though not because female HIV advocates have been asleep at the wheel. Behind every meeting and resolution addressing the needs of women are years of tooth-and-nail struggle to make it happen.
The social environment in which female community leaders speak to the needs of women in the HIV epidemic -- and are consistently ignored -- is the same environment in which women suffer trauma in silence. Part of breaking the cycle of gender violence, trauma and HIV will need to include demanding, growing and supporting leadership by women at every table where decisions that affect our community are made.
Olivia Ford is the community manager for TheBody.com and TheBodyPRO.com.
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