Untangling the Intersection of HIV and Trauma: Why It Matters and What We Can Do
Promising Elements for HIV Care
The majority of models addressing trauma-informed service delivery have been designed and evaluated for users of mental health and substance use services, or for use in correctional or domestic violence shelter settings. A 2008 paper by the National Center for Trauma-Informed Care at the Center for Health Services asserts that integrating a trauma-informed response into mental health systems is likely to be cost-effective for the service delivery system, and that many of the existing trauma-based integrated treatment approaches are effective and can be replicated within public service sector settings.18
Because of the population overlap between PLHIV and populations in which trauma-informed service delivery has been evaluated, and because of HIV's strongly collaborative service delivery networks in the U.S., it is logical that elements of evaluated trauma-informed service delivery may be applicable to HIV outpatient care and service delivery settings.
Resources that may be worth exploring include the Sanctuary Model, a framework for intervening with trauma survivors and for facilitating organizational change originally developed for traumatized adults in inpatient settings and adapted for use in domestic violence settings. Organizations and agencies that seek to become more trauma-informed can look to resources including Creating Trauma-Informed Systems of Care: Facilitating Recovery in Mental Health Services Settings and Developing Trauma-Informed Organizations: A Tool Kit, both designed for use by mental health provider agencies.
The integration of peers (defined, in this case, as trauma survivors and those in trauma recovery) throughout program design and implementation, has been widely acknowledged as key to the success of trauma-informed service delivery. The Substance Abuse and Mental Health Services Administration's (SAMHSA) Women, Co-Occurring Disorders and Violence Study (WCODVS) set out to explore the development of comprehensive, integrated service approaches and the effectiveness of those approaches for women whom they deemed "high-end" users of publicly funded services.19
This nine-site study found that it was critical and necessary that programs actively integrated consumer/survivor/recovering (C/S/R) women as program staff, on project committees, and/or to provide trainings and support for other C/S/R women.19 Other key lessons from the WCODVS were that becoming trauma-informed is a continuous process, not a one-time event, and that one or two people within a system (a strategically placed "trauma champion" or a "trauma liaision") can help to drive change towards trauma-informed service delivery.19
More recently, the Center for Mental Health Services' National Center for Trauma-Informed Care released a 96-page technical assistance guidebook, Engaging Women in Trauma-Informed Peer Support, designed to help organizations strengthen peer-based services.
Future Directions for Research and Advocacy
Trauma-informed practices represent an essential component for the overall health and well-being of impacted individuals and communities, and help create a better-equipped health care system that can more holistically meet the care needs of PLHIV. Trauma-informed practices as a high-impact strategy can help fulfill specific National HIV/AIDS Strategy (NHAS) goals to increase access to health care and improve health outcomes for PLHIV, particularly among groups that are dually and disproportionately impacted by the epidemic and trauma.
Among heavily traumatized populations (including women survivors of violence, LGBTQ communities, and most acutely, the transgender community), trauma-informed care practices may allow health providers to fully support healthy expressions of gender, sexual orientation, and self-efficacy.20 This allows individuals to live as fully vested members of society, rather than reinforce the marginalization that many in the LGBTQ community experience throughout their lifespan.20
However, additional research is needed to investigate the potential role of trauma-informed care services for people living with HIV and to develop models for the specific trauma recovery needs of LGBT populations. Such models could be adapted and evaluated in HIV care settings. In particular, Ryan White funded clinics may provide a favorable milieu for testing and evaluating such models.
Furthermore, the deeply-rooted trauma of systemic racism, homophobia, transphobia, classism, and patriarchy requires advocacy efforts to address this structural violence that continues to perpetrate trauma upon PLHIV and hamper prevention efforts among vulnerable communities. Part of the strategy might be to align with advocacy networks focused on underlying issues of trauma, such as the Positive Women's Network of the United States (PWN-USA) and the HIV Prevention Justice Alliance (HIV PJA). The work of advocacy organizations such as these, have historically pointed public health authorities towards addressing issues of structural violence and seek to empower the voice of communities impacted by and vulnerable to disproportionate trauma.
The price of unaddressed trauma is apparent: trauma leads to worse health outcomes and a lower quality of life for PLHIV. Unaddressed trauma complicates public health efforts to stem the HIV epidemic, creates inefficient delivery of services and places additional strain upon scarce public health resources. A system ill-equipped to heal trauma among highly-impacted communities may lose its ability to engage clients in care and thus to perform its very function. For PLHIV accessing services, multidisciplinary care settings including existing Ryan White care models may provide an ideal environment to integrate trauma-informed services for vulnerable populations.
Naina Khanna is Executive Director of Positive Women's Network of the United States (PWN-USA). Suraj Madoori is Prevention Justice/Policy Fellow & Communications Coordinator at HIV Prevention Justice Alliance (HIV PJA).
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This article was provided by Gay Men's Health Crisis. It is a part of the publication GMHC Treatment Issues. Visit GMHC's website to find out more about their activities, publications and services.
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