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Does a History of Trauma Contribute to HIV Risk for Women of Color? Implications for Prevention and Policy

April 25, 2002

America is facing a public health crisis. HIV infection and AIDS among women in the United States have increased dramatically over the last decade. Although only 1 in 4 women in the United States is African American or Latina, these women represent 77 percent of the AIDS cases. Several factors account for disproportionate HIV morbidity, including racial/ethnic group affiliation, socioeconomic status, overall health, sexual risk taking, and higher rates of STDs. Women who report early and chronic sexual abuse have a 7-fold increase in HIV-related risk behaviors and markers of risk compared with women without abuse histories. Additional research is needed to better understand how histories of sexual and physical trauma may contribute to greater risks for HIV and AIDS in women, particularly women of color.

This study investigated two questions: (1) Does a history of sexual and physical trauma make a significant independent contribution to HIV-related risk in women, compared with demographic and other known behavioral and psychosocial risk factors for HIV? And (2) Are there racial/ethnic differences in the relative contribution sexual and physical trauma make to HIV-related risks? The University of California Los Angeles-Drew Women and Family Project was the first national Institute of Mental Health-funded longitudinal HIV study that included a racially/ethnically diverse sample of women who were HIV positive or negative. This five-year study, conducted from 1994 to 2000, examined HIV- and non-HIV-related life stresses, sexual functioning, coping mechanisms, and disease progression. A community sample of 490 women was recruited from HIV and other service agencies in Los Angeles County. A stratified random sample of women who were HIV negative matched on race/ethnicity, age, education, marital status, and geographic residence was recruited with random-digit dialing and 1990 US census track data. All participants were paid $50 per session.

This diverse sample of women who were HIV positive or HIV negative was relatively young, poor, undereducated, underemployed, and not in stable relationships. The Latina women were younger, poorer, and less educated but more likely to be married or living with a partner than were the other women. Women were moderately sexually active and had moderate rates of STDs; Latina women reported fewer sexual partners, and fewer had histories of STDs. However, the regression model for Latina women suggested that their lower burden of risk factors did not alter the relative contributions these factors made to risk. The results also indicated that regardless of race/ethnicity, the women who were HIV positive reported having more sexual partners, more STDs, and more severe histories of abuse than did their counterparts who were HIV negative. African American women who were HIV positive were more likely to report histories of severe child sexual abuse, and this may have increased sexual risk-taking practices.

More research is needed on the causal direction of this relation. Perhaps the same factors that increase HIV risks for women also place them at risk for nonconsensual sex. It is also important to note that although more African American women were victims of violence, the relative significance of this risk factor was not moderated by race/ethnicity but was a general risk factor irrespective of race/ethnicity. These findings also indicated that deprivation of socioeconomic resources, especially the psychological benefits of employment and education, may be more important than income and other factors in increasing risks for this disease.


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Excerpted from:
American Journal of Public Health
04.02; Vol. 92; No. 4: P. 660-665; Gail E. Wyatt, Ph.D.; Hector F. Myers, Ph.D.; John K. Williams, M.D.; Christina Ramirez Kitchen, Ph.D.; Tamra Loeb, Ph.D.; Jennifer Vargas Carmona, Ph.D.; Lacey E. Wyatt, M.D., M.P.H.; Dorothy Chin, Ph.D.; Nicole Presley, B.A., M.Ed.




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