We know too well about the connection between trauma and HIV. Two recent studies have confirmed that trauma plays a significant role in both transmission of HIV and in treatment failure for women.
Concurrently, new promising practices are emerging- in particular, a program called LIFT (Living in the Face of Trauma) is demonstrating that therapeutic trauma group work can significantly reduce trauma-related symptoms, empower women and improve mental health.
The three studies advocate that trauma-related mental health care must be a critical component of HIV treatment and support to improve health outcomes for women and reduce HIV transmission.
Trauma and HIV treatment related studies: A meta-analysis and a study on recent trauma and its impact on HIV transmission and treatment
“For a long time we have been looking for clues as to why so many women are becoming infected with HIV and why so many are doing poorly despite the availability of effective treatment,” said Edward Machtinger, MD, who directs the Women’s HIV Program at UCSF and who was the co-principal investigator on both studies. “This work clearly shows that trauma is a major factor in the HIV epidemic among women.”
These studies are important because they are calling for changes – in particular, these scientists are advocating that we need to be asking questions about historical trauma and recent trauma with our clients.
“We have to learn to ask about trauma and to develop creative approaches to trauma-prevention and trauma-recovery,” Machtinger said. “This is actually an amazing opportunity to have a significant impact on the HIV/AIDS epidemic, especially among minority women.”
There’s a clear correlation between physical violence, sexual abuse and other forms of childhood and adult trauma as harbingers fueling the HIV epidemic among women.
Women with HIV are more than five times more likely to have PTSD and twice as likely to have been the victim of intimate partner violence compared to national samples of women. The work also demonstrates the personal and public health consequences of trauma in HIV-positive women: women with HIV who report recent trauma are over four times more likely to fail their HIV treatment and almost four times more likely to engage in risky sexual behaviour.
Link to article:
Link to Studies:
Psychological Trauma and PTSD in HIV- Positive Women: A Meta-Analysis by E. L. Machtinger, T. C. Wilson, J. E. Haberer and D. S. Weiss was published online by the journal AIDS and Behavior on January 17, 2012. See: http://dx.doi.org/10.1007/s10461-011-0127-4
Recent Trauma is Associated with Antiretroviral Failure and HIV Transmission Risk Behavior among HIV-positive Women and Female-identified Transgenders by E. L. Machtinger, J. E. Haberer, T. C. Wilson, and D. S. Weiss will be published online by the journal AIDS and Behavior this month. Once the article appears online, it will be accessible at: http://dx.doi.org/10.1007/s10461-012-0158-5
In light of these studies, some promising best practices are emerging from an intervention called LIFT. LIFT, Living in the Face of Trauma, is a group intervention designed for HIV+ women who have experienced trauma-in particular childhood sexual abuse. The program empowers survivors by teaching them ways to cope with and process their emotions.
Kathleen J. Sikkema of the Department of Psychology and Neuroscience at Duke University in North Carolina recently led a study that compared two interventions aimed at childhood sexual abuse (CSA) survivors with HIV/AIDS. She recruited 247 individuals and assigned half of them to Living in the Face of Trauma (LIFT), the rest of the participants were assigned to a comparison intervention. All of the participants were evaluated before and after the program, and at three separate four-month intervals post-intervention.
The results revealed that the LIFT program, which taught people how to handle current life stressors with improved coping strategies, was far more effective than the traditional intervention. Sikkema believes the success can be attributed to the unique design of LIFT, which addresses the stress of HIV and CSA simultaneously while focusing on the emotional and behavioral byproducts of CSA and HIV. Even though PTSD was not specifically targeted in LIFT, the participants who had clinical levels of PTSD prior to beginning the program saw significant reductions in symptoms at the conclusion and throughout the follow-up period. Shame also was minimized, which could decrease future victimization in people who are at risk. Although the data was based on self-reports and was underrepresented by heterosexual men, Sikkema believes the findings can have broad clinical implications. “This mediation analysis enhances our understanding of the role of coping and related interventions to improve the mental health of people living with HIV/AIDS,” she said.
Link to Article:
Link to Study:
Sikkema, K. J., Ranby, K. W., Meade, C. S., Hansen, N. B., Wilson, P. A., Kochman, A. (2012). Reductions in traumatic stress following a coping intervention were mediated by decreases in avoidant coping for people living with HIV/AIDS and childhood sexual abuse. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0030144
Questions or comments? Please email: [email protected]
Carlene Dingwall (BA, M.Ed, PhD Candidate)
Mental Health, Substance Use and HIV/HCV Initiative