Some of the key factors that fuel the HIV/AIDS epidemic amongst American women are physical violence, sexual abuse and other childhood and adult traumas. The fact that traumatized women have a higher infection risk has long been known amongst the scientific society, however, the journal AIDS and Behavior has just published two new studies, which show that highly traumatized HIV-positive women have an impact on the epidemic and that that their risk of posttraumatic stress disorder (PTSD) is substantially higher than that of women in the general population.

The study findings from the University of California, San Francisco (UCSF) and Harvard Medical School can potentially help in restructuring several types of HIV/AIDS discussions, so that more clinicians account for their patients’ trauma when working.

Traumatized women respond worse to HIV/AIDS therapy than women with no traumatic stress, and they are also put in situations that have a higher tendency for spreading the virus.

Co-principal researcher on both studies, Edward Machtinger MD, who directs the Women’s HIV Program at UCSF said:

“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. This work clearly shows that trauma is a major factor in the HIV epidemic among women.”

American HIV-positive women have a five-times higher risk of suffering from PTSD, whilst the likelihood of having experienced violence from an intimate partner is twice as high in comparison to adult females in the general population.

The findings also demonstrate the personal and public health consequences for traumatized HIV-infected women, revealing that treatment for HIV-positive women who recently underwent trauma had a four-times higher risk of failing therapy and tended to also be nearly four times more likely to partake in risky sexual behavior.

Within the last three decades, the number of women in the U.S. diagnosed with HIV/AIDS has increased steadily. For instance, in 1985 only 8% of women in the U.S. were newly diagnosed with HIV/AIDS, which increased to 14% by 1992, with the current figure lying at 27% new cases.

The new study allows scientists more insight into some of the problems that control the epidemic amongst women in the U.S., in which black women are particularly affected.

Earlier research has demonstrated that trauma is a contributing factor to the HIV/AIDS epidemic amongst U.S. women because of its link to various risky situations and behaviors amongst non-infected women and girls who are at risk.

Machtinger and his team decided to establish accurate estimates of the trauma and PTSD rates amongst HIV-positive women and girls by conducting a statistical meta-analysis that correlated data from 29 studies, involving 5,930 HIV-positive adult females.

Their results demonstrated that trauma exposure and PTSD rates were highly disproportionate in HIV-positive women, with different forms of child, sexual and physical abuse and PTSD being mostly between two and six times higher than that of women in the general population, which is specifically remarkable as trauma rates in the general female population are already high. For instance, the rate of recent PTSD in HIV-positive women is estimated to be 30% compared with a 5.2% PTSD rate in the general population.

The researchers decided to establish the reasons for the high failure rate amongst women in response to HIV/AIDS drugs, and why many women end up in situations where they could transmit the virus to others. They examined detailed clinical and behavioral data from 113 HIV-positive or AIDS infected women and female-identified transgender women in San Francisco.

They discovered that continuous trauma had a strong link to treatment failure as well as ending up in risky situations and risky behavior. The study highlighted, in particular, that HIV-positive women with recent trauma had a four times higher risk of experiencing virologic failure, which means the HIV virus is detectable in the blood, regardless of antiretroviral mediations, and can lead to HIV-related diseases as well as becoming resistant to the antiretroviral drug.

Furthermore, the study demonstrated that women with a recent trauma tended to be nearly four times more likely to have had intercourse with men who were not infected or whose HIV status was not known to them, as well as not always using condoms.

Machtinger declared that this has significant public health consequences, as infected people who are unresponsive to their medication are particularly infectious, because their virus is not suppressed, and by engaging in unprotected sex with a non-infected person the risk of infection is even higher.

He stated:

“Women who report experiencing trauma often do not have the power or self-confidence to protect themselves from acquiring HIV. Once infected, women who experience ongoing abuse are often not in positions of power to effectively care for themselves or to insist that their partners protect themselves. Effectively addressing trauma has the potential to both improve the health of HIV-positive women and that of the community.”

The study was limited by its size to accurately determine how recent trauma causes treatment failure. However, the researchers hypothesize that suffering trauma can possibly interfere with a woman’s ability to take her HIV medications as consistently as supposed to. They also believe that substance abuse and depression in some women could be closely connected to trauma, all of which may be contributing factors for the poor study outcome.

The researchers developed a very simple screening survey for recent and lifetime trauma that could be readily applied in clinical practice.

Jessica Haberer, MD, MS of Harvard Medical School said:

“Our studies have the potential for immediate clinical impact in that we ascertained practical ways for clinicians to identify patients at risk.”

Just asking patients a simple question about recent trauma could help clinicians to identify those patients with a higher risk for poor health outcomes and risk of further transmission. This mean that scarce clinical and community resources, such as safety assessment, trauma-related therapy, medication-taking support and transmission-prevention counseling could be much more effectively allocated.

The researchers also speculate that counseling therapies for abuse and depression could prove more effective if counselors account for the fact that ongoing trauma could be a contributing factor for both conditions.

Machtinger concludes:

“We have to learn to ask about trauma and to develop creative approaches to trauma-prevention and trauma-recovery. This is actually an amazing opportunity to have a significant impact on the HIV/AIDS epidemic, especially among minority women.”

Written by Petra Rattue