AIDS and Behavior

, Volume 16, Issue 8, pp 2091–2100 | Cite as

Psychological Trauma and PTSD in HIV-Positive Women: A Meta-Analysis

  • E. L. Machtinger
  • T. C. Wilson
  • J. E. Haberer
  • D. S. Weiss
Substantive Review

Abstract

Women bear an increasing burden of the HIV epidemic and face high rates of morbidity and mortality. Trauma has been increasingly associated with the high prevalence and poor outcomes of HIV in this population. This meta-analysis estimates rates of psychological trauma and posttraumatic stress disorder (PTSD) in HIV-positive women from the United States. We reviewed 9,552 articles, of which 29 met our inclusion criteria, resulting in a sample of 5,930 individuals. The findings demonstrate highly disproportionate rates of trauma exposure and recent PTSD in HIV-positive women compared to the general population of women. For example, the estimated rate of recent PTSD among HIV-positive women is 30.0% (95% CI 18.8–42.7%), which is over five-times the rate of recent PTSD reported in a national sample of women. The estimated rate of intimate partner violence is 55.3% (95% CI 36.1–73.8%), which is more than twice the national rate. Studies of trauma-prevention and trauma-recovery interventions in this population are greatly needed.

Keywords

HIV/AIDS Women Trauma PTSD Meta-analysis 

Resumen

Las mujeres enfrentan un incremento en la epidemia de VIH y altos índices de morbilidad y mortalidad. El trauma psicológico ha sido cada vez más asociado con la alta prevalencia y los resultados pobres de VIH en esta población. El presente metaanálisis estima la tasa de trauma y Trastorno por Estrés Postraumático (TPEP) en mujeres estadounidenses. Fueron revisados 9,552 artículos de los cuales 29 cumplieron los criterios, resultando en una muestra total de 5,930 individuos. Los resultados demuestran una tasa desproporcionalmente alta de exposición a trauma y reciente TPEP en mujeres VIH positivas en comparación con la población general de mujeres estadounidenses. La tasa estimada de reciente TPEP entre mujeres VIH positivas es 30.0% (95% IC 18.8–42.7%), lo cual es cinco veces la tasa de reciente TPEP reportada en una muestra nacional de mujeres. La tasa estimada de violencia del compañero íntimo (VCI) es 55.3% (95% IC 36.1–73.8%), lo cual es más del doble de la tasa nacional. Estudios de prevención de trauma e intervenciones de recuperación de trauma en esta población son enormemente necesitados.

Supplementary material

10461_2011_127_MOESM1_ESM.doc (44 kb)
Supplementary material 1 (DOC 44 kb)
10461_2011_127_MOESM2_ESM.docx (72 kb)
Supplementary material 2 (DOCX 72 kb)

References

  1. 1.
    Centers for disease control and prevention. HIV/AIDS among women. http://www.cdc.gov/hiv/topics/women/overview_partner.htm. Accessed 14 Nov 2011.
  2. 2.
    Epidemiology of HIV/AIDS–United States, 1981–2005. MMWR Morb Mortal Wkly Rep. 2006;55(21):589–92.Google Scholar
  3. 3.
    Hall HI, Song R, Rhodes P, Prejean J, An Q, Lee LM, et al. Estimation of HIV incidence in the United States. JAMA. 2008;300(5):520–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Smith DK, Gardner LI, Phelps R, Hamburger ME, Carpenter C, Klein RS, et al. Mortality rates and causes of death in a cohort of HIV-infected and uninfected women, 1993–1999. J Urban Health. 2003;80(4):676–88.PubMedCrossRefGoogle Scholar
  5. 5.
    Hessol NA, Kalinowski A, Benning L, Mullen J, Young M, Palella F, et al. Mortality among participants in the multicenter AIDS cohort study and the women’s interagency HIV study. Clin Infect Dis. 2007;44(2):287–94.PubMedCrossRefGoogle Scholar
  6. 6.
    UNAIDS. Operational plan for UNAIDS action framework: addressing women, girls, gender equality and HIV. 2010. http://www.unfpa.org/hiv/docs/unaids_operationalplan.pdf. Accessed 14 Nov 2011.
  7. 7.
    Costenbader EC, Otiashvili D, Meyer W, Zule WA, Orr A, Kirtadze I. Secrecy and risk among MSM in Tbilisi, Georgia. AIDS Care. 2009;21(5):591–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Davies SL, Horton TV, Williams AG, Martin MY, Stewart KE. MOMS: formative evaluation and subsequent intervention for mothers living with HIV. AIDS Care. 2009;21(5):552–60.PubMedCrossRefGoogle Scholar
  9. 9.
    Wyatt GE, Myers HF, Loeb TB. Women, trauma, and HIV: an overview. AIDS Behav. 2004;8(4):401–3.PubMedCrossRefGoogle Scholar
  10. 10.
    Gielen AC, Ghandour RM, Burke JG, Mahoney P, McDonnell KA, O’Campo P. HIV/AIDS and intimate partner violence: intersecting women’s health issues in the United States. Trauma Violence Abuse. 2007;8(2):178–98.PubMedCrossRefGoogle Scholar
  11. 11.
    Maman S, Campbell J, Sweat MD, Gielen AC. The intersections of HIV and violence: directions for future research and interventions. Soc Sci Med. 2000;50(4):459–78.PubMedCrossRefGoogle Scholar
  12. 12.
    Bedimo AL, Kissinger P, Bessinger R. History of sexual abuse among HIV-infected women. Int J STD AIDS. 1997;8(5):332–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Brady S, Gallagher D, Berger J, Vega M. Physical and sexual abuse in the lives of HIV-positive women enrolled in a primary medicine health maintenance organization. AIDS Patient Care STDS. 2002;16(3):121–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Burke JG, Thieman LK, Gielen AC, O’Campo P, McDonnell KA. Intimate partner violence, substance use, and HIV among low-income women: taking a closer look. Violence Against Women. 2005;11(9):1140–61.PubMedCrossRefGoogle Scholar
  15. 15.
    Chuang CH, Liebschutz JM, Horton NJ, Samet JH. Association of violence victimization with inconsistent condom use in HIV-infected persons. AIDS Behav. 2006;10(2):201–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Cohen M, Deamant C, Barkan S, Richardson J, Young M, Holman S, et al. Domestic violence and childhood sexual abuse in HIV-infected women and women at risk for HIV. Am J Public Health. 2000;90(4):560–5.PubMedCrossRefGoogle Scholar
  17. 17.
    El-Bassel N, Witte SS, Wada T, Gilbert L, Wallace J. Correlates of partner violence among female street-based sex workers: substance abuse, history of childhood abuse, and HIV risks. AIDS Patient Care STDS. 2001;15(1):41–51.PubMedCrossRefGoogle Scholar
  18. 18.
    Gielen AC, Fogarty L, O’Campo P, Anderson J, Keller J, Faden R. Women living with HIV: disclosure, violence, and social support. J Urban Health. 2000;77(3):480–91.PubMedCrossRefGoogle Scholar
  19. 19.
    Gielen AC, McDonnell KA, O’Campo PJ. Intimate partner violence, HIV status, and sexual risk reduction. AIDS Behav. 2002;6(2):107–16.CrossRefGoogle Scholar
  20. 20.
    Gielen AC, McDonnell KA, Wu AW, O’Campo P, Faden R. Quality of life among women living with HIV: the importance violence, social support, and self care behaviors. Soc Sci Med. 2001;52(2):315–22.PubMedCrossRefGoogle Scholar
  21. 21.
    Henny KD, Kidder DP, Stall R, Wolitski RJ. Physical and sexual abuse among homeless and unstably housed adults living with HIV: prevalence and associated risks. AIDS Behav. 2007;11(6):842–53.PubMedCrossRefGoogle Scholar
  22. 22.
    Kalichman SC, Sikkema KJ, DiFonzo K, Luke W, Austin J. Emotional adjustment in survivors of sexual assault living with HIV-AIDS. J Trauma Stress. 2002;15(4):289–96.PubMedCrossRefGoogle Scholar
  23. 23.
    Katz S, Nevid JS. Risk factors associated with posttraumatic stress disorder symptomatology in HIV-infected women. AIDS Patient Care STDS. 2005;19(2):110–20.PubMedCrossRefGoogle Scholar
  24. 24.
    Kimerling R, Calhoun KS, Forehand R, Armistead L, Morse E, Morse P, et al. Traumatic stress in HIV-infected women. AIDS Educ Prev. 1999;11(4):321–30.PubMedGoogle Scholar
  25. 25.
    Lang DL, Salazar LF, Wingood GM, DiClemente RJ, Mikhail I. Associations between recent gender-based violence and pregnancy, sexually transmitted infections, condom use practices, and negotiation of sexual practices among HIV-positive women. J AIDS. 2007;46(2):216–21.Google Scholar
  26. 26.
    Leenerts MH. The disconnected self: consequences of abuse in a cohort of low-income white women living with HIV/AIDS. Health Care Women Int. 1999;20(4):381–400.PubMedCrossRefGoogle Scholar
  27. 27.
    Lewis CF. Post-traumatic stress disorder in HIV-positive incarcerated women. J Am Acad Psychiatry Law. 2005;33(4):455–64.PubMedGoogle Scholar
  28. 28.
    Liebschutz JM, Feinman G, Sullivan L, Stein M, Samet J. Physical and sexual abuse in women infected with the human immunodeficiency virus: increased illness and health care utilization. Arch Intern Med. 2000;160(11):1659–64.PubMedCrossRefGoogle Scholar
  29. 29.
    Liebschutz JM, Geier JL, Horton NJ, Chuang CH, Samet JH. Physical and sexual violence and health care utilization in HIV-infected persons with alcohol problems. AIDS Care. 2005;17(5):566–78.PubMedCrossRefGoogle Scholar
  30. 30.
    Martinez A, Israelski D, Walker C, Koopman C. Posttraumatic stress disorder in women attending human immunodeficiency virus outpatient clinics. AIDS Patient Care STDS. 2002;16(6):283–91.PubMedCrossRefGoogle Scholar
  31. 31.
    Murphy LM, Koranyi K, Crim L, Whited S. Disclosure, stress, and psychological adjustment among mothers affected by HIV. AIDS Patient Care STDS. 1999;13(2):111–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Myers HF, Wyatt GE, Loeb TB, Carmona JV, Warda U, Longshore D, et al. Severity of child sexual abuse, post- traumatic stress and risky sexual behaviors among HIV-positive women. AIDS Behav. 2006;10(2):191–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Pence BW, Reif S, Whetten K, Leserman J, Stangl D, Swartz M, et al. Minorities, the poor, and survivors of abuse: HIV-infected patients in the US deep South. South Med J. 2007;100(11):1114–22.PubMedCrossRefGoogle Scholar
  34. 34.
    Sareen J, Pagura J, Grant B. Is intimate partner violence associated with HIV infection among women in the United States? Gen Hosp Psychiatry. 2009;31(3):274–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Simoni JM, Ng MT. Trauma, coping, and depression among women with HIV/AIDS in New York City. AIDS Care. 2000;12(5):567–80.PubMedCrossRefGoogle Scholar
  36. 36.
    Simoni JM, Ng MT. Abuse, health locus of control, and perceived health among HIV-positive women. Health Psychol. 2002;21(1):89–93.PubMedCrossRefGoogle Scholar
  37. 37.
    Smith MY, Egert J, Winkel G, Jacobsen J. The impact of PTSD on pain experience in persons with HIV/AIDS. Pain. 2002;98(1–2):9–17.PubMedCrossRefGoogle Scholar
  38. 38.
    Sowell RL, Phillips KD, Seals B, Murdaugh C, Rush C. Incidence and correlates of physical violence among HIV-infected women at risk for pregnancy in the southeastern United States. J Assoc Nurses AIDS Care. 2002;13(2):46–58.PubMedCrossRefGoogle Scholar
  39. 39.
    Vlahov D, Wientge D, Moore J, Flynn C, Schuman P, Schoenbaum E, et al. Violence among women with or at risk for HIV infection. AIDS Behav. 1998;2(1):53–60.CrossRefGoogle Scholar
  40. 40.
    Whetten K, Leserman J, Lowe K, Stangl D, Thielman N, Swartz M, et al. Prevalence of childhood sexual abuse and physical trauma in an HIV-positive sample from the deep south. Am J Public Health. 2006;96(6):1028–30.PubMedCrossRefGoogle Scholar
  41. 41.
    Arriola KR, Louden T, Doldren MA, Fortenberry RM. A meta-analysis of the relationship of child sexual abuse to HIV risk behavior among women. Child Abuse Negl. 2005;29(6):725–46.PubMedCrossRefGoogle Scholar
  42. 42.
    Plotzker RE, Metzger DS, Holmes WC. Childhood sexual and physical abuse histories, PTSD, depression, and HIV risk outcomes in women injection drug users: a potential mediating pathway. Am J Addict. 2007;16(6):431–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Senn TE, Carey MP, Vanable PA, Coury-Doniger P, Urban MA. Childhood sexual abuse and sexual risk behavior among men and women attending a sexually transmitted disease clinic. J Consult Clin Psychol. 2006;74(4):720–31.PubMedCrossRefGoogle Scholar
  44. 44.
    Mugavero MJ, Pence BW, Whetten K, Leserman J, Swartz M, Stangl D, et al. Predictors of AIDS-related morbidity and mortality in a southern U.S. Cohort. AIDS Patient Care STDS. 2007;21(9):681–90.PubMedCrossRefGoogle Scholar
  45. 45.
    Mugavero MJ, Raper JL, Reif S, Whetten K, Leserman J, Thielman NM, et al. Overload: impact of incident stressful events on antiretroviral medication adherence and virologic failure in a longitudinal, multisite human immunodeficiency virus cohort study. Psychosom Med. 2009;71(9):920–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Machtinger EL, Haberer JE. A Simple screening question about recent trauma predicts HIV-related health outcomes and transmission risk behavior among hiv-positive women and female-identified transgenders. In: 17th conference on retroviruses and opportunistic infections (CROI 2010); Paper #931. San Francisco; 2010.Google Scholar
  47. 47.
    McDonnell KA, Gielen AC, O’Campo P, Burke JG. Abuse, HIV status and health-related quality of life among a sample of HIV positive and HIV negative low income women. Qual Life Res. 2005;14(4):945–57.PubMedCrossRefGoogle Scholar
  48. 48.
    Leserman J, Pence BW, Whetten K, Mugavero MJ, Thielman NM, Swartz MS, et al. Relation of lifetime trauma and depressive symptoms to mortality in HIV. Am J Psychiatry. 2007;164(11):1707–13.PubMedCrossRefGoogle Scholar
  49. 49.
    Boarts JM, Buckley-Fischer BA, Armelie AP, Bogart LM, Delahanty DL. The impact of HIV diagnosis-related vs. non-diagnosis related trauma on PTSD, depression, medication adherence, and HIV disease markers. J Evid Based Soc Work. 2009;6(1):4–16.PubMedCrossRefGoogle Scholar
  50. 50.
    Hogben M. The effect of sexual and physical violence on risky sexual behavior and STDs among a cohort of HIV seropositive women. AIDS Behav. 2001;5(4):353–61.CrossRefGoogle Scholar
  51. 51.
    Sikkema KJ, Hansen NB, Meade CS, Kochman A, Fox AM. Psychosocial predictors of sexual HIV transmission risk behavior among HIV-positive adults with a sexual abuse history in childhood. Arch Sex Behav. 2009;38(1):121–34.PubMedCrossRefGoogle Scholar
  52. 52.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC; 2000.Google Scholar
  53. 53.
    Hedges LV, Pigott TD. The power of statistical tests for moderators in meta-analysis. Psychol Methods. 2004;9(4):426–45.PubMedCrossRefGoogle Scholar
  54. 54.
    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.PubMedCrossRefGoogle Scholar
  55. 55.
    Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.PubMedCrossRefGoogle Scholar
  56. 56.
    Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–27.PubMedCrossRefGoogle Scholar
  57. 57.
    National Comorbidity Survey, NCS-R appendix tables. Table 1: lifetime prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort; Table 2: twelve-month prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort. 2005. http://www.hcp.med.harvard.edu/ncs/publications.php. Accessed 14 Nov 2011.
  58. 58.
    Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.PubMedCrossRefGoogle Scholar
  59. 59.
    Tjaden P, Thoennes N. Full report of the prevalence, incidence, and consequences of violence against women. Findings from the National Violence Against Women Survey, Washington, DC, US Department of Justice, National Institute of Justice, 2000. https://www.ncjrs.gov/pdffiles1/nij/183781.pdf. Accessed 14 Nov 2011.
  60. 60.
    Cougle JR, Timpano KR, Sachs-Ericsson N, Keough ME, Riccardi CJ. Examining the unique relationships between anxiety disorders and childhood physical and sexual abuse in the National Comorbidity Survey-Replication. Psychiatry Res. 2010;177(1–2):150–5.PubMedCrossRefGoogle Scholar
  61. 61.
    Commonwealth Fund. Health concerns across a woman’s lifespan: the commonwealth fund 1998 survey of women’s health. New York. http://www.commonwealthfund.org/Publications/Fund-Reports/1999/May/Health-Concerns-Across-a-Womans-Lifespan-The-Commonwealth-Fund-1998-Survey-of-Womens-Health.aspx#citation. Accessed 11 November 2011.
  62. 62.
    Leserman J, Whetten K, Lowe K, Stangl D, Swartz MS, Thielman NM. How trauma, recent stressful events, and PTSD affect functional health status and health utilization in HIV-infected patients in the south. Psychosom Med. 2005;67(3):500–7.PubMedCrossRefGoogle Scholar
  63. 63.
    Hansen NB, Sikkema KJ. Treating posttraumatic stress disorder in people with HIV. Focus (San Francisco, CA). 2006;21(4):5–6.Google Scholar
  64. 64.
    Wyatt GE, Longshore D, Chin D, Carmona JV, Loeb TB, Myers HF, et al. The efficacy of an integrated risk reduction intervention for HIV-positive women with child sexual abuse histories. AIDS Behav. 2004;8(4):453–62.PubMedCrossRefGoogle Scholar
  65. 65.
    Hien DA, Campbell AN, Killeen T, Hu MC, Hansen C, Jiang H, et al. The Impact of trauma-focused group therapy upon HIV sexual risk behaviors in the NIDA clinical trials network “women and trauma” multi-site study. AIDS Behav. 2010;14(2):421–30.Google Scholar
  66. 66.
    Amaro H, Jo Larson M, Zhang A, Acevedo A, Dai J, Matsumoto A. Effects of trauma intervention on HIV sexual risk behaviors among women with co-occurring disorders in substance abuse treatment. J Commun Psychol. 2007;35(7):895–908.CrossRefGoogle Scholar
  67. 67.
    Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, et al. The development of a clinician-administered PTSD scale. J Trauma Stress. 1995;8(1):75–90.PubMedCrossRefGoogle Scholar
  68. 68.
    Weiss DS. The Impact of Event Scale-Revised. In: Wilson JP, Keane TM, editors. Assessing psychological trauma and PTSD: A practitioner’s handbook. 2nd ed. New York: Guilford Press; 2004. p. 168–89.Google Scholar
  69. 69.
    Weathers FW, Huska JA, Keane TM. The PTSD Checklist-Civilian Version (PCL-C) Boston. MA: The National Center for PTSD, Boston Veterans Affairs Medical Center; 1991.Google Scholar
  70. 70.
    Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048–60.PubMedCrossRefGoogle Scholar
  71. 71.
    Brady KT, Dansky BS, Sonne SC, Saladin ME. Posttraumatic stress disorder and cocaine dependence order of onset. Am J Addict. 1998;7(2):128–35.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • E. L. Machtinger
    • 1
  • T. C. Wilson
    • 1
  • J. E. Haberer
    • 2
  • D. S. Weiss
    • 3
  1. 1.Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Department of MedicineMassachusetts General Hospital and Center for Global HealthBostonUSA
  3. 3.Department of PsychiatryUniversity of California, San FranciscoSan FranciscoUSA

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