AIDS and Behavior

, Volume 16, Issue 8, pp 2160–2170 | Cite as

Recent Trauma is Associated with Antiretroviral Failure and HIV Transmission Risk Behavior Among HIV-Positive Women and Female-Identified Transgenders

  • E. L. Machtinger
  • J. E. Haberer
  • T. C. Wilson
  • D. S. Weiss
Original Paper

Abstract

Trauma and posttraumatic stress disorder disproportionally affect HIV-positive women. Studies increasingly demonstrate that both conditions may predict poor HIV-related health outcomes and transmission-risk behaviors. This study analyzed data from a prevention-with-positives program to understand if socio-economic, behavioral, and health-related factors are associated with antiretroviral failure and HIV transmission-risk behaviors among 113 HIV-positive biological and transgender women. An affirmative answer to a simple screening question for recent trauma was significantly associated with both outcomes. Compared to participants without recent trauma, participants reporting recent trauma had over four-times the odds of antiretroviral failure (AOR 4.3; 95% CI 1.1–16.6; p = 0.04), and over three-times the odds of reporting sex with an HIV-negative or unknown serostatus partner (AOR 3.9; 95% CI 1.3–11.9; p = 0.02) and <100% condom use with these partners (AOR 4.5; 95% CI 1.5–13.3; p = 0.007). Screening for recent trauma in HIV-positive biological and transgender women identifies patients at high risk for poor health outcomes and HIV transmission-risk behavior.

Keywords

Women living with HIV/AIDS Trauma PTSD Antiretroviral failure Prevention with positives 

Resumen

Trauma y el trastorno de estrés postraumático afectan desproporcionalmente a mujeres VIH positivas. Una creciente literatura sugiere que ambas condiciones pueden predecir salud pobre y comportamientos de riesgo de transmisión de VIH. Este estudio analizó datos de un programa de prevención con personas VIH positivas para entender si los factores socioeconómicos, conductuales y de salud están asociados a fracaso antirretroviral y comportamiento de riesgo de trasmitir VIH en 113 mujeres biológicas y transexuales VIH positivas. La respuesta afirmativa a una simple pregunta de detección de trauma reciente fue asociada significativamente a ambos resultados. En comparación con los participantes sin trauma reciente, aquellos que reportaron reciente trauma tienen una tasa cuatro veces más alta de fracaso antirretroviral (ORA 4.3; 95% IC 1.1–16.6; p = 0.04), y tres veces más alta de reportar sexo con una pareja VIH negativo o desconocido estado serológico (ORA 3.9; 95% CI 1.3–11.9; p = 0.02) y < 100% de uso de condones con estas parejas (ORA 4.5; 95% CI 1.5–13.3; p = 0.007). La detección de trauma reciente en mujeres biológicas y transexuales identifica a los pacientes con alto riesgo de resultados de salud pobres y comportamiento de riesgo de transmisión de VIH.

References

  1. 1.
    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
  2. 2.
    Epidemiology of HIV/AIDS—United States, 1981–2005. MMWR Morb Mortal Wkly Rep. 2006;55(21):589–92.Google Scholar
  3. 3.
    Centers for Disease Control and Prevention. HIV/AIDS among women. http://www.cdc.gov/hiv/topics/women/. Accessed 1 August 2011.
  4. 4.
    UNAIDS. Report on the global AIDS epidemic; 2010. http://www.unaids.org/globalreport/documents/20101123_GlobalReport_full_en.pdf. Accessed 20 November 2011.
  5. 5.
    Mugavero MJ, Castellano C, Edelman D, Hicks C. Late diagnosis of HIV infection: the role of age and sex. Am J Med. 2007;120(4):370–3.PubMedCrossRefGoogle Scholar
  6. 6.
    Mugavero MJ, Lin HY, Allison JJ, Willig JH, Chang PW, Marler M, et al. Failure to establish HIV care: characterizing the “no show” phenomenon. Clin Infect Dis. 2007;45(1):127–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Shapiro MF, Morton SC, McCaffrey DF, Senterfitt JW, Fleishman JA, Perlman JF, et al. Variations in the care of HIV-infected adults in the United States: results from the HIV Cost and Services Utilization Study. JAMA. 1999;281(24):2305–15.PubMedCrossRefGoogle Scholar
  8. 8.
    Wingood GM, Diclemente RJ, Mikhail I, McCree DH, Davies SL, Hardin JW, et al. HIV discrimination and the health of women living with HIV. Women Health. 2007;46(2–3):99–112.PubMedGoogle Scholar
  9. 9.
    Whetten K, Reif S, Lowe K, Eldred L. Gender differences in knowledge and perceptions of HIV resources among individuals living with HIV in the Southeast. South Med J. 2004;97(4):342–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Tobias C, Cunningham WE, Cunningham CO, Pounds MB. Making the connection: the importance of engagement and retention in HIV medical care. AIDS Patient Care STDS. 2007;21(Suppl 1):S3–8.PubMedGoogle Scholar
  11. 11.
    Vyavaharkar MV, Moneyham L, Corwin S. Health care utilization: the experiences of rural HIV-positive African American women. J Health Care Poor Underserved. 2008;19(1):294–306.PubMedCrossRefGoogle Scholar
  12. 12.
    Cunningham WE, Markson LE, Andersen RM, Crystal SH, Fleishman JA, Golin C, et al. Prevalence and predictors of highly active antiretroviral therapy use in patients with HIV infection in the United States. HCSUS Consortium. HIV Cost and Services Utilization. J Acquir Immune Defic Syndr. 2000;25(2):115–23.PubMedCrossRefGoogle Scholar
  13. 13.
    Hirschhorn LR, McInnes K, Landon BE, Wilson IB, Ding L, Marsden PV, et al. Gender differences in quality of HIV care in Ryan White CARE Act-funded clinics. Womens Health Issues. 2006;16(3):104–12.PubMedCrossRefGoogle Scholar
  14. 14.
    Mostashari F, Riley E, Selwyn PA, Altice FL. Acceptance and adherence with antiretroviral therapy among HIV-infected women in a correctional facility. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18(4):341–8.PubMedCrossRefGoogle Scholar
  15. 15.
    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
  16. 16.
    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
  17. 17.
    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 November 2011.
  18. 18.
    Committee on Preventive Services for Women; Institute of Medicine. Clinical Preventive Services for Women: closing the gaps. The National Academies Press. http://www.iom.edu/Reports/2011/Clinical-Preventive-Services-for-Women-Closing-the-Gaps.aspx. Accessed 20 November 2011.
  19. 19.
    Machtinger EL, Wilson TC, Haberer JE, Weiss DS. Psychological trauma and PTSD in HIV-positive women: a meta-analysis. AIDS Behav. 2012. [Epub ahead of print]. PMID:22249954.Google Scholar
  20. 20.
    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
  21. 21.
    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
  22. 22.
    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
  23. 23.
    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
  24. 24.
    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
  25. 25.
    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
  26. 26.
    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
  27. 27.
    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
  28. 28.
    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
  29. 29.
    Ironson G, O’Cleirigh C, Fletcher MA, Laurenceau JP, Balbin E, Klimas N, et al. Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment. Psychosom Med. 2005;67(6):1013–21.PubMedCrossRefGoogle Scholar
  30. 30.
    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
  31. 31.
    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
  32. 32.
    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
  33. 33.
    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
  34. 34.
    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
  35. 35.
    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 Acquir Immune Defic Syndr. 2007;46(2):216–21.PubMedCrossRefGoogle Scholar
  36. 36.
    Lewis CF. Post-traumatic stress disorder in HIV-positive incarcerated women. J Am Acad Psychiatry Law. 2005;33(4):455–64.PubMedGoogle Scholar
  37. 37.
    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
  38. 38.
    Lopez EJ, Jones DL, Villar-Loubet OM, Arheart KL, Weiss SM. Violence, coping, and consistent medication adherence in HIV-positive couples. AIDS Educ Prev. 2010;22(1):61–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Delahanty DL, Bogart LM, Figler JL. Posttraumatic stress disorder symptoms, salivary cortisol, medication adherence, and CD4 levels in HIV-positive individuals. AIDS Care. 2004;16(2):247–60.PubMedCrossRefGoogle Scholar
  40. 40.
    Keuroghlian AS, Kamen CS, Neri E, Lee S, Liu R, Gore-Felton C. Trauma, dissociation, and antiretroviral adherence among persons living with HIV/AIDS. J Psychiatr Res. 2011;45(7):942–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Boarts JM, Sledjeski EM, Bogart LM, Delahanty DL. The differential impact of PTSD and depression on HIV disease markers and adherence to HAART in people living with HIV. AIDS Behav. 2006;10(3):253–61.PubMedCrossRefGoogle Scholar
  42. 42.
    Cohen MA, Alfonso CA, Hoffman RG, Milau V, Carrera G. The impact of PTSD on treatment adherence in persons with HIV infection. Gen Hosp Psychiatry. 2001;23(5):294–6.PubMedCrossRefGoogle Scholar
  43. 43.
    Safren SA, Gershuny BS, Hendriksen E. Symptoms of posttraumatic stress and death anxiety in persons with HIV and medication adherence difficulties. AIDS Patient Care STDS. 2003;17(12):657–64.PubMedCrossRefGoogle Scholar
  44. 44.
    Whetten K, Reif S, Whetten R, Murphy-McMillan LK. Trauma, mental health, distrust, and stigma among HIV-positive persons: implications for effective care. Psychosom Med. 2008;70(5):531–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Meade CS, Hansen NB, Kochman A, Sikkema KJ. Utilization of medical treatments and adherence to antiretroviral therapy among HIV-positive adults with histories of childhood sexual abuse. AIDS Patient Care STDS. 2009;23(4):259–66.PubMedCrossRefGoogle Scholar
  46. 46.
    Brief DJ, Bollinger AR, Vielhauer MJ, Berger-Greenstein JA, Morgan EE, Brady SM, et al. Understanding the interface of HIV, trauma, post-traumatic stress disorder, and substance use and its implications for health outcomes. AIDS Care. 2004;16(Suppl 1):S97–120.PubMedCrossRefGoogle Scholar
  47. 47.
    Vranceanu AM, Safren SA, Lu M, Coady WM, Skolnik PR, Rogers WH, et al. The relationship of post-traumatic stress disorder and depression to antiretroviral medication adherence in persons with HIV. AIDS Patient Care STDS. 2008;22(4):313–21.PubMedCrossRefGoogle Scholar
  48. 48.
    Sledjeski EM, Delahanty DL, Bogart LM. Incidence and impact of posttraumatic stress disorder and comorbid depression on adherence to HAART and CD4+ counts in people living with HIV. AIDS Patient Care STDS. 2005;19(11):728–36.PubMedCrossRefGoogle Scholar
  49. 49.
    Rogers ES, Chamberlin J, Ellison ML, Crean T. A consumer-constructed scale to measure empowerment among users of mental health services. Psychiatr Serv. 1997;48(8):1042–7.PubMedGoogle Scholar
  50. 50.
    California Health Interview Survey. Survey design and methods. Los Angeles: UCLA Center for Health Policy Research. http://www.chis.ucla.edu/methods.html. Accessed 20 November 2011.
  51. 51.
    Amico KR, Fisher WA, Cornman DH, Shuper PA, Redding CG, Konkle-Parker DJ, et al. Visual analog scale of ART adherence: association with 3-day self-report and adherence barriers. J Acquir Immune Defic Syndr. 2006;42(4):455–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Rosenblum M, Deeks SG, van der Laan M, Bangsberg DR. The risk of virologic failure decreases with duration of HIV suppression, at greater than 50% adherence to antiretroviral therapy. PLoS One. 2009;4(9):e7196.PubMedCrossRefGoogle Scholar
  53. 53.
    Maggiolo F, Airoldi M, Kleinloog HD, Callegaro A, Ravasio V, Arici C, et al. Effect of adherence to HAART on virologic outcome and on the selection of resistance-conferring mutations in NNRTI- or PI-treated patients. HIV Clin Trials. 2007;8(5):282–92.PubMedCrossRefGoogle Scholar
  54. 54.
    Jansen HAFM, Watts C, Ellsberg M, Heise L. Garcia Moreno C. Interviewer training in the WHO multi-country study on women’s health and domestic violence. Violence Against Women. 2004;10:831–49.CrossRefGoogle Scholar
  55. 55.
    World Health Organization. Putting women first: ethical and safety recommendations for research on domestic violence against women (WHO/FCH/GWH/01.1). Geneva: Author; 2001. http://www.who.int/gender/violence/womenfirtseng.pdf. Accessed 20 November 2011.
  56. 56.
    Leserman J, Petitto JM, Golden RN, Gaynes BN, Gu H, Perkins DO, et al. Impact of stressful life events, depression, social support, coping, and cortisol on progression to AIDS. Am J Psychiatry. 2000;157(8):1221–8.PubMedCrossRefGoogle Scholar
  57. 57.
    Ressler KJ, Mercer KB, Bradley B, Jovanovic T, Mahan A, Kerley K, et al. Post-traumatic stress disorder is associated with PACAP and the PAC1 receptor. Nature. 2011;470(7335):492–7.PubMedCrossRefGoogle Scholar
  58. 58.
    Cohen MH, Cook JA, Grey D, Young M, Hanau LH, Tien P, et al. Medically eligible women who do not use HAART: the importance of abuse, drug use, and race. Am J Public Health. 2004;94(7):1147–51.PubMedCrossRefGoogle Scholar
  59. 59.
    McNutt LA, van Ryn M, Clark C, Fraiser I. Partner violence and medical encounters: African-American women’s perspectives. Am J Prev Med. 2000;19(4):264–9.PubMedCrossRefGoogle Scholar
  60. 60.
    Vyavaharkar M, Moneyham L, Tavakoli A, Phillips KD, Murdaugh C, Jackson K, et al. Social support, coping, and medication adherence among HIV-positive women with depression living in rural areas of the southeastern United States. AIDS Patient Care STDS. 2007;21(9):667–80.PubMedCrossRefGoogle Scholar
  61. 61.
    Murphy DA, Greenwell L, Hoffman D. Factors associated with antiretroviral adherence among HIV-infected women with children. Women Health. 2002;36(1):97–111.PubMedCrossRefGoogle Scholar
  62. 62.
    Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice-Hall; 1986.Google Scholar
  63. 63.
    Theory at a glance: a guide for health promotion practice. 2nd ed. U.S. Department of Health and Social Services, National Institutes of Health; 2005. http://www.cancer.gov/cancertopics/cancerlibrary/theory.pdf.
  64. 64.
    Bartholomew LK, Mullen PD. Five roles for using theory and evidence in the design and testing of behavior change interventions. J Public Health Dent. 2011;71(Suppl 1):S20–33.PubMedCrossRefGoogle Scholar
  65. 65.
    Farley M, Barkan H. Prostitution, violence, and posttraumatic stress disorder. Women Health. 1998;27(3):37–49.PubMedCrossRefGoogle Scholar
  66. 66.
    Hutton HE, Treisman GJ, Hunt WR, Fishman M, Kendig N, Swetz A, et al. HIV risk behaviors and their relationship to posttraumatic stress disorder among women prisoners. Psychiatr Serv. 2001;52(4):508–13.PubMedCrossRefGoogle Scholar
  67. 67.
    Wagner GJ, Rabkin JG. Measuring medication adherence: are missed doses reported more accurately then perfect adherence? AIDS Care. 2000;12(4):405–8.PubMedCrossRefGoogle Scholar
  68. 68.
    Sikkema KJ, Wilson PA, Hansen NB, Kochman A, Neufeld S, Ghebremichael MS, et al. Effects of a coping intervention on transmission risk behavior among people living with HIV/AIDS and a history of childhood sexual abuse. J Acquir Immune Defic Syndr. 2008;47(4):506–13.PubMedCrossRefGoogle Scholar
  69. 69.
    Sikkema KJ, Hansen NB, Kochman A, Tarakeshwar N, Neufeld S, Meade CS, et al. Outcomes from a group intervention for coping with HIV/AIDS and childhood sexual abuse: reductions in traumatic stress. AIDS Behav. 2007;11(1):49–60.PubMedCrossRefGoogle Scholar
  70. 70.
    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.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

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

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