Advertisement

AIDS and Behavior

, Volume 21, Issue 11, pp 3209–3218 | Cite as

Impact of Sexual Trauma on HIV Care Engagement: Perspectives of Female Patients with Trauma Histories in Cape Town, South Africa

  • Melissa H. Watt
  • Alexis C. Dennis
  • Karmel W. Choi
  • Nonceba Ciya
  • John A. Joska
  • Corne Robertson
  • Kathleen J. Sikkema
Original Paper

Abstract

South African women have disproportionately high rates of both sexual trauma and HIV. To understand how sexual trauma impacts HIV care engagement, we conducted in-depth qualitative interviews with 15 HIV-infected women with sexual trauma histories, recruited from a public clinic in Cape Town. Interviews explored trauma narratives, coping behaviors and care engagement, and transcripts were analyzed using a constant comparison method. Participants reported multiple and complex traumas across their lifetimes. Sexual trauma hindered HIV care engagement, especially immediately following HIV diagnosis, and there were indications that sexual trauma may interfere with future care engagement, via traumatic stress symptoms including avoidance. Disclosure of sexual trauma was limited; no women had disclosed to an HIV provider. Routine screening for sexual trauma in HIV care settings may help to identify individuals at risk of poor care engagement. Efficacious treatments are needed to address the psychological and behavioral sequelae of trauma.

Keywords

South Africa HIV Sexual violence Traumatic stress Adherence 

Notes

Acknowledgements

This study was funded by a grant from NIMH (R34 MH102001). We also acknowledge support received from the Duke Center for AIDS Research (P30 AI064518) and the UCLA HIV/AIDS, Substance Abuse and Trauma Training Program (R25 DA035692). We gratefully acknowledge the participants who contributed time and energy to this study.

Funding

This study was funded by a grant from NIMH (R34 MH102001) and supported by the Duke Center for AIDS Research (P30 AI064518) and the UCLA HIV/AIDS, Substance Abuse and Trauma Training Program (R25 DA035692).

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

The study was approved by the ethical review boards at Duke University and the University of Cape Town. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    UNAIDS. The gap report. Geneva, Switzerland: UNAIDS 2014.Google Scholar
  2. 2.
    Shisana O, Rehle T, Simbayi L, Zuma K, Jooste S, Zungu N, et al. South African national HIV prevalence, incidence and behaviour survey, 2012. Cape Town: HSRC Press; 2014.Google Scholar
  3. 3.
    Jewkes R, Penn-Kekana L, Levin J, Ratsaka M, Schrieber M. Prevalence of emotional, physical and sexual abuse of women in three South African provinces. S Afr Med J. 2001;91(5):421–8.PubMedGoogle Scholar
  4. 4.
    Watt MH, Ranby KW, Meade CS, Sikkema KJ, MacFarlane JC, Skinner D, et al. Posttraumatic stress disorder symptoms mediate the relationship between traumatic experiences and drinking behavior among women attending alcohol-serving venues in a South African township. J Stud Alcohol Drugs. 2012;73(4):549–58.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Dunkle KL, Jewkes RK, Brown HC, Yoshihama M, Gray GE, McIntyre JA, et al. Prevalence and patterns of gender-based violence and re victimization among women attending antenatal clinics in Soweto, South Africa. Am J Epidemiol. 2004;160(3):230–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Seedat M, Van Niekerk A, Jewkes R, Suffla S, Ratele K. Violence and injuries in South Africa: prioritising an agenda for prevention. Lancet. 2009;374(9694):1011–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Follette VM, Polusny MA, Bechtle AE, Naugle AE. Cumulative trauma: the impact of child sexual abuse, adult sexual assault, and spouse abuse. J Trauma Stress. 1996;9(1):25–35.PubMedCrossRefGoogle Scholar
  8. 8.
    Resnick HS, Kilpatrick DG, Dansky BS, Saunders BE, Best CL. Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J Consult Clin Psychol. 1993;61(6):984–91.PubMedCrossRefGoogle Scholar
  9. 9.
    Breslau N. Gender differences in trauma and posttraumatic stress disorder. J Gend Specif Med. 2002;5(1):34–40.PubMedGoogle Scholar
  10. 10.
    Breslau N, Chilcoat HD, Kessler RC, Peterson EL, Lucia VC. Vulnerability to assaultive violence: further specification of the sex difference in post-traumatic stress disorder. Psychol Med. 1999;29(4):813–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Breslau N, Davis GC, Peterson EL, Schultz L. Psychiatric sequelae of posttraumatic stress disorder in women. Arch Gen Psychiatry. 1997;54(1):81–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Gilbert L, Raj A, Hien D, Stockman J, Terlikbayeva A, Wyatt G. Targeting the SAVA (substance abuse, violence, and AIDS) syndemic among women and girls: a global review of epidemiology and integrated interventions. J Acquir Immune Defic Syndr. 2015;69(Suppl 2):S118–27.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet. 2004;363(9419):1415–21.PubMedCrossRefGoogle Scholar
  14. 14.
    Klot JF, Auerbach JD, Veronese F, Brown G, Pei A, Wira CR, et al. Greentree white paper: sexual violence, genitoanal injury, and HIV: priorities for research, policy, and practice. AIDS Res Hum Retrovir. 2012;28(11):1379–88.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    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
  16. 16.
    Senn TE, Carey MP, Vanable PA. Childhood and adolescent sexual abuse and subsequent sexual risk behavior: evidence from controlled studies, methodological critique, and suggestions for research. Clin Psychol Rev. 2008;28(5):711–35.PubMedCrossRefGoogle Scholar
  17. 17.
    Wilson HW, Widom CS. Pathways from childhood abuse and neglect to HIV-risk sexual behavior in middle adulthood. J Consult Clin Psychol. 2011;79(2):236–46.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Machtinger EL, Haberer JE, Wilson TC, Weiss DS. Recent trauma is associated with antiretroviral failure and HIV transmission risk behavior among HIV-positive women and female-identified transgenders. AIDS Behav. 2012;16(8):2160–70.PubMedCrossRefGoogle Scholar
  19. 19.
    Government Gazette. The criminal law (sexual offences and related matters) Amendment Act 32 of 2007. Pretoria: Government Printing Works; 2007.Google Scholar
  20. 20.
    Vetten L, Jewkes R, Sigsworth N, Christofides N, Loots L, Dunseith O. Tracking justice: The attrition of rape cases through the criminal justice system in Gauteng. Johannesburg: Tshwaranang Legal Advocacy Centre, the South African Medical Research Council and the Center for the Study of Violence and Reconcilitation; 2008.Google Scholar
  21. 21.
    Jina R, Jewkes R, Christofides N, Loots L. Knowledge and confidence of South African health care providers regarding post-rape care: a cross-sectional study. BMC Health Serv Res. 2013;13(1):257.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Leserman J. Role of depression, stress, and trauma in HIV disease progression. Psychosom Med. 2008;70(5):539–45.PubMedCrossRefGoogle Scholar
  23. 23.
    Pence BW, Mugavero MJ, Carter TJ, Leserman J, Thielman NM, Raper JL, et al. Childhood trauma and health outcomes in HIV-infected patients: an exploration of causal pathways. J Acquir Immune Defic Syndr. 2012;59(4):409–16.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Leserman J, Petitto JM, Perkins DO, Folds JD, Golden RN, Evans DL. Severe stress, depressive symptoms, and changes in lymphocyte subsets in human immunodeficiency virus-infected men. a 2-year follow-up study. Arch Gen Psychiatry. 1997;54(3):279–85.PubMedCrossRefGoogle Scholar
  25. 25.
    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
  26. 26.
    Schafer KR, Brant J, Gupta S, Thorpe J, Winstead-Derlega C, Pinkerton R, et al. Intimate partner violence: a predictor of worse HIV outcomes and engagement in care. AIDS Patient Care STDS. 2012;26(6):356–65.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Sikkema KJ, Ranby KW, Meade CS, Hansen NB, Wilson PA, Kochman A. 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. J Consult Clin Psychol. 2013;81(2):274–83.PubMedCrossRefGoogle Scholar
  28. 28.
    Blashill AJ, Perry N, Safren SA. Mental health: a focus on stress, coping, and mental illness as it relates to treatment retention, adherence, and other health outcomes. Curr HIV/AIDS Rep. 2011;8(4):215–22.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Statistics South Africa. South African national census of 2011. Pretoria: Government of South Africa; 2014.Google Scholar
  30. 30.
    South Africa Department of Health. National consolidated guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) and the management of HIV in children, adolescents and adults. Pretoria: Government of South Africa; 2015.Google Scholar
  31. 31.
    Birks M, Chapman Y, Francis K. Memoing in qualitative research: probing data and processes. J Res Nurs. 2008;13:68–75.CrossRefGoogle Scholar
  32. 32.
    Glaser BG. The constant comparative method of qualitative analysis. Soc Probl. 1965;12:436–45.CrossRefGoogle Scholar
  33. 33.
    Wood K, Lambert H, Jewkes R. “Showing roughness in a beautiful way”: talk about love, coercion, and rape in South African youth sexual culture. Med Anthropol Q. 2007;21(3):277–300.PubMedCrossRefGoogle Scholar
  34. 34.
    Mayosi BM, Lawn JE, van Niekerk A, Bradshaw D, Abdool Karim SS, Coovadia HM, et al. Health in South Africa: changes and challenges since 2009. Lancet. 2012;380(9858):2029–43.PubMedCrossRefGoogle Scholar
  35. 35.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, D.C.: American Psychiatric Association; 2013.CrossRefGoogle Scholar
  36. 36.
    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
  37. 37.
    Machtinger E, Wilson T, Haberer J, Weiss D. Psychological trauma and PTSD in HIV-positive women: a meta-analysis. AIDS Behav. 2012;16(8):2091–100.PubMedCrossRefGoogle Scholar
  38. 38.
    Post-Traumatic Stress Disorder. The management of PTSD in adults and children in primary and secondary care. Leicester: The Royal College of Psychiatrists & The British Psychological Society; 2005.Google Scholar
  39. 39.
    Darnell D, Peterson R, Berliner L, Stewart T, Russo J, Whiteside L, et al. Factors associated with follow-up attendance among rape victims seen in acute medical care. Psychiatry. 2015;78(1):89–101.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Roberts KJ. Physician-patient relationships, patient satisfaction, and antiretroviral medication Adherence among HIV-infected adults attending a public health clinic. AIDS Patient Care STDS. 2002;16(1):43–50.PubMedCrossRefGoogle Scholar
  41. 41.
    Altice FL, Mostashari F, Friedland GH. Trust and the acceptance of and adherence to antiretroviral therapy. J Acquir Immune Defic Syndr. 2001;28(1):47–58.PubMedCrossRefGoogle Scholar
  42. 42.
    Beach MC, Keruly J, Moore RD. Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV? J Gen Intern Med. 2006;21(6):661–5.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Bofill LM, Lopez M, Dorigo A, Bordato A, Lucas M, Cabanillas GF, et al. Patient-provider perceptions on engagement in HIV care in Argentina. AIDS Care. 2014;26(5):602–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Leeners B, Stiller R, Block E, Gorres G, Imthurn B, Rath W. Effect of childhood sexual abuse on gynecologic care as an adult. Psychosomatics. 2007;48(5):385–93.PubMedCrossRefGoogle Scholar
  45. 45.
    Farley M, Golding JM, Minkoff JR. Is a history of trauma associated with a reduced likelihood of cervical cancer screening? J Fam Pract. 2002;51(10):827–31.PubMedGoogle Scholar
  46. 46.
    Ullman SE. Social reactions to child sexual abuse disclosures: a critical review. J Child Sex Abus. 2003;12(1):89–121.PubMedCrossRefGoogle Scholar
  47. 47.
    Machtinger EL, Cuca YP, Khanna N, Rose CD, Kimberg LS. From treatment to healing: the promise of trauma-informed primary care. Womens Health Issues. 2015;25(3):193–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Bradley R, Greene J, Russ E, Dutra L, Westen D. A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry. 2005;162(2):214–27.PubMedCrossRefGoogle Scholar
  49. 49.
    Ponniah K, Hollon SD. Empirically supported psychological treatments for adult acute stress disorder and posttraumatic stress disorder: a review. Depress Anxiety. 2009;26(12):1086–109.PubMedCrossRefGoogle Scholar
  50. 50.
    Cukor J, Olden M, Lee F, Difede JA. Evidence-based treatments for PTSD, new directions, and special challenges. Ann N Y Acad Sci. 2010;1208(1):82–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Applebaum AJ, Bedoya CA, Hendriksen ES, Wilkinson JL, Safren SA, O’Cleirigh C. Future directions for interventions targeting PTSD in HIV-infected adults. J Assoc Nurses AIDS Care. 2015;26(2):127–38.PubMedCrossRefGoogle Scholar
  52. 52.
    Pacella ML, Armelie A, Boarts J, Wagner G, Jones T, Feeny N, et al. The impact of prolonged exposure on PTSD symptoms and associated psychopathology in people living with HIV: a randomized test of concept. AIDS Behav. 2012;16(5):1327–40.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    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
  54. 54.
    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
  55. 55.
    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
  56. 56.
    Meade CS, Drabkin AS, Hansen NB, Wilson PA, Kochman A, Sikkema KJ. Reductions in alcohol and cocaine use following a group coping intervention for HIV-positive adults with childhood sexual abuse histories. Addiction. 2010;105(11):1942–51.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Seedat S. Interventions to improve psychological functioning and health outcomes of HIV-infected individuals with a history of trauma or PTSD. Curr HIV/AIDS Rep. 2012;9(4):344–50.PubMedCrossRefGoogle Scholar
  58. 58.
    Velloza J, Watt MH, Choi KW, Abler L, Kalichman SC, Skinner D, et al. HIV/AIDS-related stigma in South African alcohol-serving venues and its potential impact on HIV disclosure, testing and treatment-seeking behaviours. Glob Public Health. 2015;10(9):1092–106.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Melissa H. Watt
    • 1
  • Alexis C. Dennis
    • 1
  • Karmel W. Choi
    • 1
    • 2
  • Nonceba Ciya
    • 3
  • John A. Joska
    • 3
  • Corne Robertson
    • 3
  • Kathleen J. Sikkema
    • 1
    • 2
    • 3
  1. 1.Duke Global Health InstituteDuke UniversityDurhamUSA
  2. 2.Department of Psychology and NeuroscienceDuke UniversityDurhamUSA
  3. 3.Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa

Personalised recommendations