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


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.


South Africa HIV Sexual violence Traumatic stress Adherence 



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.


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.


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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

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