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


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.


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.

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The authors wish to thank Naomi Azriel, Johanna Breyer, Colleen Buggs and Ginger Ruth for their sensitivity and compassion working with the participants; Brandon Norris for his administrative leadership of the prevention program; Jennifer Cocohoba, Nancy Hessol, Manya Magnus, and Maya Petersen for their helpful advice about research methodology; and Tulia Gonzales-Flores and Juanita Molina for their Spanish translation of the abstract.

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Correspondence to E. L. Machtinger.

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E. L. Machtinger and J. E. Haberer are co-principal authors.

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Machtinger, E.L., Haberer, J.E., Wilson, T.C. et al. Recent Trauma is Associated with Antiretroviral Failure and HIV Transmission Risk Behavior Among HIV-Positive Women and Female-Identified Transgenders. AIDS Behav 16, 2160–2170 (2012).

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