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

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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.

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.

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Acknowledgments

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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Authors and Affiliations

  1. Department of Medicine, University of California, 400 Parnassus Avenue, Box 0320, San Francisco, CA, 94143, USA

    E. L. Machtinger & T. C. Wilson

  2. Department of Medicine, Massachusetts General Hospital, Center for Global Health, Boston, MA, USA

    J. E. Haberer

  3. Department of Psychiatry, University of California, San Francisco, CA, USA

    D. S. Weiss

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  1. E. L. Machtinger
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  2. J. E. Haberer
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  3. T. C. Wilson
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  4. D. S. Weiss
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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). https://doi.org/10.1007/s10461-012-0158-5

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