HIV IS A SYMPTOM of a much larger problem—
violence against women.
Understanding how trauma fuels the HIV epidemic among women
WHP has undertaken a series of a significant research projects to better understand the causes of treatment failure among women with HIV/AIDS in the U.S. What we learned inspired us to transform our clinic and has the potential to transform women’s healthcare. Our research demonstrated that HIV positive women have incredibly high rates of trauma – defined as childhood and adult physical or sexual abuse. For example,
55% of HIV positive women in the U.S. have been victims of intimate partner violence compared to 22% of general population of women.
Over 60% of HIV-positive women have been sexually abused, five times the rate in the general population. Not surprisingly, the rate of post-traumatic stress disorder (PTSD) – the result of all of this abuse – is also strikingly high among HIV-positive women. Over 30% of HIV-positive women have symptoms of PTSD, six times the rate in the general population of women.
We know from prior research that trauma leads women and girls to becoming infected with HIV. And, once infected, our research shows that unaddressed trauma is a key reason why women fail their HIV medication adherence – four times the rate of medication adherence failure compared to those who had not been abused.
Developing an innovative scalable response to violence among women
We understand that unaddressed trauma fuels all aspects of the HIV epidemic among women. We looked for examples of an integrated response to trauma in other medical settings. Despite an increasing recognition among national healthcare leaders that childhood and adult trauma leads to an array of poor health outcomes, we found that no one had operationalized an integrated response to trauma in primary care. Lacking a good example to follow, we built our own. WHP created a new model of trauma-informed primary care that we now practice in our San Francisco clinic. This model is based on input and research from the nation’s leading experts on trauma-prevention and trauma-recovery.
WHP’s model of trauma-informed primary care includes three core components:
- Staff education and training on trauma-informed care;
- Robust screening for recent and past trauma and PTSD; and
- Interventions integrated into primary care to help women recover form past trauma and prevent further abuse.
The model is designed to be maximally scalable and cost effective. WHP has successfully pilot tested components of this model. As a result, our patients are becoming far more healthy and empowered. For example, one intervention focuses on improving the self-efficacy of abused women. This new program is a collaboration with a community arts organization, Medea Project: A Theatre for Incarcerated Women that helps women develop the skills and confidence to publically disclose their history of HIV and trauma. Our study of this program shows that half of the women who participate in this program develop the support and confidence to leave or avoid abusive partners. Another element of the trauma-informed primary care model focuses on reframing existing mental health interventions to address trauma. One such new program helps women overcome addiction by first addressing the trauma and PTSD that led to it in the first place.
We believe that this new model is incredibly powerful. It can transform the care of the 350,000 HIV-positive women in the U.S., and the far larger number of women and girls affected by trauma internationally. We are now focused on operationalizing and evaluating the full model of trauma-informed primary care. Doing so will allow us to most effectively influence the care systems, health, and empowerment of women and girls in this country and around the world.