Psychological Trauma and PTSD in HIV-positive Women

A Meta-analysis

E. L. Machtinger; T. C. Wilson; J. E. Haberer; D. S. Weiss

Disclosures

AIDS and Behavior. 2012;16(8):2091-2100. 

In This Article

Abstract and Introduction

Abstract

Women bear an increasing burden of the HIV epidemic and face high rates of morbidity and mortality. Trauma has been increasingly associated with the high prevalence and poor outcomes of HIV in this population. This meta-analysis estimates rates of psychological trauma and posttraumatic stress disorder (PTSD) in HIV-positive women from the United States. We reviewed 9,552 articles, of which 29 met our inclusion criteria, resulting in a sample of 5,930 individuals. The findings demonstrate highly disproportionate rates of trauma exposure and recent PTSD in HIV-positive women compared to the general population of women. For example, the estimated rate of recent PTSD among HIV-positive women is 30.0% (95% CI 18.8–42.7%), which is over five-times the rate of recent PTSD reported in a national sample of women. The estimated rate of intimate partner violence is 55.3% (95% CI 36.1–73.8%), which is more than twice the national rate. Studies of trauma-prevention and trauma-recovery interventions in this population are greatly needed.

Introduction

Women bear a steadily increasing burden of the HIV epidemic. In the United States (US), women account for at least 27% of all new HIV/AIDS diagnoses, up from 8% in 1985 and 14% in 1992.[1–3] Women of color bear the lion's share of this burden; Black and Hispanic women now represent more than three-quarters (77%) of women recently diagnosed with HIV/AIDS.[3]

Despite the availability of effective antiretroviral therapy (ART), women face surprisingly high rates of HIV-related morbidity and mortality.[1,4,5] HIV/AIDS is now the leading cause of death for US Black women aged 25–34.[1] Numerous calls have been made to identify and respond to factors associated with the high prevalence and poor outcomes of HIV in women.[6–8]

Trauma is increasingly recognized as an important factor associated with the rising prevalence and poor outcomes of HIV in women.[9–11] HIV-positive women are affected by high rates of sexual and physical trauma in both childhood and adulthood, as well as by posttraumatic stress disorder (PTSD).[12–40] Trauma and PTSD are well known to predispose women to becoming infected with HIV.[11,16,17,41–43] Once infected, women exposed to trauma and those who go on to develop PTSD have poorer health outcomes[44–49] and higher transmission risk behaviors.[12,15,16,25,27,50,51]

Although prior studies[12–40] have documented high rates of different types of psychologically traumatizing experiences and PTSD in HIV-positive women, the rates reported by individual studies often vary, even for a specific type of trauma. For example, the reported rates of intimate partner violence (IPV) among US HIV-positive women range from 10 to 100%[25,26] and the reported rates of recent PTSD range from 15 to 53%.[23,37] Many studies cannot be generalized to the larger HIV-positive female population in the US because of the use of convenience samples or site–specific recruitment methods (e.g., prisons, drug treatment programs).

The purpose of this study is to employ meta-analytic technique to clarify rates of trauma exposure and PTSD in HIV-positive women and, where possible, to compare these rates to those in the general population of US women. To the authors' knowledge, this is the first time that a meta-analysis has addressed this question.

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