International AIDS Society

Sexual Trauma Raises Risk of ART Failure and Risky Sex in US Women

Author: Mark Mascolini

19 November 2012

Recent sexual trauma quadrupled chances of antiretroviral failure in a study of 113 biological and transgender women in San Francisco. Recent trauma also quadrupled the risk of sex with HIV-negative partners or without condoms.

Both sexual trauma and posttraumatic stress disorder may predict poor HIV health outcomes and transmission risk behaviors, and both disproportionately affect HIV-positive women. Researchers in San Francisco conducted this study of 81 women and 32 transgender women to assess the impact of such trauma on virologic failure (a detectable viral load despite antiretroviral use) and HIV risk behaviors.

Study group age averaged 44.6 and ranged from 20.2 to 61.9. Two thirds of women (65%) were African American, 20% white, 7% Latina, 3% Asian/Pacific Islander, and 2% Native American. Most women (89%) had a monthly income at or below $1000. All had some form of housing in the past 30 days.

Sixty-three of 112 woman (56%) were taking combination antiretroviral therapy, and 17 of 90 women with viral load data (19%) had a detectable viral load. Fifteen of 63 women (24%) self-reported adherence below 90%.

Among 110 women questioned, 79 (72%) reported being abused, threatened, or a victim of violence at least once in their lifetime. Nine women (8%) reported being coerced to have sex in the past 30 days, and 71 (64.5%) were coerced to have sex in their lifetime.

Compared with women who did not experience recent trauma, those who did had higher chances of antiretroviral viral failure and HIV transmission risk behaviors, at the following adjusted odds ratios (aOR) (and 95% confidence intervals):

• Antiretroviral failure: aOR 4.3 (1.1-16.6), P = 0.04
• Sex with HIV-negative/unknown status partner: aOR 3.9 (1.3-11.9), P = 0.02
• Under 100% condom use with these partners: aOR 4.5 (1.5-13.3) P = 0.007

The authors conclude that “an affirmative answer to a simple screening question for recent trauma is associated with key HIV-related health outcomes and transmission risk behaviors among HIV-positive women and female-identified transgenders.”

The researchers believe their findings “call for an invigorated focus on trauma screening in clinical practice and for new interventions that focus on trauma-prevention and trauma-recovery among women with HIV.”

Source: E.L. Machtinger, J.E. Haberer, T.C. Wilson, D.S. Weiss. Recent trauma is associated with antiretroviral failure and HIV transmission risk behavior among HIV-positive women and female-identified transgenders. AIDS and Behavior. 2012; 16: 2160-2170.

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