Almost a third of HIV-positive women in the US have recent post-traumatic stress disorder and 55% have experienced intimate partner violence, according to the results of a meta-analysis published in AIDS and Behavior.
The investigators identified 29 studies examining trauma and post-traumatic stress disorder (PTSD) in women with HIV.
Overall, 33% of women had recent PTSD, some six times the rate seen in the general US population. Almost two-third of women had a lifetime experience of sexual abuse.
“The implications of these findings are highly significant,” comment the authors. “These results…support and inform longtime calls for studies of trauma-prevention and trauma-recovery interventions to reduce the high incidence and relatively poor outcomes of HIV among women.”
Women now account for 27% of all new HIV diagnoses in the US and 77% of these infections are in Blacks or Latinos. Despite general improvements in the prognosis of HIV-positive patients, HIV/AIDS is now the leading cause of death among Black women aged 25 to 34.
Trauma is increasingly recognised as contributory factor to the increasing prevalence of HIV in US women and their poorer outcomes. However, studies exploring the prevalence of trauma and PTSD among women with HIV have yielded widely varying results, or cannot be generalised to the general population of HIV-positive women.
Investigators therefore undertook meta-analysis to clarify rates of trauma and PTSD in HIV-positive women. Where possible, the observed prevalence was compared to that recorded in the general population of US women.
The authors searched for studies published between 1990 and 2009. To be included, the research had to examine current or past exposure to at least one traumatic stressor.
A total of 29 studies including 5930 women met the investigators’ criteria and were included in the meta-analysis.
The estimated rate of recent PTSD was 30%.
“This estimate is over five times the rate of recent PTSD reported in a national prevalence sample of women,” write the authors.
Prevalence of intimate partner violence among women with HIV was an estimated 55% - twice the rate reported in US women as a whole.
Rates of adult sexual and physical abuse were 35% and 54% respectively. Estimated prevalence of childhood sexual abuse and childhood physical abuse were 39% and 42%.
“Both of these samples are approximately twice those documented in a national prevalence sample of women,” note the researchers.
They calculated that an estimated 61% of HIV-positive women had a lifetime history of sexual abuse, five times the national US prevalence. The estimated prevalence of lifetime physical abuse was 72%.
“We observed very high rates of all categories of traumatic exposure and PTSD,” write the investigators. “The estimates of the various categories of trauma and recent PTSD in HIV-positive women are mostly between two and five-fold higher.”
Efforts to address trauma and PTSD should be a priority in HIV prevention and care, argue the authors.
“Effectively addressing trauma and PTSD may be an opportunity to make a transformational impact on the HIV epidemic.”
The authors suggest “screening and referrals for recent and past trauma and PTSD should be considered a core component of HIV treatment in this population, along with medication adherence, CD4 cell counts and viral loads.”
Machtinger EL et al. Psychological trauma and PTSD in HIV-positive women: a meta-analysis. AIDS Behav, online edition. DOI 10.1007/s10461-011-0127-2, 2012.