Presented at International Violence, Abuse and Trauma Conference Dr. Priscilla Dass-Brailsford Georgetown University Washington DC

Transcription

1 The Traumatic Lives of Women Living with HIV/AIDS Presented at International Violence, Abuse and Trauma Conference Dr. Priscilla Dass-Brailsford Georgetown University Washington DC

2 Funded By Center for Aids Research (DC D-CFAR)

3 HIV Rates Among Women o HIV infection rates among African American women almost 20 X higher (CDC, 2011) o 2000 to 2004: leading cause of death for African American women (between years) o Third leading cause for women years of age o More than 11,000 African American women were killed in this time period (CDC, 2007)

4 HIV Prevalence in DC Highest HIV prevalence rates (3%) in the U.S. Mostly African American women (1.7%) Low-income and primarily infected through heterosexual transmission (CDC, 2007) By race and gender, African American females are a high-risk group

5 Predisposing Factors (HIV) Biological, behavioral, and psychosocial factors Sexual violence primary Co-occurrence: Trauma and Substance Abuse (Keuroghlian et al., 2011).

6 PTSD & HIV Post-Traumatic Stress Disorder comorbid among women diagnosed with HIV/AIDS (Martinez et al., 2002) Prevalence rates have ranged from 30% to 64% (Martinez et al., 2002) vs 1.3% to 7.8% in general population (Carey et al., 2003; Emsley et al., 2003) Negative impact on HIV-related health outcomes

7 Conceptual Flow Chart Demographic Data Race/Ethnicity, SES, Age etc. Trauma exposure Child/Adult Treatment Engagement & Adherence Mental Health Outcomes (Depression, anxiety, PTSD)

8 Sample: N=120 Female 21 years or older HIV positive Prescribed antiretroviral medications Resident of the District of Columbia 8th grade level Child/adult trauma exposure (with or without PTSD).

9 Exclusion Criteria Non-English speakers Transgender Lifetime or current severe psychiatric disorder intoxicated (under the influence of alcohol or drugs)

10 Goals & Objective Long-term goal: identify & reduce mental health-related barriers to health care utilization among HIV+ Preliminary evidence suggests trauma history/ptsd is a key barrier Objective: to identify common forms trauma exposure among HIV+ women link to health care utilization

11 Specific Aim #1 To evaluate the relationship between trauma exposure, in general, and different types of trauma in particular (childhood physical/sexual/emotional abuse, adult violence) with treatment engagement and adherence to HAART

12 Specific Aim #2 To compare the extent to which mental health outcomes serve as mediators between trauma exposure and treatment engagement and adherence to HAART among WLWH with and without PTSD

13 Hypotheses High anxiety and depression scores are associated with poor treatment engagement and adherence among WLWH and with a presumptive diagnosis of PTSD compared to WLWH without PTSD Mental health outcomes mediate the relationship between trauma exposure and treatment-related outcomes

14 Specific Aim #3 To conduct in-depth LHC interviews with a sub-sample of WLWH (n=30, stratified to obtain a range of trauma histories, with and without PTSD) to elucidate the relationship between trauma history and HIV treatment adherence, and to identify mechanisms that may play a role in improving treatment utilization.

15 Mixed Methods Design Survey: data on trauma exposure, mental health outcomes (including PTSD), and patterns of treatment engagement and adherence Stratified sub-sample (n=30)- semistructured LHC interviews provide qualitative data on trauma histories

16 Recruitment Participants identified & recruited through several local CBOs: The Women s Collective Women s Interagency HIV study at Georgetown University Family Medical & Counseling Services Whitman Walker Center Our Place

17 Demographic Characteristics

18 Mental Health Scales

19 Mental Health Disorders

20 Anxiety Symptoms 120 Anxiety Symptoms Anxiety Attack Anxious Easily Annoyed

21 Traumas Reported Commonly

22 Substance Use

23 Treatment Adherence AIDS Clinical Trials Group (ACTG) Adherence Questionnaire (Cheney et al. 2000) 5-item self-report measure Cross validated medical records Viral load surrogate marker adherence undetectable viral load = indicates good adherence

24 Treatment Adherence

25 Adherence-Viral Load 56% of sample had suppressed viral load scores, 41.3% did not have suppressed viral load scores.

26 Life History Calendar Sub-sample Stratified n=30 Qualitative research tool Retrospective data collection Provides accurate event timing/sequencing data

27 LHC (Cont.) Matrix clearly visible to participant Enhances recall Enhances in-depth discussion Effective reflection tool [I can see] my whole life on paper, empirically tested - varying cultural backgrounds and ages Fidelity direct observation

28 Demographic

29

30 Quantitative Results

31 Substance Abuse History Table 4: Substance Abuse History Substance n % Marijuana 16 53% Crack/Cocaine 18 60% Heroin 10 33% Pills 6 20% Alcohol 23 77% Current Alcohol 9 30% Other 3 10%

32 Future Directions More research Empirical evidence Early Detection & Collaboration Development of Interventions Policy Changes