Gender Disparities in Traumatic Life Experiences and Antiretroviral Therapy Adherence Among People Living with HIV in South Carolina
- 325 Downloads
People living with HIV are at increased risk for experiencing trauma, which may be linked to reduced adherence to antiretroviral therapy (ART), making it more difficult to achieve and maintain viral suppression. The current study sought to assess whether traumatic life experiences were associated with lower ART adherence among a diverse sample of people living with HIV in South Carolina. A cross-sectional survey was completed by 402 individuals receiving HIV care from a large immunology center. Principal component analysis revealed three primary categories of trauma experience (extreme violence/death-related trauma, physical and sexual assault, and accidental/disaster-related trauma). Multivariable logistic regression models using complete case analysis and multiple imputation were used to determine the associations between experiencing each trauma category and ART adherence. Complete case analysis showed that overall, participants who reported exposure to any trauma were 58% less likely to be adherent to their ART (adjusted OR 0.42; 95% CI 0.21–0.86) compared to respondents who did not experience trauma. Participants exposed to extreme violence/death-related trauma were 63% less likely to be adherent to their ART (adjusted OR 0.37; 95% CI 0.15–0.95) compared to respondents who did not experience trauma. Participants exposed to physical and sexual assault were 65% less likely (adjusted OR 0.35; 95% CI 0.16–0.77) and those who reported experiencing accidental/disaster-related trauma were 56% less likely (adjusted OR 0.44; 95% CI 0.21–0.93) to report being ART adherent compared to participants who did not experience trauma. Analyses with multiple imputation yielded similar findings as the complete case analyses. When the data were analyzed separately by gender, the associations between overall trauma, extreme violence/death-related trauma, and physical and sexual assault were statistically significant for men using complete case and multiple imputation analyses. There were no statistically significant associations between trauma and ART adherence among women. Findings highlight the need to adopt trauma-informed approaches and integrate trauma- and gender-specific interventions into HIV clinical care in the Southern United States.
KeywordsTrauma ART adherence HIV Men Women
This study was funded in part by the South Carolina SmartState Program®. We would like to thank the following individuals who coordinated and participated in survey instrument development and data collection: Joi Anderson, Amir Bhochhibhoya, Michelle Deming, Akeen Hamilton, LaDrea Ingram, Crystal Stafford, and Mohammad Rifat Haider, as well as the administrative staff of the immunology clinic where this study was conducted. Finally, we are deeply grateful for the willingness of study participants to share their time and experiences with us. We take seriously our commitment to use study findings to improve outcomes for people living with HIV in South Carolina and recognize that this work could not be done without their participation and contributions.
This study was funded by the South Carolina SmartState Program®. M. J. Brown is supported by grant K01MH115794 from the National Institute of Mental Health. The sponsors had no role in the design, analysis or decision to publish these findings. The content is solely the responsibility of the authors and does not necessarily represent the official views of the South Carolina SmartState Program® or the National Institutes of Health.
Compliance with Ethical Standards
Conflict of interest
All the authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 4.Pai A, Suris AM, North CS. Posttraumatic stress disorder in the DSM-5: controversy, change, and conceptual considerations. Behav Sci (Basel). 2017;7(1):1–7.Google Scholar
- 21.McEwen BS. Protective and damaging effects of stress mediators: central role of the brain. Dialog Clin Neurosci. 2006;8(4):367–81.Google Scholar
- 33.Abler L, Sikkema KJ, Watt MH, et al. Traumatic stress and the mediating role of alcohol use on HIV-related sexual risk behavior: results from a longitudinal cohort of South African women who attend alcohol-serving venues. J Acquir Immune Defic Syndr. 2015;68(3):322–8.PubMedPubMedCentralCrossRefGoogle Scholar
- 36.Centers for Disease Control and Prevention. HIV in the Southern United States. CDC Issue Brief. Available at: https://www.cdc.gov/hiv/pdf/policies/cdc-hiv-in-the-south-issue-brief.pdf. Accessed 29 Oct 2018.
- 38.South Carolina Department of Health and Environmental Control—Division of Surveillance and Technical Support Bureau of Disease Control. An epidemiological profile of HIV and AIDS in South Carolina 2017. Available at: https://scdhec.gov/sites/default/files/docs/Health/docs/stdhiv/pp_CH1-EpiProfile.pdf. Accessed 29 Oct 2018.
- 42.Tabachnik BG, Fidell LS. Using multivariate statistics. 5th ed. Boston: Pearson; 2007.Google Scholar
- 51.Dale SK, Pierre-Louis C, Bogart LM, O’Cleirigh C, Safren SA. Still I rise: the need for self-validation and self-care in the midst of adversities faced by Black women with HIV. Cult Divers Ethnic Minor Psychol. 2018 [Epub ahead of print].Google Scholar
- 52.Grulich AE, Bavinton BR, Jin F, et al. HIV transmission in male serodiscordant couples in Australia, Thailand and Brazil. Conference on Retroviruses and Opportunistic Infections. Seattle, Washington, 2015 [abstract 1019LB].Google Scholar
- 54.Centers for Disease Control and Prevention. HIV Surveillance Report, 2016. Available at: http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Accessed 29 Oct 2018.
- 56.Deshpande B. Feature selection with mutual information, Part 2: PCA disadvantages. Available at: http://www.simafore.com/blog/bid/105347/Feature-selection-with-mutual-information-Part-2-PCA-disadvantages. Accessed 14 Dec 2018.
- 57.Tavakol M, Dennick R. Making sense of Cronbach’s alpha. Available at: https://www.statisticshowto.datasciencecentral.com/cronbachs-alpha-spss/. Accessed 29 Oct 2018.
- 59.The Institute: Harm Reduction Coalition. The forgotten population in HIV prevention: Heterosexual Black/African American men. Available at: https://harmreduction.org/wp-content/uploads/2012/02/Forgotten-Population-Position-Paper.pdf. Accessed 20 Dec 2018.