4.5: Trauma

Histories of trauma has been defined as events or circumstances “experienced by an individual as physically or emotionally harmful or life-threatening which have lasting adverse effects on the individual’s functioning and mental, physical, social, emotional or spiritual well-being”.¹ In resource-rich settings childhood physical and/or sexual abuse before age 13 is experienced by 30% of HIV-infected individuals and intimate partner violence is experienced by 68-95% of HIV –infected women, 68-77% of men, and 93% of transgendered people.¹ Among HIV-infected individuals, experiences of trauma are associated with poor mental health, increased engagement in HIV high-risk transmission behaviours, diminished adherence to HIV care and ART, more frequent opportunistic infections, and higher risk of AIDS-related mortality.¹ The high prevalence rate of both trauma, HIV-related trauma symptoms and inflammatory related comorbid chronic medical conditions in individuals living with HIV likely increases risk for mortality.²

Over the past decade there has been significant work conducted to create and evaluate interventions as a part of trauma-informed care. For example, emerging evidence suggests that interventions and programs that build social ties within communities and promote cultural strengths, restorative justice, and resiliency may help address collective trauma leading to improved health outcomes.¹