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HIV and the Long Tail of Child Sexual Abuse
Durham, NC - One in four HIV patients was found to have been sexually abused as a child, according to a two-year Duke University study of more than 600 HIV patients. Traumatic childhood experiences were also linked to worse health outcomes among these patients, who are aged 20 to 71.
More than half of these patients in the Coping with HIV/AIDS in the Southeast (CHASE) study had experienced sexual or physical abuse in their lifetimes, according to researchers from the Duke Center for Health Policy and Inequalities Research (CHPIR). Half of the patients had experienced three or more lifetime traumatic experiences, which, in addition to sexual or physical abuse, could include such experiences as witnessing domestic violence as a child, a parent's suicide attempt or completion, or losing a child.
"For whatever outcome we looked at, psychological trauma ended up being a predictor of worse medical outcomes and poorer health-related behaviors," said lead author Brian Pence, a Duke associate professor of community and family medicine and global health.
Through periodic follow-ups over a two-year period, the study made important links between traumatic experiences, HIV-related behaviors and worse health outcomes. More lifetime traumatic experiences were associated with instances of unprotected sex, missing antiretroviral medications, recent emergency room visits and hospitalizations. Those patients who had experienced trauma were more likely to see their health decline or to die during the study period.
The study appears in the April 1 edition of the Journal of Acquired Immune Deficiency Syndromes (online now), with an accompanying editorial. The research was supported by the National Institute of Mental Health.
Pence said these findings highlight the importance of assessing trauma history in patients receiving HIV care. The researchers hope the results can be used to inform the way HIV treatment programs are developed so they promote safer sex practices, optimal drug adherence and better health outcomes for HIV-infected individuals.
What surprised the researchers most was that the effects of past trauma on current behaviors and health was not explained by the usual factors.
"We would expect people with a history of exposure to trauma to have post-traumatic stress disorder (PTSD), depression or other mental health concerns, like drug abuse or poor coping skills, and that these things in turn would more fully explain why they had lower adherence to their medications and worse health," Pence said. "But, we found that trauma history was still associated with bad health outcomes independent of mental health status, drug use or coping styles. So we have more to learn about exactly how past traumatic experiences exert influence on behaviors and health outcomes years down the road."
"We hope that this study spurs further research into understanding how early trauma affects behaviors and health much later in life," Pence said. "Regardless of the reason, past trauma certainly seems to influence how HIV patients engage in their medical care and how they end up doing clinically."
Other CHPIR researchers involved in the study include Kathryn Whetten, Rae Jean Proeschold-Bell and Susan Reif, as well as collaborators from the University of Alabama at Birmingham, Appalachian State University and the University of North Carolina at Chapel Hill.
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CITATION: "Childhood Trauma and Health Outcomes in HIV-Infected Patients: An Exploration of Causal Pathways," Pence, Brian Wells; Mugavero, Michael J. et al. Journal of Acquired Immune Deficiency Syndromes. April 1, 2012.