Abstract
BackgroundIn high income nations, traumatic life experiences such as childhood sexual abuse are much more common in people living with HIV/AIDS (PLWHA) than the general population, and trauma is associated with worse current health and functioning. Virtually no data exist on the prevalence or consequences of trauma for PLWHA in low income nations.Methodology/Principal FindingsWe recruited four cohorts of Tanzanian patients in established medical care for HIV infection (n = 228), individuals newly testing positive for HIV (n = 267), individuals testing negative for HIV at the same sites (n = 182), and a random sample of community-dwelling adults (n = 249). We assessed lifetime prevalence of traumatic experiences, recent stressful life events, and current mental health and health-related physical functioning. Those with established HIV infection reported a greater number of childhood and lifetime traumatic experiences (2.1 and 3.0 respectively) than the community cohort (1.8 and 2.3). Those with established HIV infection reported greater post-traumatic stress disorder (PTSD) symptomatology and worse current health-related physical functioning. Each additional lifetime traumatic experience was associated with increased PTSD symptomatology and worse functioning.Conclusions/SignificanceThis study is the first to our knowledge in an HIV population from a low income nation to report the prevalence of a range of potentially traumatic life experiences compared to a matched community sample and to show that trauma history is associated with poorer health-related physical functioning. Our findings underscore the importance of considering psychosocial characteristics when planning to meet the health needs of PLWHA in low income countries.
Highlights
IntroductionStudies of people living with HIV/ AIDS (PLWHA) have consistently demonstrated a high lifetime prevalence of traumatic life experiences. [1] In a large US cohort of women with or at high risk for HIV, 66% had experienced domestic violence and 31% percent had experienced sexual abuse during childhood. These numbers are substantially higher than the general population lifetime prevalence of domestic violence (25%) and childhood sexual abuse (13%). [2,3] In a large cohort of HIV patients from the US Deep South, 30% of participants reported sexual abuse and 20% reported physical abuse during childhood; overall, 91% of respondents reported at least one potentially traumatic experience during their lifetimes. [4,5].In recent years, increasing attention has turned to the adverse behavioral and health consequences of trauma histories in people living with HIV/AIDS (PLWHA). [6,7] A history of potentially traumatic life events has been associated with development of post-traumatic stress disorder (PTSD), [8,9,10,11,12,13] depression, [14,15,16,17,18] and substance abuse, [12,14,19,20,21] as well as increased high risk sexual and drug use behaviors that increase the risk of becoming infected, and transmitting infection to others. [14,22,23,24,25,26,27,28] Though rates of PTSD have not been studied in large cohorts, existing data, predominately from high income countries, suggest that PTSD is highly prevalent among PLWHA
In recent years, increasing attention has turned to the adverse behavioral and health consequences of trauma histories in people living with HIV/AIDS (PLWHA). [6,7] A history of potentially traumatic life events has been associated with development of post-traumatic stress disorder (PTSD), [8,9,10,11,12,13] depression, [14,15,16,17,18] and substance abuse, [12,14,19,20,21] as well as increased high risk sexual and drug use behaviors that increase the risk of becoming infected, and transmitting infection to others. [14,22,23,24,25,26,27,28] Though rates of PTSD have not been studied in large cohorts, existing data, predominately from high income countries, suggest that PTSD is highly prevalent among PLWHA
From November 2008 to October 2009, the Coping with HIV/AIDS in Tanzania (CHAT) Study recruited 1,197 participants to form five distinct cohorts: patients with established HIV infection receiving care at the regional tertiary referral hospital (KCMC, clinic census,1400; sample n = 228); patients with established HIV infection receiving care at the local public hospital; individuals newly diagnosed with HIV at voluntary counseling and testing (VCT) sites (n = 267); individuals testing HIV-negative at VCT sites (n = 182); and a random sample of adults from the surrounding community (n = 249)
Summary
Studies of people living with HIV/ AIDS (PLWHA) have consistently demonstrated a high lifetime prevalence of traumatic life experiences. [1] In a large US cohort of women with or at high risk for HIV, 66% had experienced domestic violence and 31% percent had experienced sexual abuse during childhood. These numbers are substantially higher than the general population lifetime prevalence of domestic violence (25%) and childhood sexual abuse (13%). [2,3] In a large cohort of HIV patients from the US Deep South, 30% of participants reported sexual abuse and 20% reported physical abuse during childhood; overall, 91% of respondents reported at least one potentially traumatic experience during their lifetimes. [4,5].In recent years, increasing attention has turned to the adverse behavioral and health consequences of trauma histories in PLWHA. [6,7] A history of potentially traumatic life events has been associated with development of post-traumatic stress disorder (PTSD), [8,9,10,11,12,13] depression, [14,15,16,17,18] and substance abuse, [12,14,19,20,21] as well as increased high risk sexual and drug use behaviors that increase the risk of becoming infected, and transmitting infection to others. [14,22,23,24,25,26,27,28] Though rates of PTSD have not been studied in large cohorts, existing data, predominately from high income countries, suggest that PTSD is highly prevalent among PLWHA. Studies of people living with HIV/ AIDS (PLWHA) have consistently demonstrated a high lifetime prevalence of traumatic life experiences. [40] A South African study conducted to validate the use of the 17 item Posttraumatic stress Diagnostic Scale (PDS) in a South African patient population surveyed a convenience sample of 85 recently diagnosed HIV positive patients Among this sample, 44% met diagnostic criteria for current PTSD [41]and 54% met criteria for lifetime prevalence of PTSD. Traumatic life experiences such as childhood sexual abuse are much more common in people living with HIV/AIDS (PLWHA) than the general population, and trauma is associated with worse current health and functioning. No data exist on the prevalence or consequences of trauma for PLWHA in low income nations
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