There is a high correlation between people who suffer childhood trauma and those who contract HIV, a recent study found.
The study of more than 600 HIV patients, led by Brian Pence, associate professor of community and family medicine and global health, linked certain childhood psychological trauma—such as sexual or physical assault, death of a family member, domestic violence or a parent’s suicide attempt or completion—to worsened health outcomes. The study found that one in four HIV patients was sexually abused as during childhood, and patients usually suffered from multiple instances of pre-adolescent trauma, factors that should influence patient treatment, Pence said.
“Our medical care system often treats the patient as they walk in the door ... and what sometimes gets lost is that person’s life history,” he said. “This research shows that those life histories can profoundly influence how a patient will end up doing clinically.”
The intent of the study was to research the association between past trauma and the contraction of HIV. Factors that researchers considered in this correlation prior to the study were psychological issues, including depression and post-traumatic stress disorder, and addictive behaviors such as drug and alcohol use, Pence said.
In contrast to previous theories, this study found that trauma is associated with HIV status, independent of a particular mental health issue.
“What really surprised us in the data was that, in fact, all of those factors explained very little of the association between trauma, current behaviors and current physical health outcomes,” Pence said. Dr. Rachel Dew, assistant professor of child and adolescent psychiatry, noted that certain life circumstances are associated with childhood sexual abuse, such as poverty, neglect and substance abuse in parents. These factors can put individuals in a demographic that would be at higher risk for acquiring HIV.
Children who undergo trauma also have the tendency to recreate the incident as a coping mechanism, she added.
“It’s very hard on [an individual’s] self-esteem if they’ve been sexually abused—they may feel like sex is the only way they are going to get love from anyone,” Dew said. “That kind of psychology leads kids into a lifestyle that can be associated with HIV infection.”
Kathleen Sikkema, professor of psychology and neuroscience, global health and psychiatry and behavioral sciences, has conducted research on mental health and HIV on her own. Coping with sexual abuse in an unhealthy way often results in the revictimization of an individual, which can expose them to HIV, she said.
“People often deal with substance abuse to help deal with the all of the emotions that come with [childhood sexual abuse], which is then just another risk factor for HIV,” Sikkema said. “So they build this perfect storm of potential issues—they may end up trading sex for drugs and end up getting raped in those situations, and the cycle keeps exacerbating without some sort of intervention.”
The study shows a need for increased public focus on mental health, said Susan Reif, a co-author of the study and research consultant of the Duke Center for Health Policy and Inequalities Research. Encouraging a greater focus on mental health screening immediately after an HIV diagnosis could promote better health outcomes, she added.
“It’s clear from the study that failure to address mental health is going to lead to poor health outcomes, which leads to more transmission,” Reif said. “What needs to be built on is the ways to deal with people in various phases after the trauma.”
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