title: Impact of Sexual Trauma on HIV Care Engagement: Perspectives of Female Patients with Trauma Histories in Cape Town, South Africa.
abstract: South African women have disproportionately high rates of both sexual trauma and HIV. To understand how sexual trauma impacts HIV care engagement, we conducted in-depth qualitative interviews with 15 HIV-infected women with sexual trauma histories, recruited from a public clinic in Cape Town. Interviews explored trauma narratives, coping behaviors and care engagement, and transcripts were analyzed using a constant comparison method. Participants reported multiple and complex traumas across their lifetimes. Sexual trauma hindered HIV care engagement, especially immediately following HIV diagnosis, and there were indications that sexual trauma may interfere with future care engagement, via traumatic stress symptoms including avoidance. Disclosure of sexual trauma was limited; no women had disclosed to an HIV provider. Routine screening for sexual trauma in HIV care settings may help to identify individuals at risk of poor care engagement. Efficacious treatments are needed to address the psychological and behavioral sequelae of trauma.
authors.affiliation: Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA. melissa.watt@duke.edu.
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Watt
authors.affiliation: Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA.
authors.forename: Alexis C
authors.initials: AC
authors.lastname: Dennis
authors.affiliation: Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA.|Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.
authors.forename: Karmel W
authors.initials: KW
authors.lastname: Choi
authors.affiliation: Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Nonceba
authors.initials: N
authors.lastname: Ciya
authors.affiliation: Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
authors.forename: John A
authors.initials: JA
authors.lastname: Joska
authors.affiliation: Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Corne
authors.initials: C
authors.lastname: Robertson
authors.affiliation: Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA.|Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.|Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Sikkema
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D044383:Black People / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012742:Sex Offenses / Q000208:ethnology / Q000523:psychology*; D012725:Sexual Behavior; D012931:Social Environment; D013019:South Africa / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000208:ethnology / Q000523:psychology*; D013315:Stress, Psychological / Q000208:ethnology / Q000523:psychology; D014754:Violence / Q000208:ethnology / Q000523:psychology*; D055815:Young Adult
keywords: Adherence; HIV; Sexual violence; South Africa; Traumatic stress