Research That Matters (January 17 - 20, 2008)

Still Here: Trauma, Illness and Coping in the Lives of Women with HIV/AIDS

Abstract

Purpose: This project explores the relationship between childhood abuse and illness in the lives of women with HIV/AIDS. Quantitative studies have indicated high rates of trauma, particularly sexual abuse and domestic violence, among this population (Simoni & Ng, 2000, 2002; Whitmire, Harlow, Quina, & Morokoff, 1999). Qualitative studies have begun to explore the ways that trauma may influence self-care practices in women living with HIV/AIDS (Leenerts, 1999; Leenerts, Flaskerud, & Saunders, 1999). However, the relationship between trauma and illness in the lives of women with HIV/AIDS has not yet been explored in depth, nor is it well understood theoretically. In particular, the implications of childhood abuse for women's vulnerability to HIV infection, and for their experience of illness, have not received adequate attention. Given the rising rates of HIV infection among women, this information is significant both for HIV prevention efforts and to better support women living with HIV/AIDS.

Method: In-depth semi-structured interviews were conducted with eighteen women living with HIV/AIDS. All participants self-reported physical or sexual abuse prior to age 16. The sample was ethnically diverse, and participants ranged in age from 28 to 60. Interviews explored the impact of both childhood abuse and HIV/AIDS on several aspects of functioning: identity and self-esteem, relationship to the body, sexuality, relational patterns, and sense of control. Implications for coping and self-care were also addressed. Transcripts were analyzed using grounded theory methods, assisted by the use of the qualitative analysis software ATLAS.ti.

Results: Analysis of the qualitative data yielded descriptive information about the experiences of women living with HIV/AIDS who have histories of childhood abuse. The data suggest that child physical or sexual abuse may play an indirect role in HIV risk in women. The data also indicate striking parallels between the experience of child abuse, particularly sexual abuse, and that of living with HIV/AIDS. For many participants, both phenomena resulted in low self-esteem, feelings of self-blame, negative attitudes toward the body and sexuality, feelings of betrayal and powerlessness in relationships, and a limited sense of control over their own lives. Not surprisingly, both phenomena also generated reactions common to traumatic experience: fear, sadness, hypervigilance, and a profound sense of isolation. Issues of stigma and secrecy also emerged as salient to both childhood abuse and HIV/AIDS. A number of coping mechanisms were identified by participants, including living in the present, spirituality, and children.

Conclusion and Implications: The findings of this study provide important information for social workers in the fields of HIV prevention and treatment. HIV prevention programs would benefit from an acknowledgment of the role of childhood abuse in HIV risk. Similarly, mental health services for women with HIV/AIDS should take into account the complex interactions between trauma and illness in the lives of these women. The resonance between the experiences of abuse and HIV/AIDS suggests that living with HIV may continually reactivate the thoughts and feelings associated with childhood abuse, compounding an individual's psychological distress.