Racial Equity As a Core Component of Trauma-Informed Care in a Southern AIDS Service Organization

Background/Purpose: People living with HIV (PLWH) experience disproportionately higher rates of trauma than the general population. Though the health sector has seen an uptick in Trauma-informed care (TIC) initiatives, no information could be found depicting the experiences of HIV service providers during TIC implementation. Adoption of TIC requires that institutions make fundamental changes in organizational culture that cannot be accomplished without attention towards issues of racial equity. The need to promote racial equity is specifically heightened among HIV service providers in the south, given the historical context of structural racism driving the HIV epidemic so that the region now accounts for more than half of all cases nationwide. The purpose of this study was to investigate staff perceptions of racial equity in a southern-based AIDS Service Organization (ASO) as a means for informing areas of focus during the TIC implementation process. Research questions included: “Are there difference in perceived discrimination by race?” and “What themes of racial equity emerged during focus groups?”

Methods: As part of a longitudinal mixed methods program evaluation, baseline data were collected with a convenience sample of staff via self-guided web-based surveys. Participants completed baseline assessments, including the Brief Perceived Ethnic Discrimination Questionnaire (BPEDQ Community-Version) (N=111) and semi-structured focus groups (N=30). SPSS was used to analyze descriptive variables and a One-way ANOVA to assess mean differences by race. Thematic Content Analysis was employed to analyze qualitative data.

Results: Of the total respondents completing baseline surveys, 41% (46) identified as male, 58% (64) identified as female, and <1% (1) declined to answer. Of those participating in the BPEDQ (N=99), 29 individuals identified as non-white, and 70 identified as white. The overall mean score on the BPEDQ was 27.54 (SD= 14.57). For non-white respondents, the mean score was 37.21 (SD= 15.91), and for white respondents the mean score was 23.53 (SD= 11.97), and the differences was significant [F(1, 97) = 20.602, p=.000]. Five total focus groups were held, with four themes emerging: 1. More inclusive and effective trainings are needed to better address historical trauma—such as racial discrimination and economic poverty—and generate more practical skill building to synthesize TIC principles into action; 2. Efforts are needed to increase institutional racial equity relative to staff opportunities (promotions/insufficient opportunities for advancement in otherwise white hierarchy) and treatment (differential accountability and respect); 3. Definitions of workplace safety diverged, with participants of all races reportedly having felt unsafe with racial issues in the workplace; 4. Finally, participants were incredulous that TIC efforts will lead towards real or sustainable change.

Conclusions/Implications: Survey data reveal non-white staff experienced significant differences in perceptions of ethnic discrimination compared with white counterparts, and qualitative findings echo concerns of racial equity. Results imply TIC initiatives should strengthen efforts addressing historical trauma as a core component of implementing TIC principles (BPEDQ item responses highlight areas). Finally, comprehensive change efforts in agency policies and culture are needed to respond to perceived racial inequity if TIC will be successfully adopted by the southern-based ASO.