People living with HIV have higher rates of trauma than the general public. In the general U.S. population, post-traumatic stress disorder affects approximately 4.3% of women and 1.7% of men. In people living with HIV (PLWH), the number can be anywhere from 35% to 64%, according to a 2016 critical review. A 2006 study found that 91% of PLWH have experienced at least one traumatic event in their lifetime. To that end, any care for people living with the virus should also be trauma-informed care, according to Helena Addison, M.S.N., a registered nurse and Ph.D. student at the University of Pennsylvania, who presented "Trauma-Informed Care for Hospitalized People Living With HIV," at the 2019 Association of Nurses in AIDS Care conference (ANAC 2019) in Portland, Oregon.
Addison said that she first started thinking about trauma in patients living with HIV during nursing school, where she noticed that trauma was prevalent in the population. However, she says, she also noticed that, while many community and outpatient programs began to incorporate a trauma-informed approach into their care, that was not always the case for in-patient programs like hospital emergency rooms.
Trauma-informed care, according to Addison, is care that acknowledges the many ways trauma can impact a patient. Practicing trauma-informed care means ensuring that a patient's interaction with a health care practitioner doesn't accidentally retraumatize them.
"Medical care in general can be very traumatizing, due to the power structure," Addison said. "So for people with a history of trauma, it's being mindful of that and being mindful of people not necessarily being comfortable taking off their clothing, or any personal touching, or, for instance, having another man or another woman in the room."
As part of Addison's study, she spoke to nurses and other staff at a 23-bed general medicine unit in an urban, academic care setting where about half the beds are dedicated to PLWH. Addison presented information on trauma-informed care to participants, including the four "R"s of trauma, which include realizing the presence of trauma, recognizing signs and symptoms of trauma in patients, responding by integrating principles of trauma-informed care, and resisting re-traumatization.
When asked, all participants said that trauma-informed care was "very relevant" to their health care work.
Though not always readily apparent, Addison added, a medical visit can be full of potentially triggering power dynamics.
"Although we do talk about patient-centered care and say the patient is the boss, it does always seem like us as health care providers are in charge of the entire interaction," Addison said. To combat that, Addison said that practitioners can ask their patients questions and make sure they have a hand in every step of the visit. Practitioners can ask patients if they're more comfortable with their provider standing up or sitting down, if they're OK with being touched during an exam, and whether it's OK if another person of any gender walks into the room during their visit.
Though caregivers should be sensitive to trauma, that doesn't mean asking a patient for specifics about their past trauma, Addison added.
"We don't necessarily have to delve into the details of each traumatic experience," she said. "You can know someone has experienced trauma, but if they're not in immediate danger, you don't have to ask for more information, unless they offer that up."
Despite what most people believe about the emergency room being for last-minute, life or death events, it's often de facto primary care for the most marginalized in America. Because of that reality, and because many people living with HIV utilize hospitals and emergency rooms for care, nurses providing care to people living with HIV in hospital settings would do well to be mindful of patients' trauma while working.