July 18, 2012
By Susan Davis
Source: UCSF School of Medicine Website – Public Page – Patient Care Tab
Edward Machtinger, MD, with patient Vicki Blake Photo: Susan Merrell
It can be especially hard to keep women – who now comprise 27 percent of all AIDS cases in the US and 50 percent globally – in care, notes Edward Machtinger, MD, who directs the Women's HIV Program at UCSF. Often those patients are "women of color, and many are single mothers," he says. "And many face an array of other health and psychological challenges, the most intense of which is isolation. It can be very hard for women to 'come out' about their HIV status. The isolation that results makes it hard to take medications, come to appointments, and get support."
To make HIV treatment easier, WHP offers social and medical services (including social workers, therapists, gynecologists, primary care clinicians, and breakfast with other HIV-positive women) in its clinic. It also provides a safe place for women to develop deep supportive networks that help them in succeed with their treatment.
Even with a comprehensive "one-stop" clinic, however, many HIV-positive women still struggle to engage fully with their care, a fact that has puzzled HIV researchers for years. Yet, in recent studies, Machtinger has identified a crucial clue: trauma.
In research published in AIDS and Behavior last year, Machtinger found that HIV-positive women were twice as likely to experience intimate partner violence, five times as likely to have histories of sexual abuse, and six times more likely to suffer from PTSD than the national average among women. In a second study, published in the same journal, he found that women experiencing ongoing trauma were over four times more likely to fail their HIV treatment and approximately four times more likely to have unsafe sex. Taken together, the studies clearly showed that trauma plays a key role in both the health of HIV-positive women and the potential transmission to their partners.
"The data strongly suggests that violence is a key factor in why women get infected in the first place," Machtinger says. "But by helping women heal from that trauma, and by preventing ongoing abuse, we can have a transformative impact on the female HIV epidemic not only in San Francisco, but across the country and around the world."
Hypothesizing that helping women publicly disclose their HIV status would help them get out of abusive relationships, Machtinger has teamed with performance artist Rhodessa Jones to help women explore and publicly express both their HIV status and their trauma. Participants in the year-long workshop report being able to let go of their shame, move beyond isolation, develop supportive friendships with other women, leave abusive relationships, and begin to take better care of their own health. "What these women are doing is so inspirational," Machtinger says. "They move from feeling powerless and victimized to becoming leaders and educators in their communities. I cannot believe how strong and powerful they become."
Machtinger's current goal is to create a new model of "trauma-responsive" medical care for HIV-positive women at UCSF. "This type of work is just as important as giving medicines and checking lab tests," he adds. "Effectively addressing trauma is a key health intervention that has the potential to reframe the care of HIV in women across the US and around the world."