Voltar
Artigo Acesso aberto Revisado por pares
BIBTEX RIS

No Longer the Exception, but the Standard: Integrating Trauma-Informed Policy and Pre-exposure Prophylaxis Implementation for Women

2021; Elsevier BV; Volume: 31; Issue: 5 Linguagem: Inglês

10.1016/j.whi.2021.05.003

ISSN

1878-4321

Autores

Tiara C. Willie, Kamila A. Alexander, Trace Kershaw, Jacquelyn C. Campbell, Jamila K. Stockman,

Tópico(s)

HIV/AIDS Research and Interventions

Resumo

Almost four decades into the national HIV/AIDS epidemic, women remain significantly impacted. Heterosexually active women are a key population targeted in national HIV prevention efforts (Short et al., 2019Short W.R. Sutton M.Y. Luo Q. Frazier E.L. Use of recommended preventive health care services and variations in HIV care among women with HIV in the United States, 2013–2014: Opportunities for expanded partnerships in support of ending the HIV epidemic.JAIDS Journal of Acquired Immune Deficiency Syndromes. 2019; 82: 234-244Crossref PubMed Scopus (3) Google Scholar). In 2018, women represented 19% of all new HIV diagnoses in the United States. Among heterosexual women, unprotected condomless vaginal and/or anal sex with a male partner is the primary mode of HIV transmission and accounts for 85% of HIV diagnoses among women (Centers for Disease Control and Prevention, 2017aCenters for Disease Control and PreventionHIV among women. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention: Division of HIV/AIDS Prevention.www.cdc.gov/hiv/pdf/group/gender/women/cdc-hiv-women.pdfDate: 2017Date accessed: October 18, 2017Google Scholar). Black women experience the highest burden of HIV infections; 57% of new HIV diagnoses among women were Black women (Centers for Disease Control and Prevention, 2017aCenters for Disease Control and PreventionHIV among women. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention: Division of HIV/AIDS Prevention.www.cdc.gov/hiv/pdf/group/gender/women/cdc-hiv-women.pdfDate: 2017Date accessed: October 18, 2017Google Scholar), although they represent only 12.9% of all women in the U.S. population (U.S. Census Bureau, 2020U.S. Census BureauAnnual estimates of the resident population by sex, race, and Hispanic origin.2020www.census.gov/newsroom/press-kits/2020/population-estimates-detailed.htmlDate accessed: November 1, 2020Google Scholar). Behavior alone does not fully account for the increased risk of HIV for Black women; sociocultural context also plays a role (Aholou et al., 2016Aholou T.M. Murray A. Sutton M.Y. The social, structural, and clinical context of HIV prevention and care for Black/African American and Hispanic Women/Latinas in the United States.in: Understanding the HIV/AIDS Epidemic in the United States. Springer, New York2016: 131-175Crossref Google Scholar; Sharpe et al., 2012Sharpe T.T. Voûte C. Rose M.A. Cleveland J. Dean H.D. Fenton K. Social determinants of HIV/AIDS and sexually transmitted diseases among black women: implications for health equity.Journal of Women's Health. 2012; 21: 249-254Crossref PubMed Scopus (58) Google Scholar; Wyatt et al., 2013Wyatt G.E. Gómez C.A. Hamilton A.B. Valencia-Garcia D. Gant L.M. Graham C.E. The intersection of gender and ethnicity in HIV risk, interventions, and prevention: New frontiers for psychology.American Psychologist. 2013; 68: 247Crossref PubMed Scopus (34) Google Scholar). The South has the highest rates of HIV diagnoses, where Black women account for 69% of HIV diagnoses among women (Centers for Disease Control and Prevention, 2017bCenters for Disease Control and PreventionHIV in the United States by georgraphy.www.cdc.gov/hiv/pdf/statistics/cdc-hiv-geographic-distribution.pdfDate: 2017Date accessed: October 18, 2017Google Scholar). The U.S. Plan for Ending the HIV Epidemic (Fauci et al., 2019Fauci A.S. Redfield R.R. Sigounas G. Weahkee M.D. Giroir B.P. Ending the HIV epidemic: A plan for the United States.JAMA. 2019; 321: 844-845Crossref PubMed Scopus (558) Google Scholar) addresses these geographic disparities by targeting resources to the 48 highest burden counties; Washington, DC; San Juan, Puerto Rico; and 7 states with a substantial HIV burden (Fauci et al., 2019Fauci A.S. Redfield R.R. Sigounas G. Weahkee M.D. Giroir B.P. Ending the HIV epidemic: A plan for the United States.JAMA. 2019; 321: 844-845Crossref PubMed Scopus (558) Google Scholar). However, there remains an urgent need for effective HIV prevention policies, interventions, and programs that address the sociocultural context of women's lived experiences. Intimate partner violence (IPV), defined as physical, sexual, or psychological abuse between romantic or sexual partners (Breiding, 2015Breiding M.J. Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization-national intimate partner and sexual violence survey, United States, 2011.American Journal of Public Health. 2015; 105: E11Crossref Scopus (91) Google Scholar), constrains women's access to and engagement in HIV prevention practices. In the United States, more than one-third of women (37.3%) report at least one form of IPV in their lifetime (Black et al., 2011Black M.C. Basile K.C. Breiding M.J. Smith S.G. Walters M.L. Merrick M.T. Stevens M. National intimate partner and sexual violence survey. Centers for Disease Control and Prevention, Atlanta, GA2011Google Scholar). Compared with women without these experiences, women in physically and sexually abusive heterosexual relationships are more likely to be diagnosed with HIV (Li et al., 2014Li Y. Marshall C.M. Rees H.C. Nunez A. Ezeanolue E. Ehiri J. Intimate partner violence and HIV infection among women: A systematic review and meta-analysis.Journal of the International AIDS Society. 2014; 17Crossref Scopus (233) Google Scholar; Maman et al., 2000Maman S. Campbell J. Sweat M.D. Gielen A.C. The intersections of HIV and violence: directions for future research and interventions.Social Science and Medicine. 2000; 50: 459-478Crossref PubMed Scopus (448) Google Scholar; Prowse et al., 2014Prowse K.M. Logue C.E. Fantasia H.C. Sutherland M.A. Intimate partner violence and the CDC's best-evidence HIV risk reduction interventions.Public Health Nursing. 2014; 31: 215-233Crossref PubMed Scopus (13) Google Scholar; Sharps et al., 2019Sharps P.W. Njie-Carr V.P. Alexander K. The syndemic interaction of intimate partner violence, sexually transmitted infections, and HIV infection among African American women: Best practices and strategies.Journal of Aggression, Maltreatment & Trauma. 2019; : 1-17Crossref Scopus (1) Google Scholar). There are several direct and indirect pathways linking IPV experiences with women's greater risk of HIV acquisition (Dunkle and Decker, 2013Dunkle K.L. Decker M.R. Gender-based violence and HIV: Reviewing the evidence for links and causal pathways in the general population and high-risk groups.American Journal of Reproductive Immunology. 2013; 69: 20-26Crossref PubMed Scopus (141) Google Scholar; Stockman et al., 2013Stockman J.K. Lucea M.B. Campbell J.C. Forced sexual initiation, sexual intimate partner violence and HIV risk in women: A global review of the literature.AIDS and Behavior. 2013; 17: 832-847Crossref PubMed Scopus (140) Google Scholar). For example, forced or coercive sexual intercourse, especially forced anal intercourse with an abusive male partner who is HIV positive, can lead to HIV acquisition (Stockman et al., 2013Stockman J.K. Lucea M.B. Campbell J.C. Forced sexual initiation, sexual intimate partner violence and HIV risk in women: A global review of the literature.AIDS and Behavior. 2013; 17: 832-847Crossref PubMed Scopus (140) Google Scholar). The psychological sequalae of IPV can make it hard to negotiate safe sex practices (Dunkle and Decker, 2013Dunkle K.L. Decker M.R. Gender-based violence and HIV: Reviewing the evidence for links and causal pathways in the general population and high-risk groups.American Journal of Reproductive Immunology. 2013; 69: 20-26Crossref PubMed Scopus (141) Google Scholar). Women experiencing IPV may also fear violent retaliation or abandonment without resources from a partner if they raise the topic of safe sex practices (Overstreet et al., 2015Overstreet N.M. Willie T.C. Hellmuth J.C. Sullivan T.P. Psychological intimate partner violence and sexual risk behavior: Examining the role of distinct posttraumatic stress disorder symptoms in the partner violence–sexual risk link.Women's Health Issues. 2015; 25: 73-78Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar; Teitelman et al., 2008Teitelman A.M. Ratcliffe S.J. Dichter M.E. Sullivan C.M. Recent and past intimate partner abuse and HIV risk among young women.Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2008; 37: 219-227Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar). Finally, the physiological effects on the immune system from the stress of abuse plus the increased permeability of the vaginal wall to the HIV virus from local inflammation from other STIs that are often a result of an abusive relationship all result in increased susceptibility of abused women to HIV (CampbelCampbell J.C. Lucea M.B. Stockman J.K. Draughon J.E. Forced sex and HIV risk in violent relationships..American journal of reproductive immunology. 2013; 69: 41-44Crossref PubMed Scopus (60) Google Scholar, TsuyukiTsuyuki K. Cimino A.N. Holliday C.N. Campbell J.C. Al-Alusi N.A. Stockman J.K. Physiological changes from violence-induced stress and trauma enhance HIV susceptibility among women..Current HIV/AIDS Reports. 2019; 16: 57-65Crossref PubMed Scopus (14) Google Scholar). Policy improvements that change the structural environment could alter the relationship between IPV and HIV among women. One study found that the positive association between IPV prevalence and HIV diagnoses among women was attenuated in states with more trauma-informed policies in place when compared with states with fewer policies (Willie et al., 2018Willie T.C. Stockman J.K. Perler R. Kershaw T.S. Associations between intimate partner violence, violence-related policies, and HIV diagnosis rate among women in the United States.Annals of Epidemiology. 2018; 28: 881-885Crossref PubMed Scopus (15) Google Scholar). In this study, researchers highlighted that trauma-informed health care environments facilitate appropriate identification of women experiencing IPV and can respond to their needs in a sensitive manner, thus weakening the association between IPV prevalence and HIV diagnoses. Women experiencing IPV are navigating their HIV prevention strategies within the context of violence, trauma, and gender-based constraints (Lang and Bird, 2015Lang M.E. Bird C.E. Understanding and addressing the common roots of racial health disparities: The case of cardiovascular disease & HIV/AIDS in African Americans.Health Matrix. 2015; 25: 109PubMed Google Scholar). Thus, there is a critical need for increased education, promotion, access, and adoption of partner-independent HIV prevention. Pre-exposure prophylaxis (PrEP) has the potential to be a partner-independent HIV prevention strategy for women experiencing IPV; however, this vision has yet to be fully actualized. In 2012, the U.S. Food and Drug Administration approved PrEP, a once-daily oral medication, for heterosexual women and men, men who have sex with men, and people who inject drugs, all of whom are at substantial risk for HIV acquisition (U.S. Food and Drug Administration, 2012U.S. Food and Drug AdministrationTruvada for PrEP fact sheet: Ensuring safe and proper use.www.fda.gov/downloads/NewsEvents/Newsroom/FactSheets/UCM312279.pdfDate: 2012Date accessed: November 1, 2020Google Scholar; U.S. Public Health Service, 2014U.S. Public Health ServicePreexposure prophylaxis for the prevention of HIV infection in the United States - 2014 clinical practice guideline.www.cdc.gov/hiv/pdf/prepguidelines2014.pdfDate: 2014Date accessed: November 1, 2020Google Scholar). PrEP decreased HIV infection among high-risk individuals up to 92% (U.S. Public Health Service, 2014U.S. Public Health ServicePreexposure prophylaxis for the prevention of HIV infection in the United States - 2014 clinical practice guideline.www.cdc.gov/hiv/pdf/prepguidelines2014.pdfDate: 2014Date accessed: November 1, 2020Google Scholar). Health care providers can assess candidacy for PrEP according to the clinical guidelines established by the Centers for Disease Control and Prevention (U.S. Public Health Service, 2014U.S. Public Health ServicePreexposure prophylaxis for the prevention of HIV infection in the United States - 2014 clinical practice guideline.www.cdc.gov/hiv/pdf/prepguidelines2014.pdfDate: 2014Date accessed: November 1, 2020Google Scholar). Individuals who use PrEP must commit to taking the drug every day and visiting their health care provider for follow-ups every 3 months. An exception to this process is in effect in California, where California Senate Bill 159, approved in 2020 to expand PrEP access, authorizes pharmacists to dispense PrEP without a prescription, which eliminates mandatory doctor visits and bars insurance companies from requiring prior authorization for PrEP (Equality California, 2019Equality CaliforniaCalifornia Senate Passes Bill to Increase Access to PrEP, a Once-Daily Pill to Prevent HIV.www.eqca.org/release-senate-passes-sb-159/Date: 2019Date accessed: February 12, 2021Google Scholar). Despite this innovation, national epidemiological trends suggest important gender-, racial-, and geographic-related PrEP disparities. Only 7% of national PrEP users are women, PrEP use is significantly lower among Black women than White women, and PrEP use is the lowest in the South compared with other regions (Bush et al., 2015Bush S. Ng L. Magnuson D. Piontkowsky D. Mera Giler R. Significant uptake of Truvada for pre-exposure prophylaxis (PrEP) utilization in the US in late 2014–1Q 2015. IAPAC Treatment, Prevention, and Adherence Conference, Miami, FL2015Google Scholar). A study found that the CDC clinical guidelines disqualify women engaged in heterosexual contact at significant proportions (Calabrese et al., 2019Calabrese S.K. Willie T.C. Galvao R.W. Tekeste M. Dovidio J.F. Safon C.B. Caldwell A. Current US guidelines for prescribing HIV pre-exposure prophylaxis (PrEP) disqualify many women who are at risk and motivated to use PrEP.JAIDS Journal of Acquired Immune Deficiency Syndromes. 2019; 81: 395-405Crossref PubMed Scopus (42) Google Scholar), and that, coupled with low PrEP awareness among women (Auerbach et al., 2015Auerbach J.D. Kinsky S. Brown G. Charles V. Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk of acquiring HIV.AIDS Patient Care and STDS. 2015; 29: 102-110Crossref PubMed Scopus (199) Google Scholar; Flash et al., 2014Flash C.A. Stone V.E. Mitty J.A. Mimiaga M.J. Hall K.T. Krakower D. Mayer K.H. Perspectives on HIV prevention among urban Black women: A potential role for HIV pre-exposure prophylaxis.AIDS Patient Care and STDS. 2014; 28: 635-642Crossref PubMed Scopus (58) Google Scholar; Goparaju et al., 2017Goparaju L. Praschan N.C. Warren-Jeanpiere L. Experton L.S. Young M.A. Kassaye S. Stigma, partners, providers and costs: Potential barriers to PrEP uptake among US women.Journal of AIDS & Clinical Research. 2017; 8: 730Crossref PubMed Google Scholar), can result in ineffective PrEP uptake for women, specifically women experiencing IPV. Women experiencing IPV need partner-independent HIV prevention methods (Braksmajer et al., 2019Braksmajer A. Leblanc N.M. El-Bassel N. Urban M.A. McMahon J.M. Feasibility and acceptability of pre-exposure prophylaxis use among women in violent relationships.AIDS Care. 2019; 31: 475-480Crossref PubMed Scopus (20) Google Scholar; Braksmajer et al., 2016Braksmajer A. Senn T.E. McMahon J. The potential of pre-exposure prophylaxis for women in violent relationships.AIDS Patient Care and STDS. 2016; 30: 274-281Crossref PubMed Scopus (47) Google Scholar; Willie et al., 2017aWillie T. Kershaw T. Campbell J.C. Alexander K.A. Intimate partner violence and PrEP acceptability among low-income, young black women: Exploring the mediating role of reproductive coercion.AIDS and Behavior. 2017; : 1-9Google Scholar; Willie et al., 2020Willie T.C. Keene D.E. Kershaw T.S. Stockman J.K. "You never know what could happen": Women's perspectives of pre-exposure prophylaxis in the context of recent intimate partner violence.Women's Health Issues. 2020; 30: 41-48Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar; Willie et al., 2019Willie T.C. Stockman J.K. Keene D. Calabrese S.K. Alexander K.A. Kershaw T. Intimate partner violence influences women's engagement in the early stages of the HIV pre-exposure prophylaxis (PrEP) care continuum: Using doubly robust estimation.AIDS and Behavior. 2019; : 1-8Google Scholar; Willie et al., 2017bWillie T.C. Stockman J.K. Overstreet N.M. Kershaw T. Examining the impact of intimate partner violence type and timing on pre-exposure prophylaxis awareness, interest, and coercion.AIDS and Behavior. 2017; 22: 1190-1200Crossref Scopus (34) Google Scholar). PrEP does not require the same type of interpersonal negotiation with a sexual partner in comparison with condoms. Also, unlike condoms, women can take PrEP independent of the sexual encounter, which is critical for women experiencing IPV who may not have control over when sexual intercourse occurs (Braksmajer et al., 2019Braksmajer A. Leblanc N.M. El-Bassel N. Urban M.A. McMahon J.M. Feasibility and acceptability of pre-exposure prophylaxis use among women in violent relationships.AIDS Care. 2019; 31: 475-480Crossref PubMed Scopus (20) Google Scholar; Braksmajer et al., 2016Braksmajer A. Senn T.E. McMahon J. The potential of pre-exposure prophylaxis for women in violent relationships.AIDS Patient Care and STDS. 2016; 30: 274-281Crossref PubMed Scopus (47) Google Scholar). Women experiencing IPV are interested in PrEP (Rubtsova et al., 2013Rubtsova A.M. Wingood G. Dunkle K. Camp C. DiClemente R. Young adult women and correlates of potential adoption of pre-exposure prophylaxis (PrEP): Results of a national survey.Current HIV Research. 2013; 11: 543-548Crossref PubMed Scopus (36) Google Scholar; Wingood et al., 2013Wingood G.M. Dunkle K. Camp C. Patel S. Painter J.E. Rubtsova A. DiClemente R.J. Racial differences and correlates of potential adoption of pre-exposure prophylaxis (PrEP): Results of a National Survey.Journal of Acquired Immune Deficiency Syndromes. 2013; 63: S95Crossref PubMed Scopus (58) Google Scholar), but clinicians rarely screen for IPV routinely (Rabin et al., 2009Rabin R.F. Jennings J.M. Campbell J.C. Bair-Merritt M.H. Intimate partner violence screening tools: A systematic review.American Journal of Preventive Medicine. 2009; 36: 439-445Abstract Full Text Full Text PDF PubMed Scopus (297) Google Scholar), and CDC guidelines for PrEP do not include IPV as a criterion (Willie et al., 2020Willie T.C. Keene D.E. Kershaw T.S. Stockman J.K. "You never know what could happen": Women's perspectives of pre-exposure prophylaxis in the context of recent intimate partner violence.Women's Health Issues. 2020; 30: 41-48Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar; Willie et al., 2019Willie T.C. Stockman J.K. Keene D. Calabrese S.K. Alexander K.A. Kershaw T. Intimate partner violence influences women's engagement in the early stages of the HIV pre-exposure prophylaxis (PrEP) care continuum: Using doubly robust estimation.AIDS and Behavior. 2019; : 1-8Google Scholar); therefore, most providers likely lack protocols for the assessment and continued care of women experiencing IPV who may be eligible PrEP candidates. Possibilities for offering PrEP in domestic violence shelters have been explored but have met obstacles, especially in terms of lack of resources and official guidelines for implementation (Cavanaugh et al., 2021Cavanaugh C.E. Harvey J. Alexander K.A. Saraczewski S. Campbell J.C. Assessing domestic violence shelter workers views and practices pertaining to HIV prevention services for women residing in domestic violence shelters.Journal of Interpersonal Violence. 2021; 36: NP3964-NP3981Crossref PubMed Scopus (1) Google Scholar). We argue for the integration of trauma-informed policies with PrEP implementation and delivery for women, especially women experiencing IPV. Trauma-informed policies are rooted in principles of trauma-informed care (Bowen and Murshid, 2016Bowen E.A. Murshid N.S. Trauma-informed social policy: A conceptual framework for policy analysis and advocacy.American Journal of Public Health. 2016; 106: 223-229Crossref PubMed Scopus (95) Google Scholar; Substance Abuse and Mental Health Services Administration, 2014Substance Abuse and Mental Health Services AdministrationSAMHSA's concept of trauma and guidance for a trauma-informed approach. Author, Rockville, MD2014Google Scholar), which is grounded in four assumptions. Trauma-informed approaches assume that all individuals within organizations and systems 1) realize that trauma can affect individuals, families, and communities, 2) recognize the signs of trauma, 3) respond to trauma, and 4) resist retraumatizing clients and staff through organizational practices (Substance Abuse and Mental Health Services Administration, 2014Substance Abuse and Mental Health Services AdministrationSAMHSA's concept of trauma and guidance for a trauma-informed approach. Author, Rockville, MD2014Google Scholar). Furthermore , trauma-informed approaches exemplify strong adherence to six core principles (i.e., safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historical, and gender issues). We recommend ways for PrEP implementation and delivery to incorporate each of these principles to better serve women experiencing IPV. Trauma-informed approaches create environments that facilitate individual feelings of physical and psychological safety (Machtinger et al., 2019Machtinger E.L. Davis K.B. Kimberg L.S. Khanna N. Cuca Y.P. Dawson-Rose C. Blake M. From treatment to healing: inquiry and response to recent and past trauma in adult health care.Women's Health Issues. 2019; 29: 97-102Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar; Substance Abuse and Mental Health Services Administration, 2014Substance Abuse and Mental Health Services AdministrationSAMHSA's concept of trauma and guidance for a trauma-informed approach. Author, Rockville, MD2014Google Scholar); therefore, policies should make provisions for women experiencing IPV to be safe when considering PrEP candidacy. First, the CDC PrEP clinical guidelines should be revised to include IPV as a criterion, such that all PrEP-prescribing providers and settings should institutionalize routine screening for IPV. In addition to routine IPV screening, standard safety protocols should be in place, especially in the event that IPV is disclosed. For example, women should be alone with their health care provider during IPV screening and discussions about personal relationships. Clinic-level policies can prevent partners from being in the examination room during these conversations to allow women to discuss relational dynamics without fear of retribution. Also, for staff safety, de-escalation protocols can mitigate controlling partner behaviors. Furthermore, safety planning can improve women's safety while adhering to PrEP and attending subsequent medical appointments. Safety protocols should be implemented in tandem with violence-specific agencies and services within local communities. Trustworthiness and transparency require organizational honesty and openness regarding how operations and decisions are made (Substance Abuse and Mental Health Services Administration, 2014Substance Abuse and Mental Health Services AdministrationSAMHSA's concept of trauma and guidance for a trauma-informed approach. Author, Rockville, MD2014Google Scholar). Trustworthiness and transparency can be accomplished during patient-provider conversations regarding healthy relationships and routine IPV screening. Patient–provider conversations should clearly communicate the limits of confidentiality and privacy (e.g., providers explaining what can be kept confidential). Organizations should also be knowledgeable about changes in state-level mandates regarding IPV. Also, providers should clearly communicate why clinicians should engage in conversations about healthy relationships and IPV prevention during PrEP candidacy assessments. Transparency in information-sharing includes education about both potential risks and benefits of PrEP use, such as the possibility of nausea (or other side effects) and the fact that PrEP is one of the only HIV prevention options that women can use prior to sexual intercourse. Furthermore, although IPV is not yet part of the PrEP candidacy guidelines, organizations should recognize that it is an important risk factor to consider for women's health. To promote recovery and healing from trauma, peer supports can build trust and collaboration and instill hope among individuals (Substance Abuse and Mental Health Services Administration, 2014Substance Abuse and Mental Health Services AdministrationSAMHSA's concept of trauma and guidance for a trauma-informed approach. Author, Rockville, MD2014Google Scholar). The PrEP navigator model has been successfully implemented in real-world settings (Blackstock et al., 2020Blackstock O.J. Platt J. Golub S.A. Anakaraonye A.R. Norton B.L. Walters S.M. Cunningham C.O. A pilot study to evaluate a novel pre-exposure prophylaxis peer outreach and navigation intervention for women at high risk for HIV infection.AIDS and Behavior. 2020; : 1-12PubMed Google Scholar; Parisi et al., 2018Parisi D. Warren B. Leung S.J. Akkaya-Hocagil T. Qin Q. Hahn I. Stevens L. A multicomponent approach to evaluating a pre-exposure prophylaxis (PrEP) implementation program in five agencies in New York.Journal of the Association of Nurses in AIDS Care. 2018; 29: 10-19Crossref PubMed Scopus (17) Google Scholar; Saberi et al., 2020Saberi P. Ming K. Scott H. Liu A. Steward W. "You can't have a PrEP program without a PrEP coordinator": Implementation of a PrEP panel management intervention.PloS One. 2020; 15: e0240745Crossref PubMed Scopus (8) Google Scholar). Broadly defined, PrEP navigators are "auxiliary, nonprescribing providers whose role is to assist people in overcoming structural barriers to care" (Mugavero et al., 2013Mugavero M.J. Amico K.R. Horn T. Thompson M.A. The state of engagement in HIV care in the United States: from cascade to continuum to control.Clinical Infectious Diseases. 2013; 57: 1164-1171Crossref PubMed Scopus (363) Google Scholar; Pinto et al., 2018Pinto R.M. Berringer K.R. Melendez R. Mmeje O. Improving PrEP implementation through multilevel interventions: A synthesis of the literature.AIDS and Behavior. 2018; 22: 3681-3691Crossref PubMed Scopus (90) Google Scholar). Similar to community health workers, PrEP navigators can be trusted members of and liaisons to the communities they serve. A peer PrEP navigator trained in trauma-informed approaches with IPV experiences could provide relationship-based HIV counseling, offer PrEP education, and support women as they engage in PrEP persistence and retention in care. Federal funding supporting the Ending the HIV Epidemic initiative should be leveraged to hire, support, and retain trauma-informed PrEP navigators. Furthermore, state-level PrEP navigation training programs should be trauma informed. Collaboration and mutuality in a trauma-informed approach recognizes that every individual involved in the organization (e.g., clinical staff, clients, nonclinical staff) is accountable and has an important role in ensuring that trauma-informed practices are enacted (Substance Abuse and Mental Health Services Administration, 2014Substance Abuse and Mental Health Services AdministrationSAMHSA's concept of trauma and guidance for a trauma-informed approach. Author, Rockville, MD2014Google Scholar). Women experiencing IPV may enter the health care system through multiple points (e.g., emergency room, mental health treatment, substance use treatment) and not necessarily with concerns regarding HIV prevention. For example, women may engage with nonclinical staff members during check-in and/or even in the hallway to ask for directions to the department of choice. As such, it is paramount that cross-department collaborations are built on a shared understanding of trauma-informed care. For example, to resist retraumatization, women who are referred for HIV prevention services of an organization from the mental and behavioral health department should not have to repeat their trauma histories during the PrEP candidacy assessment. Furthermore, as more states consider expanding PrEP access through PrEP-prescribing pharmacists, trauma-informed care should be promoted in these settings as well. Organizations might find it useful to do warm hand-offs to community-based agencies that adhere to trauma-informed principles. A trauma-informed approach not only recognizes how trauma can affect the lives of staff and clients, but also builds upon individuals' strengths to support their resilience, healing, and recovery (Substance Abuse and Mental Health Services Administration, 2014Substance Abuse and Mental Health Services AdministrationSAMHSA's concept of trauma and guidance for a trauma-informed approach. Author, Rockville, MD2014Google Scholar). Organizations can ensure survivors are represented and actively engaged during program development for women experiencing IPV. Survivors have keen insights about potential challenges but also about facilitators of PrEP uptake, persistence, and retention; thus, they can be critical sources of information when developing programs and interventions. Promoting autonomy among women during the PrEP decision-making process is critical to successful programming. Shared decision aid tools can help women to assess HIV risks and explain potential HIV prevention options (Qin et al., 2020Qin Y. Price C. Rutledge R. Puglisi L. Madden L.M. Meyer J.P. Women's decision-making about PrEP for HIV prevention in drug treatment contexts.Journal of the International Association of Providers of AIDS Care (JIAPAC). 2020; 19 (2325958219900091)Crossref Scopus (12) Google Scholar). Providers should consider incorporating such tools into patient-provider conversations during PrEP education and counseling. The last principle of a trauma-informed approach emphasizes that organizations and staff recognize historical trauma and be responsive to multiple identities based on race, ethnicity, gender, sexual orientation, and other attributes (Substance Abuse and Mental Health Services Administration, 2014Substance Abuse and Mental Health Services AdministrationSAMHSA's concept of trauma and guidance for a trauma-informed approach. Author, Rockville, MD2014Google Scholar). This principle can be conceptualized according to the theories of intersectionality and constrained choice. As other trauma-informed policies have noted (Bowen and Murshid, 2016Bowen E.A. Murshid N.S. Trauma-informed social policy: A conceptual framework for policy analysis and advocacy.American Journal of Public Health. 2016; 106: 223-229Crossref PubMed Scopus (95) Google Scholar), intersectionality is a theoretical framework indicating that individuals are disadvantaged by multiple interlocking sources of oppression (e.g., racism, sexism) (Bowleg, 2012Bowleg L. The problem with the phrase women and minorities: Intersectionality—An important theoretical framework for public health.American Journal of Public Health. 2012; 102: 1267-1273Crossref PubMed Scopus (1134) Google Scholar; Collins, 2002Collins P.H. Black feminist thought: Knowledge, consciousness, and the politics of empowerment. Routledge, London, UK2002Crossref Google Scholar; Crenshaw, 1990Crenshaw K. Mapping the margins: Intersectionality, identity politics, and violence against women of color.Stanford Law Review. 1990; 43: 1241Crossref Google Scholar). Thus, taking into account individuals' multiple, overlapping identities at the microlevel is key to understanding the types of stress, discrimination, and prejudices they encounter (Lewis et al., 2017Lewis J.A. Williams M.G. Peppers E.J. Gadson C.A. Applying intersectionality to explore the relations between gendered racism and health among Black women.Journal of Counseling Psychology. 2017; 64: 475Crossref PubMed Scopus (111) Google Scholar; Seng et al., 2012Seng J.S. Lopez W.D. Sperlich M. Hamama L. Meldrum C.D.R. Marginalized identities, discrimination burden, and mental health: Empirical exploration of an interpersonal-level approach to modeling intersectionality.Social Science and Medicine. 2012; 75: 2437-2445Crossref PubMed Scopus (156) Google Scholar). Similarly, the constrained choice theory (Bird and Rieker, 2008Bird C.E. Rieker P.P. Gender and health. The effects of constrained choices and social policies. Cambridge, Cambridge, UK2008Crossref Scopus (322) Google Scholar) discusses the ways in which policies that are not necessarily health-related can have unintended impacts on health outcomes. Lang and Bird, 2015Lang M.E. Bird C.E. Understanding and addressing the common roots of racial health disparities: The case of cardiovascular disease & HIV/AIDS in African Americans.Health Matrix. 2015; 25: 109PubMed Google Scholar integrated intersectionality with constrained choice theory to illustrate how inhabiting multiple disadvantaged statuses can manifest as cumulative constraints that limit opportunities for health equity. In particular, Black women are socially located within multiple systems of oppression (e.g., gendered racism) and PrEP programs and interventions need to attend to their unique experiences. The historical context of unethical medical research and practices against Black communities (e.g., the Tuskegee syphilis study; coerced sterilization) has created a culture in which health care practices reinforce discrimination (Williams and Mohammed, 2013Williams D.R. Mohammed S.A. Racism and health I: Pathways and scientific evidence.American Behavioral Scientist. 2013; 5 7: 1152-1173Crossref Scopus (585) Google Scholar), resulting in a deep level of medical mistrust (LaVeist et al., 2000LaVeist T.A. Nickerson K.J. Bowie J.V. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients.Medical Care Research and Review. 2000; 57: 146-161Crossref PubMed Google Scholar). Medical mistrust is related to fewer positive PrEP attitudes and intentions among Black women (Nydegger et al., 2021Nydegger L.A. Dickson-Gomez J. Ko T.K. A longitudinal, qualitative exploration of perceived HIV risk, healthcare experiences, and social support as facilitators and barriers to PrEP adoption among Black women.AIDS and Behavior. 2021; 25: 582-591Crossref PubMed Scopus (15) Google Scholar; Tekeste et al., 2018Tekeste M. Hull S. Dovidio J.F. Safon C.B. Blackstock O. Taggart T. Lane S.B. Differences in medical mistrust between Black and White women: Implications for patient–provider communication about PrEP.AIDS and Behavior. 2018; : 1-12Google Scholar). Using trauma-informed approaches with an intersectional lens not only ensures that staff are knowledgeable about historical contexts, but actively engages in patient-provider discussions that recognize how this history might be an important driver of PrEP deliberation or rumination among Black women. For example, Black women's experiences of historical trauma (e.g., trauma owing to racist police brutality) may foster a deep sense of mistrust in the criminal legal system and reduce women's interest in obtaining protection orders to leave an abusive relationship (Bent-Goodley, 2007Bent-Goodley T.B. Health disparities and violence against women: Why and how cultural and societal influences matter.Trauma, Violence, & Abuse. 2007; 8: 90-104Crossref PubMed Scopus (110) Google Scholar; Bent-Goodley, 2009Bent-Goodley T.B. A black experience-based approach to gender-based violence.Social Work. 2009; 54: 262-269Crossref PubMed Scopus (19) Google Scholar; Kasturirangan et al., 2004Kasturirangan A. Krishnan S. Riger S. The impact of culture and minority status on women's experience of domestic violence.Trauma, Violence, & Abuse. 2004; 5: 318-332Crossref PubMed Scopus (185) Google Scholar). Institutional racism and racialized stereotypes have also portrayed Black women as undeserving of resources to help them leave and heal from abusive situations (Gillum, 2002Gillum T.L. Exploring the link between stereotypic images and intimate partner violence in the African American community.Violence Against Women. 2002; 8: 64-86Crossref Scopus (48) Google Scholar; Taft et al., 2009Taft C.T. Bryant-Davis T. Woodward H.E. Tillman S. Torres S.E. Intimate partner violence against African American women: An examination of the socio-cultural context.Aggression and Violent Behavior. 2009; 14: 50-58Crossref Scopus (88) Google Scholar; West, 2004West C.M. Black women and intimate partner violence: New directions for research.Journal of Interpersonal Violence. 2004; 19: 1487-1493Crossref PubMed Scopus (105) Google Scholar, West, 2018West C.M. Crucial considerations in the understanding and treatment of intimate partner violence in African American couples.in: Understanding domestic violence-theories, challenges, and remedies. Rowman & Littlefield Publishers, Lanham, MD2018: 213-235Google Scholar), and Black women may face discrimination when seeking social services related to violence (Nnawulezi and Sullivan, 2014Nnawulezi N.A. Sullivan C.M. Oppression within safe spaces: Exploring racial microaggressions within domestic violence shelters.Journal of Black Psychology. 2014; 40: 563-591Crossref Scopus (30) Google Scholar). Therefore, staff engaged in trauma-informed approaches for PrEP implementation should be trained to recognize the many barriers Black women experiencing IPV encounter when they seek help. Trauma-informed HIV prevention, treatment, and care is a well-established area of research and public health practice, but in most places PrEP-related practice does not yet fully reflect the latest evidence. Despite this dearth of research and practice, several emerging studies have elucidated significant and important relationships between IPV experiences and PrEP-related outcomes among women at risk for HIV acquisition (Braksmajer et al., 2019Braksmajer A. Leblanc N.M. El-Bassel N. Urban M.A. McMahon J.M. Feasibility and acceptability of pre-exposure prophylaxis use among women in violent relationships.AIDS Care. 2019; 31: 475-480Crossref PubMed Scopus (20) Google Scholar; Braksmajer et al., 2016Braksmajer A. Senn T.E. McMahon J. The potential of pre-exposure prophylaxis for women in violent relationships.AIDS Patient Care and STDS. 2016; 30: 274-281Crossref PubMed Scopus (47) Google Scholar; Willie et al., 2017aWillie T. Kershaw T. Campbell J.C. Alexander K.A. Intimate partner violence and PrEP acceptability among low-income, young black women: Exploring the mediating role of reproductive coercion.AIDS and Behavior. 2017; : 1-9Google Scholar; Willie et al., 2020Willie T.C. Keene D.E. Kershaw T.S. Stockman J.K. "You never know what could happen": Women's perspectives of pre-exposure prophylaxis in the context of recent intimate partner violence.Women's Health Issues. 2020; 30: 41-48Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar; Willie et al., 2019Willie T.C. Stockman J.K. Keene D. Calabrese S.K. Alexander K.A. Kershaw T. Intimate partner violence influences women's engagement in the early stages of the HIV pre-exposure prophylaxis (PrEP) care continuum: Using doubly robust estimation.AIDS and Behavior. 2019; : 1-8Google Scholar; Willie et al., 2017bWillie T.C. Stockman J.K. Overstreet N.M. Kershaw T. Examining the impact of intimate partner violence type and timing on pre-exposure prophylaxis awareness, interest, and coercion.AIDS and Behavior. 2017; 22: 1190-1200Crossref Scopus (34) Google Scholar). As states expand access to PrEP, trauma-informed principles should be considered in PrEP delivery and implementation across settings (e.g., clinics, pharmacies, and other entities). Overall, integrating trauma-informed policies and approaches into PrEP services to promote partner-independent HIV prevention is the first and critical step toward achieving women-specific HIV prevention and risk reduction goals outlined in the 2020 National HIV/AIDS Strategy and the U.S. Plan to Ending the HIV Epidemic.

Referência(s)