Double trouble: Violent and non-violent traumas among women at sexual risk of HIV infection

Background: This study examines the association between trauma and HIV risk behaviors among women at sexual risk for HIV infection. Methods: From April to August 1998, high-risk HIV negative women were recruited in the South Bronx into a year-long cohort study. At the 12-month visit, 116 women were interviewed face-to-face about recent and lifetime violent and non-violent traumas. Results: The women reported a substantial prevalence of sexual risk behaviors associated with the acquisition of HIV. At baseline, almost two-thirds (64%) reported unprotected vaginal sex in the previous six months, and in the previous year, 62% had smoked crack, 52% reported sex-for-money-or-drugs exchanges, and 47% had five or more male sex partners. ne lifetime prevalence of trauma was high: 81% had experienced one or more violent traumas and 97% had experienced one or more non-violent traumas. Women who had experienced violent trauma-physical assault by a partner (OR = 2.88; 95 % CI 1.12; 7.41)-and those who had experienced non-violent trauma-loss of a child to foster care (OR = 3.34; 95% CI 1.04; 10.65)-were more likely to use crack than others. Those who had experienced non-violent trauma, by witnessing a physical assault (OR = 2.3 1; 95 % CI 0.99; 5.40), were also more likely than others to have exchanged sex. Conclusions: Both violent and non-violent traumas appear to play a role in the behaviors that place women at risk of HIV infection, particularly using crack and exchanging sex.