Women with HIV frequently encounter health challenges tied to trauma, a pattern that reflects wider problems in primary care. Edward Machtinger, a professor of medicine at the University of California, San Francisco, has studied these connections extensively. As director of the Center to Advance Trauma-Informed Healthcare and co-leader of the university’s Women’s HIV Program, he argues that trauma drives many of the mental health and substance use issues leading to poor outcomes in these patients.
Trauma’s long shadow in healthcare
A Centers for Disease Control and Prevention study on adverse childhood experiences revealed that 40% of adult depression cases originate from 10 categories of childhood trauma. The data does not include trauma experienced later in life. Substance use and mental illness often develop as responses to trauma and can create additional harm, including violence and abuse.
This history influences how patients engage with healthcare providers. Those living with trauma or post-traumatic stress disorder may seem distrustful, reactive, or detached. Without understanding the cause, clinicians and staff sometimes mistake these behaviors for hostility. Routine interactions can then escalate, disrupting care.
Machtinger’s research reveals a gap between how women with HIV are treated and how their deaths are documented. A study published in the Journal of Acquired Immune Deficiency Syndromes found that primary care teams frequently identify different causes of death than those listed on official death certificates. The discrepancy points to a need for greater attention to the social and psychological factors affecting these patients.
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Safety and connection as treatment pillars
Trauma-informed care relies on two key elements: safety and connection. Clinics must create spaces where patients feel emotionally secure, addressing immediate risks to their well-being. Trust is equally critical—open relationships allow patients to share the real threats to their health, which are often more serious than the reason for their visit.
This method extends beyond HIV care. Trauma affects how patients interact with doctors, nurses, and administrative staff across primary care. When providers recognize trauma as the source of difficult behaviors, they can respond with patience. The change turns care from a series of tense exchanges into a shared effort to address deeper issues.
Healthcare systems, however, are not always prepared for these complexities. Many providers lack training in recognizing or responding to trauma, which can lead to retraumatization. The challenge is scaling trauma-informed care without losing its emphasis on empathy and trust.
Machtinger’s research demonstrates that understanding trauma’s role helps uncover risks like intimate partner violence or housing instability. These problems might otherwise remain hidden. Effective care requires seeing the person, not just the symptoms.
