Mitigating ‘Double Trauma’: Enforcing Trauma-Informed Care for Young People Living with HIV 

Author Bio: Sarmad M. Soomar, is a faculty member at the School of Nursing and Midwifery, Aga Khan University, Pakistan. He is a Public Health Nurse, who aims to work with marginalized populations and address their healthcare needs.   

Living and surviving with the effects of trauma is a burden on a young individual’s mental, social and physical health. This burden becomes heavier when an individual suffers from a disease or disorder, which is stigmatizing and traumatic. For Young People Living with HIV (YPLH) stigma is a tragic process, and thus catering this with more sophisticated techniques and evidenced based research strategies, is highly required in countries like Pakistan. As per the NASTAD’s Trauma-Informed Approaches Toolkit, the presence of trauma increases vulnerability in YPLH to develop Post Traumatic Stress Disorder (PTSD), mood disorders, and drug use disorders. These are among the mental health conditions that are linked to poor outcomes in the HIV care continuum, including retention in the care, adherence to the treatment, and viral suppression (see figure 1). Apart from mental, social and physical consequences, it can adversely affect the healthcare access of YPLH and compromise their quality of care due to the double burden of trauma. 

A past or current history of trauma associated with poverty or hunger, stigma, violence, minority stress, gender or sexual identity crisis, intergenerational trauma, family or work-related distress or presence of any comorbid chronic medical illnesses, can all increase the burden of trauma in YPLH. This is a potentially alarming situation for healthcare providers, especially primary care professionals, to mitigate experiences of trauma in YPLH. This can vice versa as individuals might get angry, anxious or show reluctance for treatments or prevention measures because of previous existing traumas. Providers need to understand the trauma informed care models and include such guidelines to the practice and policy of mitigating and managing double trauma.  

Figure 1 – Impact of Trauma and Opportunities for Healing Across the HIV Continuum 

Trauma Informed Care (TIC) 

Berring et al., (2024) ‘s scoping review inquired that TIC is a comprehensive and client-centered strategy that recognizes trauma and its consequences on the health of an individual. This also works as the providers associated with clients experiencing trauma, to be sensitive and trauma informed while planning and providing them care. Strengthening the role, competencies and skills of providers goes hand in hand. Respect, empathy, changing conventional cultures of care, capacity building of staff, and improving administrative support are major areas of emphasis. An ideal TIC practice incorporates trauma-informed principles and values that direct all the work dynamics, creates a safe atmosphere to prevent re-traumatization, trains all staff on trauma and its effects on clients and themselves, promotes staff self-care, screens all clients for trauma and common behavioral health comorbidities, and provides onsite or community-based treatment options. 

TIC in HIV practice and policy  

The research on practice suggests that, during assessment of YPLH, it is necessary to explore sensitive factors as listed above, which may be a cause of trauma in the client’s current or past life. Though clinical checklists and teaching learning have limitations for healthcare workers, they should take a strong and additional step for advocacy and explore such sensitive factors. Since the care provider will be aware about such factors, it will make their care planning stronger. As a result, it will lower the trauma effects among the clients and their participation in care and treatment compliance will be extraordinary. The main aim of trauma informed HIV care plan is associated with keeping the important principles of safety, choice, collaboration, trustworthiness, and empowerment in mind during the practice (Brezing, Ferrara & Freudenreich, 2015). This practice guidance is also shared and validated by reviewing Substance Abuse and Mental Health Services Administration (SAMHSA)’s Concept of Trauma and Guidance for a Trauma-Informed Approach.  

Very basic literature is available related to TIC and HIV associations in policy areas. The available information only looks at the policy angle to revamp the care protocols of medication adherence. Trauma and care of YPLH is a concerning area, it requires attention at policy levels as it will indirectly enhance practices. It is recommended that policies should address the training and sensitization of caregivers in such a manner that they can mitigate the presence of trauma and explore its related consequences while caring for YPLH. Another key area for future policy should be enforcing TIC through an interdisciplinary approach involving TIC practitioners. Currently, there are no TIC practitioners licensed in Pakistan, nor are they recruited in Primary or Tertiary care setups. Having a TIC practitioner and its liaison with a nurse and doctor will be transformational for YPLH health outcomes. This can lessen the workforce burden and nurses, or a doctor can also improve their practice efficacy.  

TIC is a significant aspect of intervention to improve the health and compliance of treatment among YPLH. It is noteworthy more than usual now to make policies to streamline the process of incorporating and replicating the TIC approach (models and interventions) that have been demonstrated to enhance the health of YPLH. Despite all the burden of trauma, the power of healing does exist that can work effectively through enforcement of TIC. 

Sources cited: 

Berring, L. L., Holm, T., Hansen, J. P., Delcomyn, C. L., Søndergaard, R., & Hvidhjelm, J. (2024, April). Implementing Trauma-Informed Care—Settings, Definitions, Interventions, Measures, and Implementation across Settings: A Scoping Review. In Healthcare (Vol. 12, No. 9, p. 908). MDPI. 

Brezing, C., Ferrara, M., & Freudenreich, O. (2015). The syndemic illness of HIV and trauma: implications for a trauma-informed model of care. Psychosomatics, 56(2), 107-118. 

NASTAD (n.d.) Impact of trauma and opportunities for healing across the HIV continuum. Retrieved from: https://nastad.org/trauma-informed-approaches-toolkit/trauma-and-healing-across-hiv-continuum 

Substance Abuse and Mental Health Services Administration (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. Retrieved from: https://ncsacw.acf.hhs.gov/userfiles/files/SAMHSA_Trauma.pdf