Differentiating Exposure From Consequence: A Longitudinal Examination of Trauma and Posttraumatic Distress in a Public HIV Care Clinic

Persons living with HIV (PLWH) are disproportionately exposed to traumatic events, which are associated with posttraumatic psychological distress and impaired HIV-related health outcomes (e.g., antiretroviral non-adherence, HIV viremia, lower CD4 count). Prior literature has not adequately differentiated the effects of trauma and posttraumatic distress on HIV-related health outcomes. This study examined longitudinal data of trauma exposure and posttraumatic psychological distress among PLWH. Participants were 255 PLWH in care at a public HIV clinic that completed baseline and one-year follow-up psychosocial assessments between April 2017 and May 2024. Assessments included measures of lifetime trauma exposure, symptoms of depression, anxiety, and posttraumatic distress, and antiretroviral adherence. HIV RNA viral load and CD4 count were extracted from medical records. Factor analysis was used to consider multifaceted posttraumatic responses. Path analysis was used to examine direct and indirect effects of trauma exposure and posttraumatic distress on HIV-related outcomes. Most participants endorsed lifetime trauma exposure (88.2%). Trauma exposure was associated with increased posttraumatic psychological distress (est.=0.281, p = 0.004). Psychological distress predicted lower antiretroviral adherence (est.=-0.070, p = 0.033), which was associated with higher log HIV RNA viral load (est.=-0.477, p < 0.001) and lower CD4 count (est.=84.754, p < 0.001). Controlling for distress, trauma exposure did not predict HIV-related health outcomes. Trauma exposure was highly prevalent and posttraumatic psychological distress predicted poorer HIV-related health outcomes at follow-up. These findings highlight the need for universal trauma-informed care and the utility of integrated psychological services for those impacted by posttraumatic distress within HIV treatment settings to improve HIV-related health outcomes.