Sociodemographic Characteristics Associated with Lifetime and Recent Traumatic Experiences Among People Living with HIV in Florida

Abstract

Trauma prevalence among people with HIV (PWH) exceeds that of the general population by 2 times in the United States. Conducted within the Florida Cohort (2019–2022; n = 509), this study aimed to (1) describe the prevalence of 12 types of traumatic experiences (TEs) over a lifetime and within the past 12 months, and (2) describe whether the prevalence of lifetime and past 12-month traumatic experiences varied by age, race/ethnicity, sex assigned at birth, and sexual orientation among PWH in Florida. Participants were predominantly non-heterosexual men (42%) aged 50 + years (59%), identified as Black (43%), White (39%), and Hispanic (18%). TEs were measured by participants’ “Yes” responses to questions about having ever experienced verbal harm, emotional abuse, physical abuse, harmful punishment, physical attack, being stalked, discrimination, hate crime, sexual harassment, unwanted sexual touch, forced sex, and transactional sex in their lifetime and the past 12 months. Chi-square analyses compared traumatic experience prevalence rates by age, race/ethnicity, sex assigned at birth, and sexual orientation, with significant differences reported at a p-value of < 0.05. Overall, the most prevalent TEs were lifetime emotional abuse (56%), verbal harm (55%), physical abuse (53%), and discrimination (44%). Younger participants (< 35 years) reported the highest prevalence of lifetime discrimination, unwanted sexual touch, and hate crime compared to those aged 35–50 or 50+ (p < 0.05). Patterns for the past 12 months were mostly similar. Non-Hispanic Whites reported the highest lifetime prevalence of emotional abuse, verbal harm, physical abuse, being stalked, forced sex, sexual harassment, unwanted sexual touch, and harmful punishment compared to Hispanics or non-Hispanic Blacks (p < 0.05). For past 12-month experiences, Hispanics reported the highest prevalence of discrimination compared to non-Hispanic Blacks or non-Hispanic Whites (p < 0.05). Male non-heterosexuals reported the highest lifetime prevalence of discrimination, verbal harm, physical attack, and sexual harassment compared to females or male heterosexuals (p < 0.05). Similar patterns were reported for the past 12 months. Overall, among PWH in this sample, there was a significant prevalence of lifetime traumatic experiences, particularly verbal harm, emotional abuse, physical abuse, and discrimination. This study highlights demographic variations in trauma prevalence, especially among younger individuals, non-Hispanic Whites, and male non-heterosexuals. Clinicians may consider the significant importance of screening for traumatic experiences due to their intersecting impact on the HIV care continuum. Further research is needed to determine whether trauma-informed interventions could enhance health care in this population

Supplementary Information

The online version contains supplementary material available at 10.1007/s10461-025-04872-y.

Introduction

Trauma is defined as a perceived event that poses a risk to one’s health, safety, or bodily integrity and instills helplessness, horror, and fear in the victim [1]. Trauma includes experiences of interpersonal trauma such as childhood and adult physical, sexual, or emotional abuse or neglect, and socio-structural violence, including racism, sexism, homophobia, transphobia, xenophobia, or residing in a community characterized by prevalent violence [2, 3]. Trauma prevalence in the U.S. ranges from 10 to 90% [4–7], varying by age group, geographical area, gender, racial background, and ethnicity [6]. More lifetime trauma has been reported among older compared to younger age groups, in rural versus urban areas, among women compared to men, and among Hispanics and non-Hispanic Blacks compared to non-Hispanic Whites [8–13]. Additionally, bisexual and lesbian women, as well as gay and bisexual men, experience a higher prevalence of sexual violence, stalking, and intimate partner violence compared to their heterosexual counterparts [14]. Among people with HIV (PWH), the prevalence of interpersonal traumatic experiences (TEs) is twice as high as that of the general population [15, 16]. This convergence of HIV infection and trauma constitutes a syndemic illness, increasing the disease burden within vulnerable populations [17–19].

PWH face elevated rates of sexual, physical, and emotional abuse, as well as hate crimes and discrimination, particularly among men who have sex with men (MSM) [6, 15, 20–25]. Additionally, stalking and understudied forms of trauma, such as forced sex and physical attacks, affect a significant portion of the population [26, 27]. Research on traumatic experiences among people with HIV (PWH), particularly across different demographic groups, remains limited [27–30]. Geographical and cultural factors significantly influence trauma experiences, with higher violence rates observed in the Southern U.S [31–34]. Florida encompasses urban, as well as rural and semi-urban regions, including the northern and central parts of the state, which reflect broader Southern cultural norms and historical influences. Notably, non-heterosexual PWH in the Deep South of the U.S. have higher odds of childhood trauma [16].

Most research underscores the hidden importance of critical life stages, where numerous challenges and unique opportunities for disease prevention and treatment emerge [35]. While previous studies have typically isolated adverse childhood experiences (ACEs) before age 18 [28, 30, 35] and lifetime traumatic events separately [2, 36, 37], few studies have explored these experiences concurrently across various periods [16, 21, 27, 38, 39]. Few (if any) studies have compared the prevalence of lifetime vs. recent (past 12 months). Therefore, there is a need for data to determine whether the prevalence of lifetime or recent traumatic experiences differs by these various demographic characteristics.

Understanding sociodemographic differences in traumatic experiences among PWH is important for addressing health disparities. While disparities in HIV care are well-documented, differences in lifetime and recent traumatic experiences may also help to explain disparities in HIV outcomes across different population groups. Traumatic experiences linked to poorer antiretroviral therapy (ART) adherence and negative health outcomes may contribute to these disparities [40]. Assessing the prevalence of traumatic experiences across different demographic groups could help determine whether screening may be prioritized for certain groups and inform which populations might benefit most from tailored interventions [41].

Current Study Focus

The purpose of this paper was to (1) describe the prevalence of 12 types of traumatic experiences throughout a lifetime and during the past 12 months; and (2) describe whether the prevalence of lifetime and recent (past 12 months) traumatic experiences vary by age, race/ethnicity, sex assigned at birth, and sexual orientation among PWH in Florida. These findings can enhance our understanding of which groups to screen and which types of traumatic experiences are most common.

Methods

Study Design

This study is a cross-sectional analysis of de-identified data collected from the Florida Cohort study, which is a longitudinal study funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). It has enrolled 900 PWH from both private and public health settings in Florida to obtain a representative sample of PWH [42]. The Florida Cohort sought participants mostly from a collaborative network of county health departments and community-based clinics/organizations throughout Florida in both urban and rural areas to reach a community that traditionally had limited access to healthcare [43]. Additionally, the research staff at each site engaged clinical and administrative personnel by sharing details about the study and distributing brochures throughout the clinic settings. Potential participants were either referred by clinic staff or self-referred by directly contacting the study team [43]. The initial goal of the Cohort was to link questionnaires and public health surveillance data to guide policies aimed at enhancing HIV viral suppression and reducing new HIV infections [43].

Participants were eligible for the study if they had been diagnosed with HIV, were at least 18 years old, planned to reside in Florida for a minimum of six months, and could communicate in English (at all sites) or Spanish [43]. Eligible participants were approached by research assistants for informed consent and enrollment in the study. Participants who provided consent completed An online series of study questionnaires. Our secondary data analysis included PWH who completed the traumatic experiences measure within the baseline survey conducted between October 2020 and February 2023 (n = 509). All research procedures received approval from a central institutional review board (IRB) based at the University of Florida.

Measures

Socio-Demographic Characteristics

Participants’ self-reported sociodemographic information included age, race/ethnicity, sex assigned at birth, and sexual orientation. The average age was 50 years (Standard Deviation = 12). For analysis, age was categorized as < 35, 35–50 years, and 50+ years. Race was combined with ethnicity to categorize participants. Race/ethnicity groups were categorized as Hispanic, non-Hispanic White, and non-Hispanic Black. Participants in the “other” race/ethnicity category were excluded from analyses of comparisons by race/ethnicity if the groups had fewer than 10 participants. Sex assigned at birth was categorized as male or female. Sexual orientation, based on self-reported responses, was classified as heterosexual or non-heterosexual. Those in the “non-heterosexual” category identified as gay/lesbian, bisexual, or asexual. We combined the sex assigned at birth and sexual orientation variables for the males, creating male heterosexual and male non-heterosexual categories. This was not done for the females because only 26 (5%) female participants identified as being non-heterosexual.

Traumatic Experiences

The prevalence of traumatic experiences was measured by 12 questions about negative experiences in the extended module of the Florida Cohort questionnaires. The 12 negative experience questions were adapted from subsets of the Life Stressors Checklist, created by the National Center for Posttraumatic Stress Disorder under the United States Department of Veterans Affairs [44]. Based on recent literature, the name was modified to “traumatic experiences.”

Participants were first asked if they ever had each of the 12 experiences, which we labeled as verbal harm, emotional abuse, physical abuse, harmful punishment, physical attack, stalked, discrimination, hate crime, sexual harassment, unwanted sexual touch, forced sex, and transactional sex. We labeled the 12 questions according to their common themes, as identified in previous literature [30, 36]. Refer to Table 1 for the specific questions and definitions of the 12 types of traumatic experiences. For each lifetime traumatic event endorsed, a follow-up question asked if they had experienced it recently (in the past 12 months).

Table 1.

Specific questions and definitions of the 12 types of traumatic experiences

Trauma type	Questions
Verbal Harm	Have you ever been insulted, belittled, humiliated or threatened with harm by someone you cared about such as a parent, brother, sister, boyfriend, or girlfriend?
Emotional Abuse	Have you ever been emotionally abused or neglected?
Physical Abuse	Have you ever been physically abused (for example, hit, choked, burned, or beaten) by someone you knew well such as a parent, brother, sister, boyfriend, or girlfriend?
Harmful Punishment	Have you ever been severely punished (for example, locked up, shut in a closet, tied up, or chained) by someone you knew well such as a parent, brother, sister, boyfriend, or girlfriend?
Physical Attack	Have you ever been robbed, mugged, or physically (not sexually) attacked by a stranger or someone you did not know well?
Stalked	Have you ever been stalked or had anyone threaten to kill or seriously harm you?
Discrimination	Have you ever been discriminated against because of race, ethnic group, gender, sexual orientation, or religion?
Hate Crime	Have you ever been the victim of a hate crime (having violence directed at you because of your race, ethnic group, gender, sexual orientation, or religion)?
Sexual Harassment	Have you ever been bothered or harassed by sexual remarks, jokes, inappropriate touching or demands for sexual favors by someone at work or school?
Unwanted Sexual Touch	Have you ever been touched or made to touch someone else in a sexual way because you felt forced in some way or threatened by harm to yourself or someone else?
Forced Sex	Have you ever had sex because you felt forced in some way or threatened by harm to yourself or someone else?
Transactional Sex	Have you ever had unwanted sex in exchange for money, drugs, or other material goods such as shelter or clothing?

*Those who said “Yes” to ever having a traumatic experience were asked if it had happened in the past 12 months

Statistical Analysis

The socio-demographic characteristics of this sample were described using frequencies and percentages. Chi-square tests (or Fisher’s exact test for cell sizes < 5) were used to assess the differences in the prevalence of traumatic experiences by age, race/ethnicity, sex assigned at birth, and sexual orientation. Associations were considered statistically significant at a p-value < 0.05 or < 0.01. All statistical analyses were conducted using SAS V9.4 software.

Results

Socio-Demographic Characteristics of People with HIV in Florida

The majority of the 509 participants were male non-heterosexuals (42%), and 50+ years old (59%). Most participants were non-Hispanic Black (43%), non-Hispanic White (39%), Hispanic (18%), and college-educated (46%). See Table 2 for a complete account of the socio-demographic characteristics of the sample.

Table 2.

Socio-demographic characteristics of the study sample of people with HIV in Florida (N = 509)

Variables	Frequency (N)	Percentage (%)
Mean Age (Standard Deviation) = 50 (12)
Age
<35  35–50  50+	69 141 299	14 27 59
Race/Ethnicity
Hispanic  White  Black  Other	93 172 208 28	18 34 42 6
Sex Assigned at Birth and Sexual Orientation
Male heterosexual  Male non-heterosexual  Female	84 212 211	16 42 42
Education
< High school  High school/GED  Some college or more	126 147 235	25 29 46

*All may not add to 509; Race/Ethnicity was missing 8, Sex Assigned at Birth and Sexual Orientation were missing 2, and Education was missing 1 observation

Lifetime and Recent (Past 12-Month) Prevalence of 12 Types of Traumatic Experiences Among PWH in Florida (N = 509)

The most frequently reported lifetime experiences were emotional abuse (56%), verbal harm (55%), physical abuse (53%), and discrimination (44%). The least frequently reported lifetime experiences were harmful punishment (17%), hate crime (21%), and transactional sex (24%) (Fig. 1).

Fig. 1.

Lifetime and Past 12-Month Prevalence of 12 Types of Traumatic Experiences Among People with HIV in Florida (N = 509)

The most frequently reported traumatic experiences in the past 12 months were emotional abuse (20%), discrimination (19%), and verbal harm (18%). The least reported traumatic events in the past 12 months were harmful punishment (2%), unwanted sexual touch (3%), and forced sex (3%) (Fig. 1).

Prevalence of Traumatic Experiences by Age of PWH (N = 509)

Regarding the lifetime prevalence of traumatic experiences, age was statistically significantly associated with discrimination, unwanted sexual touch, and hate crime (Fig. 2 and Supplementary Table 1). Participants aged < 35 years had the highest lifetime prevalence of discrimination (61% vs. 48% vs. 38%, p < 0.01), unwanted sexual touch (33% vs. 25% vs. 23%, p < 0.05), and hate crime (29% vs. 26% vs. 17%, p < 0.05), relative to participants aged 35–50 or 50+.

Fig. 2.

Prevalence of Traumatic Experiences by Age Among People with HIV (N = 509). *p-value < 0.05, **p-value < 0.01

Age was significantly associated with recent (past 12 months) experiences of discrimination, emotional abuse, physical abuse, sexual harassment, unwanted sexual touch, transactional sex, and forced sex (Fig. 2 and Supplementary Table 1). Younger participants (aged < 35 years) reported significantly higher prevalence rates of discrimination (38% vs. 21% vs. 13%, p < 0.01), emotional abuse (30% vs. 27% vs. 14%, p < 0.01), physical abuse (14% vs. 13% vs. 4%, p < 0.01), sexual harassment (14% vs. 6% vs. 3%, p < 0.01), unwanted sexual touch (14% vs. 3% vs. 0.3%, p < 0.01), transactional sex (12% vs. 6% vs. 2%, p < 0.01), and forced sex (10% vs. 4% vs. 1%, p < 0.01) relative to those aged 35–50 or 50+.

Prevalence of Traumatic Experiences by Race/Ethnicity of PWH (N = 473)

Race/ethnicity was significantly associated with the lifetime prevalence of emotional abuse, verbal harm, physical abuse, physical attack, being stalked, forced sex, sexual harassment, unwanted sexual touch, and harmful punishment (Fig. 3 and Supplementary Table 2). Non-Hispanic Whites had a greater lifetime prevalence of emotional abuse (66% vs. 54% vs. 48%, p < 0.01), verbal harm (64% vs. 55% vs. 48%, p < 0.01), physical abuse (64% vs. 47% vs. 45%, p < 0.01), being stalked (41% vs. 34% vs. 27%, p < 0.05), forced sex (38% vs. 19% vs. 22%, p < 0.01), sexual harassment (36% vs. 20% vs. 22%, p < 0.01), unwanted sexual touch (35% vs. 23% vs. 18%, p < 0.01), and harmful punishment (22% vs. 16% vs. 13%, p < 0.05) relative to Hispanics or non-Hispanic Blacks. However, Hispanics reported a higher lifetime prevalence of physical attack (51% vs. 34% vs. 48%, p < 0.01) compared to non-Hispanic Blacks or non-Hispanic Whites.

Fig. 3.

Prevalence of Traumatic Experiences by Race/Ethnicity Among People with HIV (N = 473). *p-value < 0.05, **p-value < 0.01. *Race/Ethnicity was missing 8 observations. *We excluded Other (N = 28) from these specific analyses because some groups had < 10 participants

Race/ethnicity was significantly associated with recent (past 12-month) experiences of discrimination, with Hispanics reporting the highest prevalence (29% vs. 19% vs. 14%, p < 0.01) relative to non-Hispanic Blacks or non-Hispanic Whites (Fig. 3 and Supplementary Table 2). However, no other types of trauma were significantly associated with race/ethnicity.

Prevalence of Traumatic Experiences by Sex Assigned at Birth and Sexual Orientation of PWH (N = 507)

Sex assigned at birth and sexual orientation were statistically significantly associated with lifetime prevalence of emotional abuse, physical abuse, discrimination, verbal harm, physical attack, sexual harassment, hate crime, unwanted sexual touch, and forced sex (Fig. 4 and Supplementary Table 3).

Fig. 4.

Prevalence of Traumatic Experiences by Sex Assigned at Birth and Sexual Orientation Among People with HIV (N = 507). *p-value < 0.05, **p-value < 0.01. *Sex Assigned at Birth and Sexual Orientation were missing 2 observations

Females had the highest lifetime prevalence of emotional abuse (64% vs. 57% vs. 34%, p < 0.01), physical abuse (63% vs. 54% vs. 27%, p < 0.01), forced sex (36% vs. 26% vs. 11%, p < 0.01), and unwanted sexual touch (30% vs. 27% vs. 10%, p < 0.01) compared to male-non heterosexuals or male heterosexuals. However, male non-heterosexuals had the greatest lifetime prevalence of discrimination (61% vs. 29% vs. 36%, p < 0.01), verbal harm (58% vs. 57% vs. 44%, p < 0.05), physical attack (52% vs. 35% vs. 38%, p < 0.01), sexual harassment (35% vs. 26% vs. 11%, p < 0.01), and hate crime (30% vs. 12% vs. 20%, p < 0.01) relative to females or male heterosexuals (Fig. 4 and Supplementary Table 3).

In the past 12 months, sex assigned at birth and sexual orientation were statistically significantly associated with physical abuse, discrimination, and hate crime. Male non-heterosexuals had a greater recent (past 12-month) prevalence of discrimination (27% vs. 12% vs. 17%, p < 0.01), hate crime (10% vs. 3% vs. 6%, p < 0.05), and physical abuse (9% vs. 9% vs. 1%, p < 0.05) relative to females or male heterosexuals (Fig. 4 and Supplementary Table 3).

Discussion

This study is the first to report on the prevalence of 12 interpersonal lifetime and recent (past 12 months) traumatic experiences among PWH in Florida, concurrently analyzing their association with age, race/ethnicity, sex assigned at birth, and sexual orientation across two exposure periods. Our findings underscore a significant epidemiological burden, with over half of participants reporting prior traumatic experiences (Fig. 1), consistent with prevalence findings across various studies [2, 21, 38]. Among the most prevalent traumatic experiences reported were lifetime emotional abuse (56%), verbal harm (55%), physical abuse (53%), and discrimination (44%). These findings align with existing literature reporting higher rates of trauma among PWH compared to the general population [2, 15, 16, 37, 39, 45]. Other studies have linked trauma to various health challenges across the HIV care continuum, including HIV acquisition, transmission, testing, missed healthcare visits, ART adherence, and morbidity/mortality [38, 39, 45–50]. Lifetime discrimination, notably prevalent among younger individuals and male non-heterosexuals in our study, aligns with prior research highlighting discrimination’s impact on health behaviors and outcomes in sexual and gender minority groups with HIV [24, 25, 51]. These studies underscore the vulnerability of minority groups to poor health outcomes and emphasize the necessity for interventions targeting trauma reduction to improve overall health.

Further analysis by age, race/ethnicity, birth sex, and sexual orientation revealed nuanced patterns of traumatic experience prevalence. Most lifetime and recent (past 12 months) traumatic experiences were prevalent among young participants (< 35 years) compared to older participants (50 + years). The cohort effect may explain why younger people report more traumatic experiences, reflecting the distinct social and cultural conditions of each generation [52]. Younger cohorts have grown up with greater societal awareness of trauma and mental health alongside modern stressors like social media pressures and economic uncertainties, leading to increased recognition and reporting of trauma. In contrast, older cohorts have faced less open discussion of trauma and may have developed resilience, contributing to underreporting or differing perceptions of traumatic events [53]. Nonetheless, the higher reporting of trauma among younger populations could also be influenced by the survivor effect, where older individuals with severe trauma may not survive to later ages, leading to an underrepresentation of those with significant trauma histories. Additionally, those most vulnerable to trauma may experience greater health challenges and mortality as they age, resulting in a more resilient older sample [54]. These findings raise concern, as prior studies have linked the high prevalence of past trauma among young men to increased risky sexual behavior compared to older men [55]. This has been attributed to the potential challenges younger men may encounter when coping with past trauma [55]. Our findings also align with research indicating that young non-heterosexual males with a history of sexual assault are more likely to be HIV positive and may engage in subsequent risky behaviors as a form of coping [56].

Interestingly, the prevalence of lifetime traumatic experiences was unexpectedly highest among non-Hispanic Whites, differing from typical reports of higher rates among Hispanics and Blacks compared to Whites [37, 57]. Other studies in the southern U.S. have reported physical assault more among the non-Hispanic Whites in urban areas compared to their counterparts in suburban areas [52]. This may be attributed to the fact that more non-Hispanic Whites report traumatic experiences compared to non-Hispanic Blacks. One possible explanation is that non-Hispanic Whites may have developed more effective coping strategies for dealing with social stigmas, making them more willing to disclose negative life events [58]. Additionally, within the non-Hispanic White population of PWH, there may be additional intersecting factors such as sexual orientation, which could lead to more traumatic experiences compared to the broader population in the southern U.S. Conversely, our study identified significant discrimination disparities across racial/ethnic groups in the past 12 months, with Hispanics experiencing the highest burden, followed by non-Hispanic Blacks, compared to non-Hispanic Whites. Moreover, Black individuals who have had traumatic experiences may be less likely to participate in research due to fear, mistrust, and the emotional impact of trauma [59]. This aligns with previous studies that suggest increased instances of healthcare discrimination within minority communities, which may potentially foster distrust in healthcare providers and lower adherence to antiretroviral therapy (ART), contributing to disparities in HIV care engagement [55, 60]. Additionally, the Medical Monitoring Project (a nationally representative, annual cross-sectional survey of U.S. adults diagnosed with HIV) highlighted that racial and sexual minority groups experiencing intersectional discrimination are less likely to participate in HIV care continuum activities [61, 62], emphasizing the urgency of targeted interventions for vulnerable populations.

Notably, our findings highlighted disparities in traumatic experience prevalence by sex assigned at birth and sexual orientation, with male non-heterosexuals reporting the highest burden. Our findings were contrary to most literature, which highlights that women are exposed to more lifetime traumatic experiences compared to males [21, 63, 64]. Ethnically diverse studies have linked sexual orientation-based discrimination to increased HIV risk behavior among MSM [65]. Exploring the relationship between traumatic experiences and sexual orientation/gender may be crucial, particularly given the elevated risk of HIV among non-Hispanic White MSM, as reported by the Florida Department of Health in 2012 [66].

Implications for Prevention and Clinical Care

This study specifically addressed interpersonal trauma, but there is a scarcity of research on socio-structural trauma, encompassing factors like racism, sexism, homophobia, transphobia, xenophobia, war, natural disasters, deportation, or living in communities marked by widespread violence among people with HIV; such a gap warrants further investigation. Hence, this study underscores the need for more longitudinal prospective cohort studies on traumatic experiences and HIV outcomes.

In clinical practice, enhanced screening for traumatic events among gender and ethnically diverse individuals living with HIV may prove beneficial. While there is significant interest in integrating trauma-informed interventions into clinical care, evidence demonstrating their benefits remains limited [67]. However, the U.S. Preventive Services Task Force (USPSTF) does not currently recommend screening for trauma among older adults (60 + years) and vulnerable adults (aged 18–59 years) due to insufficient evidence on the balance of benefits and harms of screening in these populations [68]. The USPSTF review identified only one study examining the accuracy of tests for detecting elder abuse and found no studies focused on vulnerable adults [69]. Furthermore, no randomized controlled trials (RCTs) have been conducted on screening or interventions for abuse among these populations, highlighting significant gaps in research and leaving older and vulnerable adults underserved [69]. To address these gaps, more clinical trials are needed to evaluate the long-term benefits and potential harms of trauma screening among older and vulnerable adults living with HIV. In parallel, advocacy efforts are also essential to encourage the USPSTF to re-evaluate and update its recommendations on trauma screening. Such advocacy should be coupled with rigorous research to build the evidence base needed for policy change and to guide the effective implementation of screening and interventions that improve health outcomes in this population. Therefore, there is an urgent demand for research to determine whether trauma-informed care within establishments catering to PWH in Florida and beyond can promote healing, empowerment, and safety among vulnerable populations [68]. Notably, the fundamental tenets of trauma-informed care include understanding trauma and its impact, encouraging safety, facilitating survivors’ autonomy, guaranteeing cultural competence and sensitivity, offering opportunities for holistic and integrated care, and realizing that recovery from trauma is possible [70]. Hence, advocacy for comprehensive, trauma-informed HIV care is relevant to enhance health outcomes and the overall welfare of PWH [41]. Our findings add to existing literature that calls for comprehensive and continuous assessments of trauma-informed care interventions among PWH. These evaluations help gather evidence to support the potential implementation of trauma-informed care as a strategy for preventing HIV transmission and improving the overall health outcomes of diverse PWH in Florida. Based on our findings, the high prevalence of traumatic experiences reveals the potential need for prevention interventions among this vulnerable population.

Limitations and Strengths

This study’s reliance on sex assigned at birth, rather than gender identity, is a limitation. This was because our gender identity data were limited (< 1%). As the overall sample included very few transgender participants, we lacked enough participants to produce meaningful findings or to perform robust statistical analyses within the scope of this study. Future research should prioritize collecting more gender identity data to better understand trauma experiences among transgender individuals within this population. Furthermore, it is important to note that our findings may not generalize to all PWH in different geographic regions, as our participants were exclusively PWH receiving care in Florida. Our outcomes may also deviate from existing literature due to potential sampling bias, possibly comprising individuals with easy access to enrollment facilities. In addition, the use of convenience sampling may have resulted in differential recruitment by age, race/ethnicity, and sexual orientation. We were limited in the ability to combine the sex assigned at birth and sexual orientation variables for the females because only 26 (5%) female participants identified as being non-heterosexual. Future studies may need to examine this proportion of women who may be at high risk of experiencing a disproportionate amount of sexual violence. Moreover, the reliance on self-reported traumatic experiences in our study may introduce recall and response biases. Additionally, considering that our traumatic experiences responses were limited to “yes/no” Answers, this limited our understanding of the frequency with which these experiences occur or whether they matter. However, the inclusion of a geographically diverse sample with a high level of racial and cultural diversity, owing to the multi-site nature of the Florida cohort study, enhances the robustness of our findings. In addition, the relatively large sample size of 509 participants strengthens the statistical power of our analyses and supports the reliability of our observed associations.

Conclusion

This study reveals a significant burden of traumatic experiences among PWH, with variations across different demographic groups and between lifetime and recent (past 12 months) events. Notably, non-Hispanic Whites and male non-heterosexuals reported the highest rates of lifetime trauma, suggesting a possible benefit for long-term trauma-specific interventions targeted at these groups. Furthermore, younger individuals (< 35 years) reported the highest rates of recent (past 12 months) trauma, highlighting that immediate interventions focusing on this demographic may be beneficial. These results emphasize certain favorable aspects of integrating trauma-informed care into healthcare settings for individuals with HIV. Such approaches may help prevent HIV transmission and improve overall health outcomes for diverse PWH in Florida. Overall, addressing trauma through tailored interventions may be helpful in the enhancement of the quality of life and supporting the nationwide effort to end the HIV epidemic by 2030.

Supplementary Information

Below is the link to the electronic supplementary material.

Funding

Financial support for this research was provided by the National Institutes of Health/National Institute of Alcohol Abuse and Alcoholism (U24AA022002, T32AA025877) and the National Institute on Drug Abuse (K01 DA057881-02). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Data Availability

The data supporting the results or analyses presented in the paper can be found at www.sharc-research.org.

Declarations

Conflict of interest

The authors report there are no competing interests to declare.