Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA.
Internal/Preventive Medicine, Griffin Hospital, Derby, CT, USA.
Int J Equity Health. 2023 Sep 1;22(1):174. doi: 10.1186/s12939-023-01994-4.
At increased risk for poor health outcomes, physical and/or sexual violence, and onward transmission of HIV, women who use drugs and are living with HIV (WWUDHIV) are vulnerable and in need of services. Understanding the role of trauma across their life history may offer insights into HIV and drug use prevention and opportunities for intervention. We explored trauma and drug use among WWUDHIV in Dar es Salaam, Tanzania.
We conducted in-depth interviews with 30 WWUDHIV from January-March 2019. Interviewers used semi-structured interview guides and asked questions about the life history as related to drug use. Interviews were audio recorded, transcribed, translated, coded, and life histories charted. We utilized content analysis.
Participants described death of family members as traumatic catalysts for drug use. Sexual partners early in their life history were often the point of introduction to drugs and source of HIV acquisition. Death of partners was present across many life histories and was a traumatic event negatively influencing life trajectories, including start of sex work for survival or to support drug use. Sex work in-turn often led to traumatic events including sexual and/or physical violence. HIV diagnosis for many participants followed the start of drug use, frequently occurred during pregnancy or severe illness and was described by most participants as a trauma. Despite this, particularly during pregnancy, HIV diagnosis was a turning point for some participant's desire to engage in drug use treatment. Traumatic events were often cumulative and regularly described as catalysts for poor mental health that could lead to new or increased drug use for coping.
These findings suggest trauma is common in the life history of WWUDHIV and has negative impacts on drug use and HIV vulnerability. Our life history charting highlights the cumulative and cyclical nature of trauma and drug use in this population. This study allows for better understanding of trauma, drug use, and HIV prevention, which offers opportunities for intervention among a group with limited access to services: during adolescence for orphaned youth, following the death of a child or partner, and when vulnerable women engage with the health system (HIV diagnosis, pregnancy, illness).
由于存在健康状况不佳、身体和/或性暴力以及艾滋病毒继续传播的风险，吸毒且感染艾滋病毒的妇女（WWUDHIV）处于弱势地位，需要服务。了解她们整个生命历程中的创伤角色，可能会深入了解艾滋病毒和药物使用预防，并为干预提供机会。我们在坦桑尼亚达累斯萨拉姆探索了 WWUDHIV 的创伤和药物使用情况。
我们于 2019 年 1 月至 3 月期间对 30 名 WWUDHIV 进行了深入访谈。访谈者使用半结构化访谈指南，询问与吸毒相关的生命史问题。访谈以音频记录、转录、翻译、编码和生命史图表的形式进行。我们利用内容分析法。
参与者描述说，家庭成员的死亡是促使他们吸毒的创伤性催化剂。他们生命早期的性伴侣往往是他们接触毒品和感染艾滋病毒的源头。许多人的生命史中都出现过伴侣的死亡，这是一个创伤性事件，对他们的生活轨迹产生了负面影响，包括为了生存或支持吸毒而开始从事性工作。性工作反过来又经常导致创伤性事件，包括性暴力和/或身体暴力。对于许多参与者来说，艾滋病毒诊断是在开始吸毒之后发生的，通常发生在怀孕或重病期间，大多数参与者将其描述为创伤。尽管如此，特别是在怀孕期间，艾滋病毒诊断成为一些参与者渴望接受药物治疗的转折点。创伤性事件经常是累积性的，经常被描述为导致心理健康状况不佳的催化剂，这可能导致新的或更多的药物使用来应对。
这些发现表明，创伤在 WWUDHIV 的生命史中很常见，对药物使用和艾滋病毒易感性有负面影响。我们的生命史图表突出了该人群中创伤和药物使用的累积和循环性质。这项研究使我们更好地了解了创伤、药物使用和艾滋病毒预防，为服务有限的群体提供了干预机会：在青少年时期为孤儿提供服务，在孩子或伴侣死亡后提供服务，以及当弱势妇女与卫生系统接触时（艾滋病毒诊断、怀孕、疾病）提供服务。
