Trauma, anxiety and reported health among HIV-positive persons in Tanzania and the US Deep South.

ABSTRACT

Little research has been conducted in less wealthy nations to evaluate the prevalence of severe life traumas in general population groups and the impact of such traumas. Previous studies in wealthy nations have found that experiencing severe traumas can cause elevated levels of anxiety, but few studies have examined this association in non-disaster situations in less wealthy nations. Trauma and trauma-related anxiety are associated with greater sexual risk taking behaviours, lower HIV medication adherence levels and poorer health outcomes in wealthy nations. The objectives of this manuscript are (1) to compare rates of trauma in two HIV-positive samples from areas that have not experienced disaster situations that are recognized by the international community as traumatic events; and (2) to examine whether the reported traumatic experiences are similarly associated with self-reported mental and physical health. The samples come from a region of a wealthy nation that consistently experiences large increases in incident AIDS cases and where the epidemic is largely transmitted heterosexually (Deep South, United States; n =611) and a region in a less wealthy nation with relatively high HIV prevalence and incidence rates and where transmission is also primarily heterosexual (Moshi, Tanzania; n =72). Compared to the US sample, the Tanzanian sample reported significantly higher rates of trauma in the areas of illness, injury, accidents and "other" significant traumas, a higher prevalence of anxiety and poorer physical health. The experience of trauma was similarly associated with greater mental health symptomatology and poorer physical health in both samples. Further investigation into the area of trauma and its sequelae is warranted, particularly in relation to risk behaviours and HIV medication adherence. At a time of increasing anti-retroviral therapy (ART) availability in less wealthy nations, additional focus on trauma care could improve ART adherence rates and reduce risk behaviors, thereby assisting in stemming the further spread of the epidemic.