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Trauma exposure is highly prevalent in urban areas, especially among individuals who have HIV and lower incomes. Trauma can impact functioning across physical, mental, and behavioral health domains (Centers for Disease Control and Prevention [CDC], 2023; Powers & Duys, 2020). In the United States, 77% of primary care patients with HIV were exposed to trauma in their lives (Glynn et al., 2021). Individuals with HIV experience significantly higher trauma exposure and more significant mental health symptoms compared to people without HIV (Glynn et al., 2021; Whittle et al., 2020). Often, emotional, verbal, physical, and sexual abuse/violence occur at higher rates for this population across their life span (LeGrand et al., 2015). Intersectionality of marginalized identities (e.g., a gay person of color with HIV) can exacerbate care quality and HIV prognosis (Logie et al., 2019; Turan et al., 2017). In addition, people of color often experience greater exposure to violent trauma compared to their White counterparts (McLaughlin et al., 2019).
Given significantly higher rates of trauma for people with HIV, particularly people of color with HIV, studies have examined trauma as it relates to HIV health outcomes. Sequential trauma exposure is the development of posttraumatic stress disorder (PTSD). Notably, PTSD prevalence rates in individuals with HIV range from 21% to 56% (Glynn et al., 2021; O'Cleirigh et al., 2015; Tang et al., 2020; Yiaslas et al., 2014), up to nine times the overall 3.5% to 4.7% 1-year PTSD prevalence rate in the United States (Goldstein et al., 2016). This rate is also much higher than the current prevalence rate of PTSD in primary care patients, which ranges from 2% to 29% (Greene et al., 2016). Furthermore, international research suggests that an HIV diagnosis may qualify as a traumatic event and is reported as the index trauma for 30% to 40% of individuals diagnosed with HIV and PTSD (Verhey et al., 2018). Among primary care patients in Zimbabwe (Verhey et al., 2018), using the Posttraumatic Stress Disorder Checklist–5 (PCL-5; Weathers, Litz, et al., 2013), 46.2% of patients with HIV scored positive for PTSD; and for the Clinician Administered...