Childhood trauma and the structure of behavioral sequelae among HIV-infected women of color

Among HIV-positive women of color (WoC), childhood trauma is associated with later-life substance abuse, depression and abusive adult relationships, but causal mechanisms remain obscure. We examine the total effect of childhood trauma on substance use and depression, as well as the direct effect of childhood trauma on these outcomes not mediated by adult and / or ongoing partner abuse. We use data from the Guide to Healing project, an intervention designed to recruit and retain HIV-positive WoC into appropriate HIV care. Childhood and adult trauma (WHO measure), depression (PHQ9), partner abuse (Index of Psychological Abuse) and substance use data were collected from approximately 250 unique HIV-positive WoC receiving clinical care at the University of North Carolina's Infectious Disease clinic (April 2010-January 2012), along with data on social support and demography. Women were equally distributed across education categories (less than high school (HS), HS, more than HS) and 65% were under 50 years old. About 10% were in non-permanent housing and the majority (72%) were unemployed. Depression, child trauma, adult trauma and partner abuse scales were internally reliable (Cronbach's alpha = 0.87, 0.82, 0.70 and 0.90, respectively). Marginal structural models with stabilized inverse probability weighted linear repeated measures regressions will be used to estimate the total, direct effects of childhood abuse on adult substance use, and depression, which were not mediated by ongoing abuse. This study illustrates how early life violence conditions adult behavioral and emotional sequelae.