Gender differences in PTSD and HIV treatment adherence

Background: Adherence to treatment among HIV-positive individuals is a key factor affecting treatment outcomes and infection transmission.  For those who have a history of incarceration compared with individuals with HIV infection in the general population, adhering to treatment may be even more challenging, in part due to limited resources, risky lifestyles, and frequent encounters with the criminal justice system. 

Studies have shown that women who experienced traumatic experiences including childhood abuse and adulthood violence are more likely to have depressive symptoms which lead to poor adherence to HIV treatment. 

Studies have documented that higher levels of social support may improve treatment adherence, but gender differences in treatment adherence and the effects of PTSD on social support and adherence have not been fully explored, particularly among inmates. 

Methods: We analyzed 243 men and women with HIV infection incarcerated in a large county jail in Chicago. 

Results: Overall, those who had stopped taking HIV medication before incarceration were more likely to be women, younger and to have more severe substance use issues.  In addition, women compared with men and those who scored higher on trauma symptomology had more severe substance use problems.  Older inmates and those with more severe trauma symptoms had a lower level of social support.  Social support and the level of trauma were significantly associated. 

Conclusion: We conclude that women are more likely to stop taking HIV medication in part due to trauma symptoms that directly and indirectly influence social support and substance severity.