Trauma-Informed Decision-Making Between Providers and Victims of Intimate Partner Violence during HIV Testing: A Qualitative Study

Introduction: Recent research highlighting the intersection between HIV and intimate partner violence (IPV) has led to calls for increased HIV testing among this high-risk population. Victims of IPV, however, face numerous barriers to HIV testing, often stemming from a lack of trauma-informed services. A better understanding of the HIV testing process from the perspective of victims of IPV and those who work with victims may help reduce these barriers and ultimately lead to higher rates of HIV testing along with increased awareness and better quality services. The purpose of this study is to examine the barriers, facilitators, and decision-making processes involved during the implementation of an HIV testing program at an IPV service agency from the perspectives of both providers and clients.

Methods: A qualitative descriptive approach was used to guide this study. Semi-structured interviews were conducted with 19 key informants, namely, 10 women with a history of IPV, 5 HIV service providers, and 4 IPV service providers. Interviews focused on facilitators and barriers to the HIV testing implementation process, the decision-making process during HIV testing, and support needs. All interviews were recorded and transcribed verbatim and text was analyzed using directive content analysis.

Results: Three main themes emerged from preliminary analyses. The first focused on the importance of assessing readiness for HIV testing. Victims of IPV are often living in stressful, tenuous, environments and may not be prepared to cope with the added stress of HIV testing, particularly if they receive a positive result. A second theme indicated that HIV testing is often not a central issue for victims of IPV. This generally stemmed from either a lack of awareness of increased risks associated with IPV or lack of knowledge about HIV testing. Also, other needs (e.g., legal, housing, financial, familial) can be looked as a higher priority over HIV testing. The last theme centered on the need for more trauma-informed processes within HIV testing. Examples of these processes include increasing the availability of testing at locations where victims often access other services (e.g., courts, shelters); consolidating the collection of data on sexual risk factors as victims often have to provide this information numerous times when seeking IPV-related services and recalling traumatic experiences can be re-victimizing; and increasing referral networks between HIV and IPV services agencies.

Conclusions: The results of this study provide important information that can be used to improve the implementation of HIV testing, tailoring processes so they are more trauma-informed and better support individuals with a history of IPV.