Social and structural violence and HIV care continuum outcomes: Developing a trauma-informed HIV care intervention among WLWH

PROJECT SUMMARY/ABSTRACT We will use innovative social epidemiological methods to longitudinally characterize the impacts and mechanisms of gender-based violence on the HIV care continuum, define key components of differentiated HIV care models that mitigate these relationships and develop a platform for trauma- and violence-informed HIV care and practice (TVI-HCP) interventions, among cisgender (cis) and transgender (trans) women living with HIV (WLWH). Emerging evidence suggests that the COVID-19 pandemic has resulted in heightened social and structural gender-based violence against cis and trans women, who are shouldering an inequitable share of the resulting impact of restrictions, physical distancing and economic downtown. Impacts felt by marginalized cis and trans women, including WLWH, are even more severe and the short- and long-term consequences in terms of trauma, violence, safety and HIV care continuum outcomes of cis and trans WLWH will need to be addressed. Even prior to COVID-19 crisis, despite substantial programmatic advancements, WLWH experienced gaps relative to cisgender men in all global HIV targets in many settings. Although the global prevalence of social and structural violence by WLWH is alarmingly high, there is a lack of research delineating mechanisms through which different types of violence impact HIV care continuum outcomes, to inform intervention targets. Moreover, despite calls to apply a trauma-and violence-informed care approach to HIV care and practice (TVI-HCP) and the unique needs of WLWH, surprisingly little is known about how this approach can be tailored in HIV clinical practice environments. In the proposed study we will leverage an existing community-based cohort of cis and trans WLWH in a Canadian setting (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment) and recapture and expand this cohort to 300 WLWH in the City of Vancouver. This quantitative study will include survey interviews, innovative mapping and spatial analyses, HIV disease monitoring, and confidential administrative linkages to fill critical research gaps and inform components of multi-level TVI-HCP programming to optimize HIV care continuum outcomes by: (1) Prospectively characterizing relationships between different types of violence experiences (interpersonal emotional, physical and sexual violence; neighbourhood violence) and viral load suppression failure and identifying critical mediators in these relationships on which to intervene; (2) Prospectively characterizing the key components of differentiated HIV care models that have the strongest associations with viral load suppression, expanding on our preliminary development and validation of a TVI-HCP Scale for WLWH; and (3) Establishing an innovative social epidemiological platform for informing and evaluating future multi-level trauma- and violence-informed HIV care interventions. Amidst the ongoing COVID-19 crisis, in parallel with a syndemic of violence, trauma and HIV in North America, our study offers an unprecedented opportunity to inform differentiated HIV care models to optimize HIV clinical outcomes among marginalized women.