The relationship between trauma and HIV is well established. Sexual violence, for obvious reasons, makes people more vulnerable to contracting HIV. When a person is forced to have unprotected sex, for example, either in an attack or a relationship where there is a power imbalance, HIV can spread.

Regan HofmannBut even if trauma, violence or abuse doesn't directly lead to HIV transmission, each has a lingering impact that threatens physical and mental health. The emotional scars of abuse and violence can cause people to make decisions that can put them at higher risk for HIV. During or in the aftermath of abuse, it is often difficult to maintain one's self-esteem. When you have been attacked, put down, devalued or told by an individual or society that you “deserve” to be treated poorly, it's hard to tell yourself otherwise.

For people who contract HIV (whether through trauma or not), being the object of abuse and violence can make it far more difficult to summon the will and resources to get tested, to seek and stay connected to care, and to muster the sense of empowerment and courage to risk disclosing their HIV status. Disclosure, in turn, can also prevent the spread of HIV—so anything that further helps people feel they can safely disclose is good for individual and public health.

Which is why health care providers should screen men and women for HIV if they show signs of physical and/or emotional abuse—and why they should ask those living with HIV about their past and current experiences with emotional abuse and physical violence. Helping people break free of abusive relationships and heal from trauma protects them from contracting HIV. If someone is already living with the virus, overcoming emotional and physical threats can help them access proper care. 

Screening people in health care settings is one way to slow the spread of violence and HIV. But another way is for friends and families to pay attention and watch for signs of violence. The estimated rate of intimate partner violence among all U.S. women is about 25 percent. For HIV-positive women, that rate is double. Though it can be difficult to ask someone if she (or he) is facing emotional or physical threats, broaching the delicate topic could save a person's life.

And most important, if you are in an abusive situation or relationship—seek help. Know that you're not alone and that there are people available to assist you. In “Healing the Hurt” on page 32, you will read the stories of four incredible women who have risen above the pain of their own experiences with HIV and violence.

They are living proof that what doesn't kill you makes you stronger. By courageously sharing their stories, they signal to all other women out there in need that safe havens can be found.

By overcoming fear and realizing that we don't deserve to be attacked, beaten or emotionally tormented, we can reclaim our sense of self-worth and dignity. When we allow ourselves to believe we are worth protecting and when we take steps to defend ourselves, we are on the road to a safer future. It is when we move past episodes of pain that we emerge stronger than ever before.