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What Is Getting in the Way? Recognizing Trauma in HIV Care

Clinical Thought
Clinical Thought
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Released: August 28, 2026

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HIV healthcare professionals can identify possible PTSD with simple questions without asking people to recount details of traumatic experiences. Learn practical tips in this case commentary.

Kathleen Page
Kathleen Page, MD
PTSD in HIV Care


A 38-year-old woman with well-controlled HIV repeatedly avoids pelvic and genital exams. Her healthcare professional (HCP) notes multiple health maintenance flags in the chart for missed Pap smears, but when this is discussed, she becomes guarded and irritable. She says the exams make her feel unsafe but does not want to talk about it.

As HIV HCPs, we might initially try to convince her to get the exam by talking about the importance of cervical cancer screening. But instead, we could ask ourselves whether trauma may be affecting her ability to engage in care. By asking gently, we can show that we care and begin to understand how we can best serve her. Questions like, “You seem reluctant to do this exam. Is there anything we can do to make it easier?” and “Is there something about this exam that makes you uncomfortable?” can shift the focus from why she is not following our recommendations to what may be making it difficult for her to do so.

Many people living with HIV have experienced trauma, including interpersonal violence, stigma and discrimination, substance use, poverty, incarceration, migration-related experiences, and living through the early HIV epidemic. But few explicitly tell us that trauma is affecting them. Instead, they may avoid certain examinations, have difficulty trusting the medical team, or seem hypervigilant, irritable, or emotionally guarded.

Ask but Don’t Require the Person to Tell Their Story
We do not need to know the details of the person’s trauma to recognize that it may be affecting their care. When we suspect trauma, we do not need to ask people to tell us exactly what happened to them. Instead, we can ask simple questions such as:

  • Would it be ok if I ask a few questions about stress or trauma?
  • Do you find yourself avoiding situations, including medical care, that make you feel unsafe?
  • Do you often feel on guard?
  • Do nightmares or unwanted memories affect you?

Our goal is to recognize symptoms and create a safe environment that builds trust and gives people the opportunity to share concerns if and when they choose. Brief validated tools like the PC-PTSD-5 can help identify people who would benefit from further assessment.

Integrating Trauma-Informed Care Into HIV Care
Recognizing trauma can change how we deliver care at every step. This is a team effort: from registration and rooming through the clinical encounter and follow-up. Staff can be trained to recognize behaviors that may reflect trauma and respond with empathy rather than frustration. Before examining a person, we can explain what will happen and ask permission. We can offer choices when possible and make clear that they can ask to pause or stop an exam at any time. 

Trauma can also affect other aspects of HIV care, including medication adherence or keeping appointments. For some people, taking antiretroviral medication every day may be a reminder of HIV-related stigma, discrimination, or difficult past experiences. Understanding what is behind treatment avoidance can help us find strategies that work better for each person.

People with posttraumatic stress disorder may benefit from referral for trauma-focused mental health treatment. But referral does not mean that our role is done. We must continue to support people and understand how trauma may be affecting their care. When a person’s behavior interferes with HIV care, curiosity is more useful than judgement. Instead of becoming frustrated because a person is not doing what we recommend, we should ask, “What is getting in the way, and what can we change to make care possible?”

Your Thoughts
How do you approach trauma in your care for people living with HIV? Leave a comment to join the discussion!