It was the murder of a beloved patient that led to a seismic shift in the Women’s HIV Program at the University of California, San Francisco: a move toward a model of trauma-informed care. “She was such a soft and gentle person,” said Dr. Edward Machtinger, the medical director of the program, who recalled how utterly devastated he and the entire staff were by her untimely death.
“This murder woke us up,” he said. ”It just made us take a deeper look at what was actually happening in the lives of our patients.” The Women’s HIVprogram, explained Machtinger, was well regarded as a model of care for treating HIV patients – reducing the viral load of HIV in the majority of its patients to undetectable levels.
But the staff was clearly missing something. A closer look at the lives of their patients revealed that 40 percent were using hard drugs – including heroin, methamphetamine and crack cocaine, according to Machtinger. Half of them suffered clinical depression, the majority had isolated themselves due to deep shame associated with having HIV, and many experienced violence.
“And way too many of our patients were dying,” he said. “When we did an analysis of why they died, the vast majority of deaths were related to trauma – either directly through murders or indirectly through substance abuse, overdose, depression and suicide.”
His patients were not dying from HIV, he said, “but from a lifetime history of trauma.”
This led the clinic to integrate into its practice the science of adverse childhood experiences, known as ACEs science, which explores the lifetime toll on physical, emotional, social and economic health linked to childhood experiences of everything from physical or sexual abuse to living with an alcoholic parent or witnessing violence outside the home.