"They are human": Creating Safe and Supportive Environments in Trauma-Informed Settings for People Living With HIV Restricted; Files Only

Abstract

Background

Human Immunodeficiency Virus (HIV) has impacted people living with HIV (PLWH) ability to 

retain care in the Southern United States for multiple decades. The Traum-Informed Care 

framework’s domain of Safe and Supportive Environments emphasizes the impact that positive 

clinical environments can have on a patient’s experience. The goal of this study was to explore 

the strategies employed by Ryan White clinics in the Southeastern US in creating safe and 

supportive environments for their patients. The purpose of this qualitative analysis was to 

identify existing strategies and areas for improvement in Ryan-White clinical environments. 

Methods

This qualitative sub-study was nested within a larger mixed-methods study. The parent study 

used an explanatory sequential design, which utilized web-based surveys among 400 Ryan white 

Clinics within the Southeast. For this sub-study, a qualitative methodological approach was 

utilized to analyze the original 36 key informant interviews conducted with clinic staff and 

providers. 

Results

Thematic analysis resulted in the identification of four primary themes: 1) Definitions of Safety, 2) Barriers to 

Creating a Safe Environment, 3) Methods Currently Employed to Create a Safe Environment, 

and 4) Methods for Enhancing a Safe Environment. Within this analysis, themes were developed 

by consistent descriptions and patterns relating to the safety and security of a Ryan White 

Clinic’s environment. Key areas for improvement included: strengthening comprehensive 

understanding of providers and increasing the presence of providers and staff that have diverse 

cultural, ethnic, and racial backgrounds. Improving infrastructure is an additional action that can 

be taken create a to create a safe and comfortable environment within Ryan White clinics.

Discussion

Thematic analysis of in-depth interviews demonstrated that values of safe and secure clinic 

environments often encompassed trust in providers and clinic staff, comprehensive 

understanding of providers, general maintenance of privacy, and physical manifestations of 

security. These findings provide an opportunity to open and shape conversations with Ryan 

White clinic staff and HIV patients, surrounding the creation of safe spaces in TIC 

environments.

Table of Contents

Table of Contents

CHAPTER 1: LITERATURE REVIEW......................................................................................................1

Prevalence of HIV in the USA..................................................................................................................1

Prevalence of HIV in the Southern USA ..................................................................................................1

HIV Care Continuum................................................................................................................................2

Ryan White Clinics...................................................................................................................................3

Barriers to HIV Care.................................................................................................................................4

Impacts of Trauma on the HIV Care Continuum......................................................................................4

Trauma Informed Care Framework ..........................................................................................................5

Importance of a Safe Environment ...........................................................................................................8

Gaps within Literature ..............................................................................................................................9

CHAPTER 2: MANUSCRIPT ...................................................................................................................10

Introduction.............................................................................................................................................10

Methodology...........................................................................................................................................11

Study Design.......................................................................................................................................11

Sample and Recruitment .....................................................................................................................11

Data Collection ...................................................................................................................................12

Thematic Data Analysis......................................................................................................................12

Results.....................................................................................................................................................14

Findings...............................................................................................................................................14

THEME ONE: DEFINITIONS OF SAFETY.....................................................................................14

THEME TWO: BARRIERS TO CREATING A SAFE ENVIRONMENT.......................................17

THEME THREE: METHODS CURRENTLY EMPLOYED TO CREATE A SAFE 

ENVIRONMENT ...............................................................................................................................20

THEME FOUR: METHODS FOR ENHANCING A SAFE ENVIRONMENT................................25

Discussion...............................................................................................................................................27

CHAPTER 3: PUBLIC HEALTH IMPLICATIONS AND RECOMMENDATIONS..............................31

Research..............................................................................................................................................31

Policy ..................................................................................................................................................32

Practice................................................................................................................................................32

Conclusion ..............................................................................................................................................33

APPENDICES ............................................................................................................................................34

REFERENCES ...........................................................................................................................................39

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palabra Clave	clinic environment safe space Trauma-Informed Care HIV clinics HIV/AIDs
Committee Chair / Thesis Advisor	Dr. Ameeta Kalokhe, Emory University

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