"They are human": Creating Safe and Supportive Environments in Trauma-Informed Settings for People Living With HIV Restricted; Files Only
Fitzgerald, Bridget (Spring 2023)
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
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