The scars of childhood trauma go much deeper than the emotional and/or physical abuse experienced by the child – research shows that it can also have a lifelong impact on a person's brain function. In the run up to Child Protection Week, marked from 27 May to 2 June, a researcher at Stellenbosch University's Department of Psychiatry unpacks the long term effects of childhood trauma in a population also affected by HIV.

An ongoing study exploring the impact of early childhood trauma and HIV on the brain has highlighted the need for trauma screening to be included into HIV care.

People with HIV commonly experience cognitive deficits such as disturbances with attention, memory, delayed reaction time and executive functioning (the mental processes that enables a person to plan, focus attention, remember instructions, and juggle multiple tasks). In addition, studies assessing early life trauma have also reported disturbances in brain function and structures.

"The brain and behavioural changes that accompanies early life trauma may result in additional complications related to the course of HIV disease in this vulnerable population," says Dr Georgina Spies, a post-doctoral researcher at the Department of Psychiatry at the Faculty of Medicine and Health Sciences, Stellenbosch University.

Spies is leading a long-term study comparing the brain function and structure of more than 300 Cape Town women. Half of the women are HIV positive, while the other half are HIV negative. In each of these groups there are women with and without a history of childhood trauma.

All of the women underwent neurocognitive assessment using a neuropsychological battery sensitive to the effects of HIV, and Structural Magnetic Resonance Imaging (sMRI) was done to measure brain volume. These tests were done at the onset of the study as well as one year later.

"The most commonly reported childhood trauma type was emotional abuse, followed by emotional neglect, physical neglect, physical abuse and lastly sexual abuse. Results revealed that the average brain volume was significantly smaller in HIV-positive women with childhood trauma, compared to the other three groups," Spies reports.

Several regions of the brain were affected, including the domains associated with processing speed, working memory, executive function, motor skills, learning and verbal fluency. These effects were more pronounced in women living with both HIV and childhood trauma.

"Preliminary analyses of the data revealed that the effects of HIV and childhood trauma remained evident a year later despite greater antiretroviral (ART) uptake and improved HIV disease status among these women," she says.

"This is the first study to assess the combined impact of HIV and trauma in women with more advanced disease and highlights the potential contributory role of childhood trauma to brain volume alterations and neurocognitive decline in HIV-infected individuals. These findings highlight the need for trauma screening and for the integration of trauma focussed interventions in HIV care to improve outcomes in affected individuals," Spies concludes.

This research is supported by the South African Research Chair in PTSD hosted by Stellenbosch University, funded by the DST and administered by the NRF.