HIV and Post-Traumatic Stress

posted: 20/08/2010

One third of HIV-positive gay and bisexual men in a London survey fit the definition for post-traumatic stress disorder (PTSD), according to a report in AIDS Patient Care and STDs. Starting HIV treatments was one of the triggers for PTSD among these men with HIV.
 

What is Post Traumatic Stress and what does it do?

PTSD is a frequently debilitating psychological disorder caused by experiencing or witnessing traumatic events, such as physical violence. People with PTSD experience symptoms of depression and anxiety, have intrusive memories of the traumatic event, and often begin avoiding places and activities that trigger such memories. Taken together, these symptoms can significantly affect a person’s ability to function in life and experience pleasure.
 

HIV and Post Traumatic Stress

Various studies have examined whether HIV-related experiences, such as the threat of physical or psychological harm, increase the risk of developing PTSD. With HIV, harm can come from the threat of illness or death due to disease progression or opportunistic infection or from social rejection due to a person’s HIV status.
 

Up to Two Thirds of people with HIV may get post-traumatic stress
Rates of PTSD in people with HIV have ranged from 13 to 64 percent, depending on the group being studied. Among people with HIV various studies before have found it among

• 13% of adolescent and young adults
• 15% in ethnic minority women
• 30% among gay men
• 64% for people who have difficulty taking all their HIV treatments properly.

Gay and bi men and post traumatic stress: 33%

To determine the frequency and causes behind PTSD in HIV-positive gay and bisexual men, Anthony Theuninck, a doctor of clinical psychology, and colleagues from the Oxleas NHS Trust in London, surveyed 100 gay and bisexual men.
 

Theuninck’s team found that 33 percent of the men met the criteria for HIV-related PTSD, in that they experienced threats to their physical health from HIV, or witnessed someone else’s death from HIV, and that they had profound feelings of fear and helplessness related to these events.
 

PTSD diagnosis

There's a rather complex set of rules for daignosing PTSD but they assess people under these headings: 

• Experience event as a physical threat
• Thought that I might die
• Fear
• Helplessness
• Horror
• Shame
• Humiliation
• Guilt

Three Stress Triggers

Three HIV-related events most strongly predicted these men developing PTSD. They were:

• experiencing physical symptoms
• witnessing a HIV-related death 
• receiving antiretroviral (ARV) treatment.

Though 55 percent of the survey respondents rated

• being diagnosed with HIV as a traumatic event, this was not correlated strongly with developing PTSD
• feelings of shame or guilt over becoming HIV positive were also felt to be traumatic by the men, but was not strongly correlated with a PTSD diagnosis.

Starting treatment trigger

Theuninck and his colleagues stated that receiving HIV treatment was both “the strongest predictor and an unexpected finding. The emotional distress evoked by receiving treatment was more highly correlated with [post-traumatic stress symptoms] than any other stressor.”
 

Treatment can be a shock
The authors hypothesised that receiving ARV treatment “could include catastrophic expectations about the limitations a medication regime may impose on social or occupational functioning thus leading to traumatic fear, or the perceived failure of alternative medicines and lifestyle remedies leading to traumatic helplessness.”
 

Doctors and clinics: be on the look out
As for the treatment implications of their findings, the authors recommend that clinicians become familiar with the diagnostic criteria of PTSD and remain on the lookout for these symptoms in their patients. Given previous findings about the increased likelihood for poor adherence among people with PTSD, this may be critical.
 

In cases where PTSD comes on within a month of a traumatic event, immediate intervention is not recommended by current guidelines, the authors noted.

People whose symptoms persist beyond one month, however, should receive professional treatment specific to PTSD.
 

People with HIV: knowledge and support helps
The authors also recommended that people with HIV receive education about the symptoms of PTSD and the kinds of events that can increase a person’s vulnerability to developing the condition.
 

HIV and certain events associated with HIV are a big shock to most people. But with the right information and support, especially from other people living with HIV, most people get over the shocks and get on with their lives. Shock is a natural normal reaction to some traumatic changes and news in our lives. People haven’t 'failed;' and asking for support from community organisations, your doctor and the HIV clinic make sense.
 

“Further research is needed to determine the conditions that contribute to some HIV-related events being more likely to be traumatic than others,” the authors concluded. “Such research may benefit from being guided by psychological PTSD models…to inform further service and treatment development.”
 

Source
Full AIDS Patient Care and STDs article (free)
 

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