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)
 

Living More Confidently

posted: 07/05/2010

A self-help book by three clinical psychologists expert in HIV, stress and trauma, may help some people think more positively about living with HIV. The writers hope the book

• increases your knowledge about HIV
• helps you adjust better to having HIV
• builds confidence in yourself despite having HIV
• supports good relationships despite having HIV
• increases your life choices despite having HIV
• widens your support networks
• improves your quality of life with HIV
• gives you a more positive outlook and motivation for the future.

This book talks frankly about the issues that people living with HIV face. As HIV is associated with much fear and stigma, this self-help book covers aspects of living with HIV that may be difficult for people to discuss with others. Fears of talking about HIV and HIV disclosure are problems for many. They hope this book will help release some fears and lift some of the stigma that people experience.

This self-help book faces some of the psychological needs of people who are HIV positive. It answers frequently asked questions and it draws on the experts clinical experience of what works. They hope it helps normalise the experience of living with HIV, creates hope for change, and provides a way of learning new skills.

Who should read it
This book is for all adults living with HIV especially anyone struggling to accept and adapt to having HIV, including :

• Struggles with accepting diagnosis, in adjusting to HIV, and in finding a way forward
• Where health problems make reaching your goals uncertain
• People dealing with stress
• People who are isolated, unsupported and worried about talking openly about HIV
• People feeling overwhelmed by emotions to do with HIV
• People wanting to make changes in their lives
• People who want a better sense of living for a future and to make plans
• Partners, carers, family or friends who would like to understand more and support others better.

Living Confidently with HIV - A Self-Help Book for People living with HIV  £12.99
by Liz Shaw, Erasmo Tacconelli, Robert Watson and Claudia Herbert, London, 2009

You could order this at your local public library.

Another similar but free book

living with HIV  by NAM / aidsmap is online here  - printed copies are no longer available.

Stigma – Why and When it’s Upsetting

posted: 12/11/2009

Some types of HIV-related stigma cause much more harm and upset to people living with HIV, than other types of stigma. The types of stigma that cause most upset seem to be

• problems with health care workers,
• secrecy and lack of openness within the family, and
• exaggerated kindness from members of your family.

“Our findings suggest that certain setting-specific manifestations of stigma are indeed more psychologically damaging than others”, comment the Dutch investigators in the article in the journal AIDS.

There is a lot of research showing that HIV-related stigma causes psychological distress. No-one before has looked at the impact of different types of stigma, in different situations.

In 2007, Dutch investigators did a “snap-shot” study of 669 people living with HIV. The people had a mean age of 47 years and were well educated, with almost 50% having a degree. Most (80%) were gay men, 68% were in employment and 48% had a partner.

Each answered a questionnaire about the most distressing affects of stigma in six settings (friends, family, healthcare, partner, work, and leisure).

The questionnaire allowed people to select from eleven types of stigma

• advice to conceal HIV infection or not to disclose,
• blame,
• increased physical distance,
• excessive hygiene,
• indifference,
• exclusion,
• awkward social interactions,
• exaggerated kindness, and
• aggression.

People may mean well
Friends caused the most upset with their awkwardness and excessive kindness.

Family caused a lot of upset if they tell you to hide your HIV, avoid you, or were excessively kind were all associated with distress if experienced from family members.
 

In healthcare stigma caused the greatest upsets if health staff are indifferent (don’t seem to care) or if social interactions are awkward.
 

In our close relationships, being told to hide HIV, and being over-kind caused more upset.

Proven links

They did a statistical analysis and found that only four types of stigma are really linked to psychological distress.

Three of the four linked stigma types were within the family:

• being told to hide HIV,
• family members avoiding you, and
• being over-kind to you

were all statistically proven.

The only other example of upsetting stigma that is statistically significant is in healthcare when there are awkward social situations.

Family upsets hurt
“Stigmatiszation by family may be particularly detrimental as families are not chosen and often considered an important source of unconditional love and support”, write the investigators, who suggest that experiencing stigma from family members may threaten the fundamental human “need to belong.”

Healthcare stigma worse because unexpected
Healthcare professionals should know about HIV, so when healthcare workers stigmatise, that is unexpected and more distressing because it is from people whose job it is to care for you.

George House Trust comment

This is interesting but of limited use.

It only examined 11 types of stigma, in certain situations, and the sample was heavily biased to older, well-educated white gay Dutch men.

Physical violence, denial of rights or services, and sacking people, are all examples of stigma they did not investigate. Many people would say that these are all much more upsetting examples of stigma and discrimination than some of the types of stigma they did look into.

People from other groups - eg young people, migrants, Africans, injecting drug users, among others, may have very different experiences of stigma to older, well-educated, white gay men.

Source and reference details