The first essential step for initiating trauma and PTSD treatment is identification. While this seems obvious, screening is not commonplace in most HIV clinical settings.
People living with HIV may not recognize that the symptoms they are experiencing relate to traumatic life events, or have knowledge of PTSD, or feel comfortable talking about trauma and related symptoms with their health care provider or loved ones. Although difficult, acknowledging past traumatic events, recognizing symptoms indicative of PTSD, and breaking the silence are vital steps towards seeking medical help.
Trauma and PTSD treatment has focused on intensive psychological and behavioral approaches, with a common theme of group-based support sessions and emphasis on coping skills.3 The focus is generally on developing and enhancing adaptive, or healthy, coping mechanisms like problem-solving, positive re-framing, and relaxation techniques, as well as stress management and sexual risk reduction skills. Common subjects addressed are things like intimacy, safety, and self-esteem, in the context of past trauma, re-victimization, and HIV.6
Few interventions have been rigorously tested through randomized trials. There is a compelling need for more intervention research.
Larry connected with a clinical psychologist, which was highly beneficial for his emotional, psychological, and physical health. They worked on coping skills to address his past trauma and PTSD symptoms. He got a new job, and was quite pleased and successful in his new work environment. His ART adherence improved and he regained virologic control. Aided by the steadfast support of his partner, Larry's sense of distress, emotional detachment, and related PTSD symptoms abated over time, and he felt an improved sense of connection with his partner.
Recognizing and treating co-occurring mental illness and/or substance abuse disorders are also essential to the successful management of trauma and PTSD. Enlisting the support of close friends and family, avoiding alcohol, drugs, and maladaptive coping strategies (such as denial and substance abuse), and challenging the sense of detachment and emotional numbness that accompany PTSD can make the initial steps to fostering a connection to a skilled health care provider easier. The provider can then assist with subsequent management and connection to treatment and support resources.
While decades of research have focused on PTSD in response to traumatic life events, only recently has the concept of post-traumatic growth (PTG) emerged in the context of HIV and other medical conditions like cancer and rheumatoid arthritis.3 PTG describes the positive behaviors that emerge following a diagnosis of HIV or related medical condition. It has been linked to stronger social support, adaptive coping strategies, and favorable indicators of mental and physical health.
Following trauma exposure, people experiencing PTG may have improved relationships, a greater appreciation of life, and a greater sense of spirituality and personal strength.3 Moreover, in HIV-positive people, PTG has been linked to lower levels of depression, alcohol use, and substance abuse. Future study of PTG may enhance our understanding and inform our treatment approaches for those experiencing PTSD.
Traumatic life events and PTSD are incredibly common and widely under-recognized in people living with HIV/AIDS. An understanding of what constitutes trauma and an appreciation of symptoms of PTSD are essential first steps to successfully addressing them. Because trauma, PTSD, and co-occurring mental illness and substance abuse are so pervasive and so damaging across a range of self-care behaviors, risk behaviors, and HIV disease progression, it is imperative that knowledge and resources expand to properly identify and treat these conditions.
We must break the silence and recognize the insidious effects of PTSD on the lives of people living with HIV and their loved ones. Only with recognition and action can full emotional, psychological, and physical health and wellness be achieved by survivors of trauma.
Michael J. Mugavero, M.D., is an Associate Professor of Medicine at the University of Alabama at Birmingham (UAB), Associate Director of the UAB Center for AIDS Research (CFAR), and a practicing Infectious Diseases physician at the UAB 1917 HIV Clinic. He focuses on HIV health services research with particular emphasis on the influence of socio-behavioral and contextual factors related to HIV testing, engagement and retention in HIV medical care, antiretroviral medication adherence, and clinical outcomes.
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