May 1, 2017
Although great strides have been made researching the health implications of HIV/AIDS for long-term survivors (LTS), the main focus of these studies has been on physiological issues such as virologic and immunologic concerns, the long-term impact on immune function and other body systems, and HIV pathogenesis. Largely absent from these studies is detailed, solution-focused research on the psychological impact of long-term survival, particularly post-traumatic stress disorder (PTSD).
There have beenstudies on the general psychological impact of HIV/AIDS, such as an overall higher suicide rate, high rates of anxiety and depression, cognitive impairments, increased risk for addictive and high-risk behaviors, and greater social isolation. While these represent an enormous burden for LTS, it is important to highlight PTSD, a specific disorder with distinct symptoms and treatments, and one for which LTS are at greatly increased risk.
For LTS, trauma can include an HIV diagnosis at a time when that represented a "death-sentence;" a foreshortened sense of survival or even having a future; multiple losses of friends and family members (sometimes entire circles of friends); years of life-threatening illnesses and clinging to survival waiting for the next drug to be released; and rejection by families and friends due to the stigma of HIV/AIDS.
I see signs of PTSD among LTS everywhere in my practice and among my friends. Like soldiers returning from war, many of us who survived the 1980s and 1990s are reluctant to talk about those times, choosing instead to avoid painful memories. Many others isolate, or continue to experience anger, fear or grief out of scale with a triggering event. PTSD is caused by the unexpressed and unprocessed feelings resulting from trauma, and these emotions continue to bubble up in support groups, in workshops focusing on LTS issues, and in indirect ways such as social isolation or avoidance of relationships, and therefore potential loss. It should not be assumed that all LTS experience PTSD, but it is incumbent upon health care providers and the community to recognize it and, when identified, provide assistance.
Trauma causes PTSD, and to diagnose it properly a person must have symptoms from each set of criteria below. While almost everyone can relate with some of these symptoms, PTSD is very specific and can only be diagnosed by a health care professional.
While these symptoms of PTSD can be overwhelming, there are a variety of treatment interventions for which effectiveness has been well-documented. PTSD can be diagnosed by any medical professional but mental health professionals typically have more expertise with various interventions. Most treatments are short-term and include:
The lives of many people living with HIV/AIDS have been shaped by traumatic events, some of which occurred 30 years ago. As a result, many remain locked in the painful and crippling emotional states characterized by PTSD. There are solutions, and with awareness and treatment, PTSD need not create even more casualties among long-term survivors.
David Fawcett, Ph.D., L.C.S.W., is a substance abuse expert, certified sex therapist and clinical hypnotherapist in private practice in Ft. Lauderdale, Florida. He is the author of Lust, Men, and Meth: A Gay Man's Guide to Sex and Recovery.
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