Posttraumatic Stress Disorder in Patients with HIV: Intergrading medical and psychological treatment.

Extensive evidence has indicated that the majority of people living with the Human Immunodeficiency Virus (HIV), almost certainly suffer from posttraumatic stress disorder (PTSD). The complexities of PTSD in people living with HIV or AIDS are extensive and may negatively impact their overall HIV treatment, bearing in mind that a person's mental health greatly influences one’s health-related behaviours and quality of life (www.nlm.medlineplus/ency/article.htm). It is therefore important to raise awareness to the extent in which psychological treatment must be integrated with the medical treatment of people living with HIV and AIDS.

The Diagnostic and Statistical Manual of Mental Disorders (4th edition) stipulates that the defining characteristic of a traumatic stressor is the presence of a threat to a person's life or a threat in which the person's response involves intense fear, helplessness, or horror. Similarly HIV–positive individuals experience symptoms of associated trauma which may eventually lead to PTSD. They are exposed to a traumatic life event by receiving the HIV positive diagnosis and then having to live with the medical condition which may drastically contribute to their continued trauma (www.nlm.medlineplus/ency/article.htm).

Individuals confronted with an HIV – positive diagnosis most frequently will react with initial shock, numbness, disbelief and consequently anxiety and depression. HIV positive individuals face various psychological challenges during the course of the disease. This includes numerous traumatic factors such as receiving the diagnosis of AIDS, beginning new treatment programmes, discontinuing treatment, the appearance of new symptoms, relapse and terminal illness (www.nlm.medlineplus/ency/article.htm).

In addition to flashbacks or disturbing thoughts after receipt of their diagnosis, a PTSD diagnosis can negatively impact the course and advancement of HIV/AIDS in a number of ways. HIV infected people with PTSD, for example, tend to report more health problems. Studies have also found that a diagnosis of PTSD correlates with high indications of depression and anxiety; this may be a dominating factor which may interfere with the individual’s adherence to antiretroviral (ARV) treatment (www.ptsd.about.com/od/related.conditions/a/depressionPTDS.htm.).

The majority of public health care practitioners are unaware of the importance of not only providing medical treatment for HIV/AIDS, but also the importance of providing treatment for PTSD. Examining PTSD symptoms in medical settings where HIV–positive individuals are treated is imperative in order to identify those individuals most at risk for PTSD. It has been indicated that counselling is offered at local clinics from either HIV counsellors upon the person's diagnosis with HIV, or from ARV adherence counsellors for people with a HIV positive status. However, counsellors and medical staff at these clinics may not be adequately qualified or supervised to provide appropriate assessment and therapeutic intervention for traumatised patients (Saraceno et al., 2007). A good recommendation proposed by the Human Science Research Council (HSRC), is to have medical and counselling staff at various HIV clinics in the public sector. These professionals need to be appropriately trained in order to evaluate trauma symptoms among HIV positive individuals and to subsequently refer those at risk for PTSD for suitable therapeutic treatment. (HSRC, 2006)

Research studies in South Africa have indicated that the majority of HIV–positive individuals in need of treatment for common mental disorders such as depression and anxiety do not receive it (Saxena et al., 2007.) The severe shortage of mental health professionals in many low and middle income countries, including South Africa, is a major reason for this large treatment deficiency. It is therefore crucial to integrate mental health care and psychosocial support of HIV positive people in South Africa into the general healthcare system. The various barriers to resourceful mental health interventions and services in South Africa require further investigation. It is essential to ensure that the mental health and well-being of these individuals are both appropriately evaluated and adequately implemented.

References

Human Science Research Council (2005). South African National HIV Prevalence, HIV Incidence, behaviour and Communication Survey, 2005. Cape Town: HSRC Press.

Jacob et al., Sharah, P., Mirza, I., Garrido-Cumbera, M., Seedat, S., Mari, J., Sreenivas, V., Saxena, S., (2007). Mental Health Systems in Countries: Where are we now? Lancet, 370, 1061 – 1076.

Joshua J., Matacotta, M.A , Posttraumatic Stress Disorder in Patients with HIV: A Review of the Current Literature. [ Mar 2, 2010]. www.nlm.medlineplus/ency/article.htm.

Matthew HYPERLINK "http://ptsd.about.com/bio/Matthew-Tull-PhD-26501.htm"TullHYPERLINK "http://ptsd.about.com/bio/Matthew-Tull-PhD-26501.htm". PTSD and HIV/AIDS. [January 29, 2012]. www.ptsd.about.com/od/related.conditions/a/depressionPTDS.htm.

Saraceno, B., Ommeren, M., Batniji, I., Cohen, A., Gureje, O., Mahoneye, J., Sridhar, D., Underhill, C., (2007) Barriers To Improvement of Mental Health Services in Low - Income and Middle - Income Countries, Lancet, 370, 1164 – 1174.

Saxena, A., Thornicroft, G., Knapp, M., & Whiteford, H ( 2007). Resources for Mental Health: Scaricity, Inequity and Inefficiency. Lancet, 370, 878 -889.