Understanding the interface of HIV, trauma, post-traumatic stress disorder, and substance use and its implications for health outcomes

Abstract

Many individuals living with HIV have been exposed to some type of traumatic event during their lives and may be living with symptoms of post-traumatic stress disorder (PTSD). A substantial number of these individuals are also likely to show evidence of a co-morbid substance use disorder (SUD). There is reason to believe that the co-occurrence of HIV and PTSD or co-morbid PTSD and SUD (PTSD/SUD) may predict poorer health outcomes. There are several pathways through which PTSD or PTSD/SUD might adversely impact the health of individuals living with HIV, including participation in negative health behaviours, low levels of adherence to antiretroviral medications, and/or a direct, deleterious effect on immune function. Psychological interventions are needed to treat PTSD and PTSD/SUD in HIV-positive individuals, and reduce the negative impact of these conditions on health outcomes. This article will explore data on the prevalence of trauma exposure, PTSD, and PTSD/SUD among individuals living with HIV, the pathways through which these conditions might affect health, possible interventions for PTSD and PTSD/SUD for individuals living with HIV, and methods for integrating care for individuals with these disorders. Future directions for research related to HIV, PTSD, and PTSD/SUD will also be discussed.

Mental Health Needs of People Living with HIV/AIDS: A Thematic Overview

“…Also, other mental health issues like alcohol and substance abuse, Post traumatic stress disorder etc., are higher among PLHA [20,21]. Post-Traumatic stress Disorder (PTSD) is also among most common Psychiatric comorbidities among PLHA [19][20][21]. Studies show the prevalence of PTSD being as high as 30-40% among PLHA (DJ brief 2004), and further higher among those who were the victims of physical and sexual abuse (such as rape victims, those with history of Child sexual abuse etc) and those with the history of trauma [19][20][21].…”

“…Similarly, literature shows a higher prevalence of drug abuse among those with HIV [15][16][17][18][19][20][21][22][23][24][25], with life time prevalence of 23-56% among PLHA compared to that of 6-12% among normal individuals [15]. Mental health issues like suicide are more prevalent among PLHA than that of normal population.…”

“…Studies from India show the prevalence of Depression among PLHA to be ranging from 33.3% to 70% [20]. Also, other mental health issues like alcohol and substance abuse, Post traumatic stress disorder etc., are higher among PLHA [20,21]. Post-Traumatic stress Disorder (PTSD) is also among most common Psychiatric comorbidities among PLHA [19][20][21].…”

“…Further, PLHA are at risk of developing chronic mental health issues like dementia, schizophrenia, bipolar disorder etc., [29,30]. Also within PLHA, mental health issues are more prevalent among socially disadvantaged groups such as MSMs, Gays, Transgender, women, victims of abuse and children especially those orphaned by HIV [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Figure 2, gives an overview of mental health and HIV/AIDS and there interrelationship.…”

“…Post-Traumatic stress Disorder (PTSD) is also among most common Psychiatric comorbidities among PLHA [19][20][21]. Studies show the prevalence of PTSD being as high as 30-40% among PLHA (DJ brief 2004), and further higher among those who were the victims of physical and sexual abuse (such as rape victims, those with history of Child sexual abuse etc) and those with the history of trauma [19][20][21]. Alcohol and substance abuse is one of the major issues related to HIV and Mental health, serving as both the risk factor and mental health outcome of HIV [16].…”