Application of the DSM-IV criteria to the experience of living with AIDS: Some concerns

Department of Psychology, Stellenbosch University, South Africa.
Journal of Health Psychology (Impact Factor: 1.22). 12/2008; 13(8):1008-11. DOI: 10.1177/1359105308097964
Source: PubMed


A diagnosis with HIV is often considered traumatic. According to the DSM-IV-TR's criteria for PTSD, a traumatic event precipitates a set of reactions in an individual that includes avoidant behaviour, intrusive thoughts, and physiologic hyperarousal. However, persons diagnosed with HIV are typically concerned with events that will occur in the future such as physical decline and death, access to treatment, the welfare of dependants, and stigma and discrimination. Their concerns are thus future-oriented rather than anchored to a past traumatic event, which is the requirement of PTSD. This article argues that an HIV diagnosis may be inappropriately regarded as traumatic.

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    • "HIV stigma remains a ubiquitous threat to those who are HIV-positive. With the country's high burden of HIV infections, South Africans commonly report attitudes and beliefs that are stigmatising (see Kalichman, Simbayi, Jooste, Toefy, Cain, Cherry & Kagee, 2005; Visser, Kershaw, Makin & Forsyth, 2008). The complex nature of HIV stigma has seen many and varied research efforts and theoretical contributions — from the social model of Parker & Aggleton (2003), which emphasises that stigma reproduces social inequalities, to the more individualistic model of Herek (1999), who argues that HIV and AIDS provides a symbolic vehicle through which individuals can express their negative attitudes to already marginalised groups. "
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    ABSTRACT: A number of epidemiological studies have attempted to measure the prevalence of HIV-related posttraumatic stress disorder (PTSD) in sub-Saharan Africa. A systematic review of the literature identified eight relevant studies that put current estimates of the prevalence of HIV-related PTSD between 4.2% and 40%. Even the lower estimates suggest that PTSD in response to the trauma of being diagnosed and living with HIV is a significant mental health burden. However, a conceptual framework to advance our understanding of the prevalence and phenomenology of HIV-related PTSD is lacking. This article argues that the Ehlers & Clark (2000) cognitive model of PTSD provides a useful conceptual framework for understanding HIV-related PTSD in South Africa. The model emphasises the role of trauma appraisals in the development and maintenance of PTSD, which can also be usefully applied to some of the other psychological disorders associated with HIV infection. The model appears to fit some of the important research findings, and it offers insights into the relationships between HIV-related PTSD and other psychological disorders, HIV stigma, the high prevalence of non-HIV traumatic events, occasional problems with the delivery of antiretroviral drugs in the South African public health service, the unpredictable course of HIV illness, and the quality of HIV testing and counselling. Implications for individual treatment strategies and broader public health interventions are briefly discussed.
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    ABSTRACT: This cross-sectional study sought to determine the percentage of individuals who met criteria for lifetime PTSD and HIV-related PTSD among 85 recently diagnosed HIV-positive patients attending public health clinics in the Western Cape, South Africa. The PTSD module of the Composite International Diagnostic Interview (CIDI) was used to determine the percentage of those who met criteria for lifetime PTSD and HIV-related PTSD. The rate of lifetime PTSD and incidence of HIV-related PTSD was 54.1% (95% CI: 43.6-64.3%) and 40% (95% CI: 30.2-50.6%), respectively. Findings suggest that receiving an HIV-positive diagnosis and/or being HIV-positive may be considered a stressor that frequently results in HIV-related PTSD. Given the various barriers to efficient mental health interventions and services in South Africa, there are significant challenges that need to be addressed in order to ensure that the mental health of HIV-positive individuals is appropriately addressed.
    AIDS and Behavior 01/2009; 15(1):125-31. DOI:10.1007/s10461-008-9498-6 · 3.49 Impact Factor
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