Understanding HIV-related posttraumatic stress disorder in South Africa: a review and conceptual framework

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 4.2and 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 et 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