mbulelo smpofu
People living with HIV in Zimbabwe have high exposure to traumatic events, but most do not go on to develop post-traumatic stress disorder (PTSD), according to new research from the Institute of Psychiatry, Psychology and Neuroscience (IoPPN) at King’s College London and the University of Zimbabwe.
The study, published in BJPysch Open, revealed over two thirds of participants living with HIV in Zimbabwe had experienced or witnessed at least one traumatic event (68.3 per cent). This rose to 90 percent when including participants who had learned about a traumatic event from others.
Around one in eight people in Zimbabwe live with HIV – a virus that damages the cells in your immune system and weakens your ability to fight everyday infections and disease. This is one of the highest prevalences in the world.
Previous evidence has shown that mental health difficulties are more common among people living with HIV and that poor mental health is linked with worse HIV outcomes. There has been less attention to the prevalence and impact of post-traumatic stress disorder (PTSD) among people living with HIV in low-income countries in southern Africa, like Zimbabwe.
Researchers at the IoPPN and the University of Zimbabwe analysed data from 222 young adults aged 18 to 29 with HIV in Harare, Zimbabwe,and conducted interviews with eight participants who met the criteria for probable PTSD to investigate the prevalence and impact of traumatic experiences and PTSD in this population.
They found nearly 70 per cent of participants living with HIV had experienced, witnessed or learned about four or more traumatic events. Around one in 12 participants met the criteria for probable PTSD (8.6 per cent). The majority of people who had experienced a traumatic event, however, did not develop PTSD.
The results of interviews with people with probable PTSD suggest that HIV stigma may worsen psychological distress caused by trauma. Some participants reported that receiving their HIV diagnosis was a traumatic event in itself. The findings highlight the importance of ensuring mental health support is available within HIV care.
“We know that mental health difficulties like depression are linked with worse outcomes for people living with HIV, however very little attention has been given to the impact of traumatic experiences and PTSD, particularly in low and middle-income countries. We analysed data collected from young adults living with HIV.
Although trauma exposure was worryingly common, the prevalence of probable PTSD was not high, possibly showcasing important coping abilities in this population,” said Renato Silveira, lead author of the study and MSc student at King’s IoPPN at the time of research.
The researchers also investigated the types of traumatic events that were associated with developing PTSD. Those who experienced trauma from fire, explosion or sexual assault and those who had experienced multiple exposures to any trauma, were most likely to meet the criteria for probable PTSD.
In the interviews, several participants explained that having HIV led to stigma, discrimination, isolation and relationship difficulties with their family. Being exposed to traumatic events led to negative thinking, feelings of loneliness, hopelessness and helplessness, which exacerbated the challenges of coping with HIV.
One participant said: “When people at work discover that you are an HIV patient, they start to discriminate (against) you. Some will not even eat the food that you eat, some will stop being friends with you and some can call you names because they do not know how you got infected.”
Participants with probable PTSD said that they found social support, faith and strategies such as positive self-talk most helpful for dealing with the impacts of HIV and traumatic experiences. Attitudes towards healthcare staff and counsellors were mostly positive, although many participants reported that it is difficult to open up to counsellors as they were often from an older generation. They suggested increasing the availability of counselling sessions specifically for people living with HIV, implementing support groups and improving education about HIV in Zimbabwe.
Dr Helen Jack, senior author of the study, Visiting Lecturer at the IoPPN, General Practitioner and Assistant Professor at University of Washington School of Medicine, said:
“We found that many people living with HIV in Zimbabwe experienced traumatic events. Some of those who screened positive for PTSD faced discrimination due to their HIV status, which made them feel isolated from their social community.
Experiencing a traumatic event, like a fire or a sexual assault, was really common. To better support these patients, we not only need to support those with PTSD but also think about public health programs to prevent some of these traumatic events from happening in the first place.”
Dr Rukudzo Mwamuka, Consultant Psychiatrist and Research Fellow at University of Zimbabwe, said:
“The project will help with contextualisation of what young adults living with HIV perceive to be traumatic events in Zimbabwe. These findings will help clinicians working in the HIV clinics to identify these traumatic experiences early and refer these young people for appropriate therapy to prevent PTSD and build resilience.”
The research was a collaboration between the Centre for Global Mental Health at King’s IoPPN and the Faculty of Medicine at University of Zimbabwe, funded by the African Mental Health Research Initiative and Wellcome.
Renato Silveira conducted the study as part of his MSc dissertation, supervised by Professor Melanie Abas, together with Dr Helen Jack and Dr Rukudzo Mwamuka. Renato is now a High Intensity Cognitive Behavioural Therapist at Whittington Health NHS Trust.
“This research is another important output of the long-standing mutual partnership we have with the University of Zimbabwe. In this case, a King’s student was able to learn from our collaborators in Zimbabwe. It is inspiring to see how Renato took his experience as an MSc student and went on to publish a paper with Zimbabwean co-authors,” said Professor Melanie Abas, Professor of Global Mental Health at King’s IoPPN.
The data was originally collected by researchers at the University of Zimbabwe using questionnaires about traumatic events and PTSD symptoms to understand how exposure to trauma might impact adherence to antiretroviral therapy. The interviews with those who met the criteria for probable PTSD were added as part of the new study. — King’s College London
