title: 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.
authors.affiliation: Boston University School of Medicine, Boston, MA, USA. deborah.brief@med.va.gov
authors.forename: D J
authors.initials: DJ
authors.lastname: Brief
authors.forename: A R
authors.initials: AR
authors.lastname: Bollinger
authors.forename: M J
authors.initials: MJ
authors.lastname: Vielhauer
authors.forename: J A
authors.initials: JA
authors.lastname: Berger-Greenstein
authors.forename: E E
authors.initials: EE
authors.lastname: Morgan
authors.forename: S M
authors.initials: SM
authors.lastname: Brady
authors.forename: L M
authors.initials: LM
authors.lastname: Buondonno
authors.forename: T M
authors.initials: TM
authors.lastname: Keane
mesh_terms: D001294:Attitude to Health; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D005260:Female; D015658:HIV Infections / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D010349:Patient Compliance; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D019966:Substance-Related Disorders / Q000523:psychology* / Q000628:therapy; D014947:Wounds and Injuries / Q000523:psychology*