Prevalence of probable post-traumatic stress disorder and experiences of trauma in emerging adults living with HIV in Zimbabwe

Background: Little is known about the prevalence of post-traumatic stress disorder (PTSD) in emerging adults living with HIV in low-income countries.

Aims: Determine prevalence of trauma exposure, prevalence of probable PTSD and conditional prevalence of probable PTSD for different traumatic events; and better understand the experiences of individuals with HIV and PTSD.

Method: This mixed method study used secondary data from a cross-sectional survey of people (N = 222) aged 18 to 29 living with HIV in Zimbabwe and primary qualitative data collection. The PTSD Checklist for DSM-5 (PCL-5) and the Life Events Checklist for DSM-5 (LEC-5) were used to measure PTSD and exposure to traumatic events, both translated to Shona. In-depth interviews (n = 8) with participants who met the criteria for probable PTSD were analysed using thematic analysis.

Results: In all, 68.3% [95% CI (61.4-74.1)] of participants reported exposure to at least one traumatic event. The observed prevalence of probable PTSD was 8.6% [95% CI (5.2-13.0)], most observed following exposure to fire or explosion 29.0% [95% CI (13.0-45.0)] and sexual assault 27.8% [95% CI (7.2-48.7)]. Probable PTSD was also more prevalent following multiple exposure to trauma; four and six events, N = 4 (21%) [95% CI (5.1-8.8)] each, two and three events N = 3 (15.7%) [95% CI (5.9-9.2)] each, and five events N = 1 (5.4%) [95% CI (7.5-9.6)]. Qualitative results indicated that HIV stigma exacerbated psychological distress from trauma.

Conclusions: Despite trauma exposure being common, prevalence of probable PTSD was not high, but was higher in those with multiple exposures. Participants described coping strategies, including social support and religious thinking.