Posttraumatic Growth and HIV: A Study on Associations of Stigma and Social Support

AIDS was first identified more than 30 years ago (AIDS, gov, n.d.). Since then, the disease, and the virus that causes it (HIV), has become an epidemic, claiming the lives of more than 25 million people worldwide (Centers for Disease Control and Prevention, 2013). The introduction of antiretroviral treatments brought a drastic decrease in the mortality rate associated with the diagnosis (Simon, Ho, & Karim, 2006), as well as changed the diagnosis from a death sentence to an oftentimes manageable chronic disease (National Institute on Drug Abuse, 2012; Simon et al., 2006). Despite the aforementioned medical advancements, HIV tends to be a life-altering, traumatic experience that often requires attention and expertise from mental health professionals (Maguire, McNally, Britton, Werth, & Borges, 2008; Nightingale, Sher, & Hansen, 2010). This study sought to identify factors that counselors could use to further conceptualize the needs of clients with HIV and to identify ways in which these clients could begin to move toward greater mental health. Mental Health and HIV People living with HIV/AIDS (PLWHA) experience a range of mental health concerns that can affect their physical health and thus threaten their quality of life, physical abilities, and medication adherence (Substance Abuse and Mental Health Services Administration [SAMHSA], 2012). For example, an estimated 48% of PLWHA struggle with mental health concerns such as depression and substance use (Whetten, Reif, Whetten, & Murphy-McMillan, 2008), whereas fewer than 19% of people not affected by HIV/AIDS struggle with mental health concerns (SAMHSA, 2012). These concerns are further exacerbated by the presence of HIV-related stigma. Stigma adds to the complex mental health needs of PLWHA by complicating the decision to disclose one's HIV status (Ostrom, Serovich, Lim, & Mason, 2006). With stigma, such disclosure brings the risk of social isolation, increased stress, and potential abandonment (Kalichman et al., 2007). Stigma is particularly felt among individuals living with HIV for four reasons: (a) HIV is often viewed as the bearer's responsibility; (b) HIV is seen as permanent and fatal; (c) HIV is contagious; and (d) HIV is sometimes accompanied by physical changes, especially for individuals with AIDS (Brown, Macintyre, & Trujillo, 2003). For PLWHA, the presence of HIV-related stigma, or societal disapproval geared at PLWHA, directly affects quality of life (Maguire et al., 2008). Furthermore, stigma serves as a complicating barrier toward providing effective services to individuals living with HIV and it often undermines the work mental health professionals are doing to treat clients (Brown et al., 2003; Steward et al., 2008). Despite the aforementioned stressors associated with living with HIV, researchers have suggested that personal growth and positive outcomes are possible following such a diagnosis (Milam, 2006). These positive outcomes, referred to as posttraumatic growth (PTG), describe the positive psychological changes a person undergoes as a result of experiencing highly challenging or traumatic life circumstances (Calhoun & Tedeschi, 1998). Central to PTG is the idea that meaning can be drawn from the survival of traumatic events, which can therefore bring emotional relief to the survivor, and change the core life assumptions the person holds (Tedeschi & Calhoun, 1996). Although terms such as hardiness, resilience, and optimism are often used interchangably with PTG, they do not fully capture the same experience. Whereas these terms refer to an ability to carry on after a challenge or maintain control, PTG refers to reaching a level of functioning greater than previously held by the individual before experiencing trauma (Tedeschi & Calhoun, 2004). Given that PLWHA often cite the receiving of their diagnosis as a traumatic event (e.g., Anderson et al., 2010; Martin & Kagee, 2011; Sherr et al. …