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Samuels, E. Khalife, S. Alfonso, C.A. Alvarez, R. Cohen, M.A. (2011). Early Childhood Trauma, Posttraumatic Stress Disorder, and Non-Adherence in Persons with AIDS: A Psychodynamic Perspective. J. Amer. Acad. Psychoanal., 39(4):633-650.

(2011). Journal of American Academy of Psychoanalysis, 39(4):633-650

Early Childhood Trauma, Posttraumatic Stress Disorder, and Non-Adherence in Persons with AIDS: A Psychodynamic Perspective

Erin Samuels, M.D., Sami Khalife, M.D., César A. Alfonso, M.D., Ricardo Alvarez, M.D. and Mary Ann Cohen, M.D.

Non-adherence to treatment and risk-reduction measures not only leads to increased morbidity and mortality in patients with HIV/AIDS but is also a major public health hazard. While there are multiple determinants of non-adherence, one that is particularly complex and refractory to intervention appears to be the history of childhood trauma and the development of posttraumatic stress disorder (PTSD). While behavioral intervention is occasionally helpful in increasing a patient's commitment to self-care, it is our view that the use of a more psychoanalytic framework, as well as the development of a psychodynamic understanding of the patient's history and struggles, may provide both patient and clinician with a more profound understanding of the forces that perpetuate non-adherence, thus facilitating a more cohesive and empathic approach to treatment. It is the aim of this article to explore, from a psychodynamic perspective, the possible connections between early childhood trauma resulting in PTSD and non-adherence to risk reduction and HIV treatment.

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