Social Learning and Clinical Psychology.

JOHN P. WILSON AND TERENCE M. KEANE, EDS.: Assessing Psychological Trauma and PTSD. Guilford Press, New York, 1997, 575 pp, $55.00, ISBN 1-57230162-7. The recent impressive expansion of our clinical knowledge about PTSD and psychological trauma has been paralleled by a progressive introduction of a variety of self-report measures, each one with its own emphasis and relative specificity. The array of assessment instruments related to various psychological traumas and posttrauma disorders has become overwhelming if not confusing. The need for a reference book in this area was acute and crucial not only for clinicians but also for researchers. The editors have thoughtfully addressed this issue by bringing together a group of experts who have covered all the important aspects of psychological assessment in this field. The book is divided into three main areas of assessment, each addressing a particular area of psychological trauma. The first area covers standardized measures and physiological techniques related to PTSD and child-abuse effects in adults supported by a chapter on physiological assessments and another one on psychometric theory explanatory of the degree of validity of the tests. It will be unrealistic to discuss the strength and weakness of each one of the 20 standardized tests already evaluated by the contributing authors. However, an issue affecting all these tests seems to be the questionable validity of attempting by the testdevelopers to objectify the subjective answers of the clients-patients. Like in all self-report measures, there is a subjective bias which may falsify the responses, though it may measure the degree of severity of clinical symptoms, if the specific trauma is documented independently of the client. (Trauma symptom checklist -40) Another problem with these tests is that, while they have been developed based on relatively small samples, they have not been validated against the general population. As noticed by the authors, the validation of these tests is not quite documented in terms of the discriminative validity of the PTSD measures versus other measure constructs. The second group of articles reviews the standardized assessment of the traumatic reaction among victims and survivor populations. The articles included here assess a wide variety of psychological trauma from life-threatening medical illness to bereavement, marital strife with physical aggression, child abuse or combat-related stress trauma. They empirically evaluate the impact of a particular natural or human-induced stressor on people subjected to it, without telling us why some are affected more than others or not at all. …

Assessing Psychological Trauma and PTSD

Coerced or forced sexual initiation and sexual intimate partner violence (sexual IPV) contribute significantly to a woman’s risk for HIV infection. This review systematically examines global research (n = 21 studies) published since 2000 on the role of coerced/forced sexual initiation and sexual IPV on HIV risk in women. In predominantly low- and middle-income countries, coerced/forced sexual initiation was associated with HIV/STIs, multiple and high-risk sex partners, and no condom use. Most studies using behaviorally specific terms for sexual IPV found strong associations between sexual IPV and HIV risk behaviors. In contrast, studies using less specific definitions often failed to find these significant associations. To develop more comprehensive HIV prevention programs, future efforts should integrate behaviorally specific terms into assessing prevalence of sexual IPV and its association with HIV risk, consider cultural differences, and identify causal pathways between coerced or forced sexual initiation, HIV risk behaviors and HIV/STI infection.

Forced sexual initiation, sexual intimate partner violence and HIV risk in women: a global review of the literature.

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African Charter on the Rights and Welfare of the Child

Gender-based violence (GBV) is common in southern Africa. Here we use GBV to include sexual and non-sexual physical violence, emotional abuse, and forms of child sexual abuse. A sizeable literature now links GBV and HIV infection.Sexual violence can lead to HIV infection directly, as trauma increases the risk of transmission. More importantly, GBV increases HIV risk indirectly. Victims of childhood sexual abuse are more likely to be HIV positive, and to have high risk behaviours.GBV perpetrators are at risk of HIV infection, as their victims have often been victimised before and have a high risk of infection. Including perpetrators and victims, perhaps one third of the southern African population is involved in the GBV-HIV dynamic.A randomised controlled trial of income enhancement and gender training reduced GBV and HIV risk behaviours, and a trial of a learning programme reported a non-significant reduction in HIV incidence and reduction of male risk behaviours (primary prevention). Interventions among survivors of GBV can reduce their HIV risk (secondary prevention). Various strategies can reduce spread of HIV from infected GBV survivors (tertiary prevention). Dealing with GBV could have an important effect on the HIV epidemic.A policy shift is necessary. HIV prevention policy should recognise the direct and indirect implications of GBV for HIV prevention, the importance of perpetrator dynamics, and that reduction of GBV should be part of HIV prevention programmes. Effective interventions are likely to include a structural component, and a GBV awareness component.

Gender-based violence and HIV: relevance for HIV prevention in hyperendemic countries of southern Africa.

This study examined the hypothesis that sexual assault in childhood is a risk factor in HIV and AIDS prevention and control in adulthood. It comprised 40 participants who were survivors of child sexual abuse and 40 participants who were not sexually abused. The sample had 20 sexually abused men, 20 non sexually abused men, 20 sexually abused women and 20 non sexually abused women. The group that had men and women who had a history of sexual assault reported higher HIV and AIDS risk behaviours than the non-abused comparison group. The survivors of sexual assault also had higher levels of post-traumatic stress disorder, depression, suicide ideation and external locus of control. They reported low self-esteem. This unhealthy psychological functioning was found to be a risk factor in HIV and AIDS prevention and control. Implications for future research are discussed.

Sexual assault in childhood: risk HIV and AIDS behaviours in adulthood.

This position paper seeks to explore the ethical concerns surrounding the use of medical male circumcision as an effective method of preventing HIV infection in sub-Saharan Africa. The study explores research that looked at the effectiveness of medical male circumcision in clinical trials. While clinical trials reveal that medical male circumcision showed statistically significant results in HIV prevention, there is still a paucity of studies that take into consideration the ethical challenges posed by medical male circumcision in sub-Saharan Africa. This paper argues that rolling out medical male circumcision to the larger community without adequately addressing the ethical concerns could weaken programme initiation, implementation and evaluation in sub-Saharan Africa.

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The ethical concerns of using medical male circumcision in HIV prevention in sub-Saharan Africa

Objective : This study explored the concept of home-based care for people living with full-blown AIDS and the impact of this on their children's psychological functioning. There were 30 children in the study whose parents had full-blown AIDS. The comparison group comprised 30 children. The parents of the children in the comparison group reported that they did not have full-blown AIDS and were not registered as AIDS patients with their community home-based care group. Method : The children's psychological functioning and performance on cognitive tasks were examined, using the Impact of Event Scale — Revised, the Secondary Traumatic Stress Scale (STSS), the Stress Symptoms Checklist, the Child Behaviour Checklist (CBCL), the British Ability Scales and Daniel and Diack's Graded Spelling Test. Result : The results of the study showed that children whose parents had full-blown AIDS showed mental distress and low cognitive performance on numerical and spelling skills. Conclusion : The findings of the study seem to suggest that although the home-based care concept is a noble and global idea, it should be accompanied by psychological support mechanisms to mitigate the effects of traumatic stress that normally follow exposure to a traumatic event. Suggestions for further research on the topic are discussed. Journal of Child and Adolescent Mental Health 2007, 19(1): 29–44

Home-based care for parents with AIDS: impact on children's psychological functioning

The aim of the study was to investigate the perceptions of football players on the provision of employee assistance programmes by a football club in South Africa. The study interviewed eight footba...

The Provision of Employee Assistance Programmes in South African Football Clubs: A Case Study

The aim of the study was to compare the psychological well-being of bank employees who handled cash and those who did not. The study assessed employees' levels of work stress, burnout and life satisfaction. The Job Stress Survey Scale was used to measure work stress, Maslach Burnout Inventory was used to measure burnout and the Congruity Life Satisfaction Scale was used to measure life satisfaction. Two independent sample t tests were run on Statistical Analysis Software. The results showed that the two groups differed significantly in terms of work stress, emotional exhaustion, depersonalisation and overall burnout. The findings of this study suggest the need for organisational support, skills development and the provision of wellness programmes for bank employees.

Calvin Gwandure

Papers

Sexual assault in childhood: risk HIV and AIDS behaviours in adulthood.

The ethical concerns of using medical male circumcision in HIV prevention in sub-Saharan Africa

Home-based care for parents with AIDS: impact on children's psychological functioning

The Provision of Employee Assistance Programmes in South African Football Clubs: A Case Study

The psychological well-being of employees who handle cash in a bank in inner city Johannesburg