Multigenerational Trauma and HIV in Southern Africa

S. Leclerc-Madlala Office of HIV/AIDS

Global Health Bureau

USAID AIDS2012, July 22-27, Washington DC

Definition of Multigenerational Trauma: Trauma passed from one generation to the next, either directly or indirectly

One type

Historical Trauma – A cumulative emotional and psychological wounding emanating from deliberately perpetrated massive group trauma experience, that becomes culturalized and passed down to successive generations

Historical Trauma Theory builds upon…Four theoretical frames -• Psychological/psychoanalytic• Political/economic • Social/ecological • Anthropological

Studies of several ‘traumatized’ populations -• 1960s - Holocaust survivors and families • 1980s - American Indian groups (healing ‘soul wounds’)• 1990s - African Americans (Post Traumatic Slavery Syndrome)• More recent - Palestinians, Russians, Cambodians

Major premise of the theory:

Populations historically subjected to mass trauma - colonialism, slavery, war, genocide, apartheid(?) - are prone to develop maladaptive social, behavioral and dispositional patterns that are transmitted as learned behavior from generation to generation.

Complex of symptoms:

• chronic alcohol use/abuse• distrust of others, including intimates• high levels of violence, GBV, IPV• ‘vacant’ esteem (helplessness, depression,

victimhood)• poor parenting• sense of resignation, fatalism• search for instant gratification, frequent partner

change

Southern Africa

has amongst the

world’s highest

rates of

• Violence• Sexual abuse/

violation of children• GBV, IPV• Alcohol use/abuse• Youth hopelessness/

suicidal thoughts• Elderly abuse

Is the region suffering from a form of historical, multigenerational trauma?

Are the resulting behavioral and dispositional patterns catalyzing transmission of HIV and impeding all attempts to address the epidemic?

Yes

Relevance of the Theory to HIV

1. It is a new paradigm that links the past to present & helps explain high HIV prevalence.

2. It demands social/collective approaches to re-build the capacity of communities to sustain protective practices – collective efficacy or communal healing.

3. It alerts us to the fact that the creation of an ‘AIDS-free generation‘ is a multi-layered social project – breaking the trauma cycle.

A Theory-in-Progress

Validating construct requires more empirical research

• To identify specific mechanisms of trans-generational transmission (i.e. ‘carrier groups’ and systematic oppression as ‘composite shocks’)

• To link measures of historical mutigenerational trauma to health outcomes

• To investigate mass trauma manifestations in different populations

Historical Multigenerational Trauma Theory:

A compelling, relevant theoretical framework to help the HIV community gain a broader and deeper perspective

of the disease & conceptualize new approaches for solutions.

“Medicines can never heal a soul wound”

- Dr. Maria Yellow Horse Braveheart, University of Nevada