Monday, 24 July 2017: “Depression and anxiety are currently the most commonly diagnosed psychiatric conditions affecting HIV-infected patients. The complex links between HIV/AIDS and mental illness compound the complexity of the healthcare sector’s response when diagnosing and treating these diseases,” said Dr Seithati Molefi, programme lead for adult antiretroviral care and treatment at RIGHT TO CARE speaking during Mental Health Awareness Month.
Molefi outlines some of the issues related to mental illness and HIV/AIDS:
- Undiagnosed and untreated mental illness may lead to high risk behaviours and therefore contribute to the acquisition and spread of HIV
- Patients who are mentally ill may be delusional or psychotic and may thus engage in high risk behaviour including sexual practices that may put them at risk for HIV because they are oblivious of the consequences
- Mental illnesses make sufferers more vulnerable to sexual abuse
- Mental illnesses often affects adherence to medication, including antiretroviral therapy
- The fear of being stigmatised keeps many HIV positive people as well as the general public from seeking treatment for mental illness.
She says the links between HIV/AIDS and mental illness are so multi-layered that many HIV-treating clinicians struggle to determine which came first and may not have the specialist expertise to deal with psychiatric conditions. Meanwhile, mental healthcare professionals may not even know that the patient is infected with HIV, making diagnosis and treatment very difficult.”
Molefi explains, “We see patients who have a pre-existing mental condition and then become infected with HIV and also patients with no history of mental illness who become mentally ill after being diagnosed with HIV. This could be as a result of the trauma of the diagnosis where the person experiences feelings of overwhelming fear, worthlessness and hopelessness sets in – precursors to anxiety and depression.”
In addition, HIV infection can cause damage to the nervous system including the brain and nerves, creating a physiological predisposition to mental illness. Prevalence rates of psychiatric disorders among HIV-infected patients in South Africa are high, but no accurate statistics are available. Suicide has been found to be higher among those infected with HIV. Here too, statistics are not available.
Craig Chapman, programme coordinator at Right to Care for the Department of Correctional Services, Kick TB & HIV, says that these conditions are even more difficult to diagnose and treat because people who are lesbian, gay, bisexual, transgender and intersex (LGBTI) are often already socially isolated and then further alienate themselves from mainstream society because of their fear of stigma. “THE SOUTH AFRICAN DEPRESSION AND ANXIETY GROUP was the first NGO to address the issue of depression linked to HIV/AIDS and set in motion interventions to support the LGBTI community,” says Chapman.
Right to Care, other partners and the Department of Health are currently working on:
- Upskilling and further training for healthcare workers
- More supportive and empathetic pre and post-HIV counselling
- Routine mental health screening for early detection and treatment
- A functional referral system from facility to district, right up to hospital level
- Improving access to healthcare and promoting compliance in rural areas
- Educating communities and the public about mental illness.
Concludes Molefi: “There is no health without mental health.”
RIGHT TO CARE is a non-profit organization that supports and delivers prevention, care, and treatment services for HIV and TB. Through technical assistance, Right to Care supports private sector, the Department of Health and the Department of Correctional Services. In addition, through direct service delivery, Right to Care treats patients for HIV, TB, cervical cancer, and sexually transmitted infections.
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