Health-e (Cape Town)

South Africa: The Link Between Mental Health and HIV

People living with HIV and AIDS are at an increased risk of developing serious mental disorders, according to mental health professionals at a Johannesburg meeting this week.

The meeting resolved that mental health interventions should be incorporated into existing AIDS services.

Studies from all over the world show that mental health disorders are growing fast among people infected with HIV compared to the general population. People with HIV have double the incidence of mental illnesses of HIV-negative people. Cluster Manager of the Non-Communicable Diseases Unit in the national Health Department, Professor Melvyn Freeman, was involved in a study that showed similar results in 2007.

"In the general population it was found that South Africa has 16.5% of people suffering from some form of mental disorder. When you come to people living with HIV, it went up to 43.7%. That's a huge difference", Prof Freeman said.

"When you look at the higher rates among HIV-infected people, you have to ask the question: Is this because they had a prior condition and their vulnerability led to their infection or is it that, because they have contracted HIV, it has mental impact on them, and, therefore, this raises the numbers of people living with HIV who have mental disorders. This is a complex issue and I would like to suggest that both are true that it's very, very likely that mental disorder is both a risk factor and a consequence of HIV", he continued.

Quoting a study conducted among school-going youths in KwaZulu-Natal, Freeman supported the theory that having a mental disorder is a risk factor for contracting HIV.

"They looked, initially, at the relationship between knowledge of HIV and risk behaviour. This study was done by Dr Omar and Martin Prins, and others. Not surprisingly, from what we know, there was very little correlation between knowledge of HIV and risk behaviour. They also measured these youths' depression and not surprisingly, in my view, they found that those who had higher levels of depression had higher risk behaviours. That makes sense to me because if you don't really care about your life and your future, are you really going to take the protection that you should be taking? So, depression, then, for me, is a key risk factor for contracting HIV. Having a mental disorder - whether it's a serious mental disorder or a more common mental disorder, such as depression - the risk factor is higher".

Freeman also showed how a mental health disorder can be as a result of having HIV.

"We have to look at the other side. What does it feel like to actually be told that you have HIV? How do you cope with this? Who do you tell? Who don't you tell? How are you going to be accepted? People living with HIV have informed me that this is a real, real difficult thing to handle and if you do not have support; and if you do not have help to get through this initial period and as you have to live longer with HIV, it does become a difficult thing to live with".

Professor Rita Thom, a psychiatrist with more than 30 years experience, added that from a medical perspective, it's not uncommon for people living with HIV to acquire a mental health condition. She said these mental health conditions can be divided into three groups.

"That is the HIV-associated neuro-psychiatric disorders. Those are the disorders that result from HIV brain infection; then you've got HIV and serious mental illness, which is quite complicated because it includes both some of the results of HIV brain infection as well as people who have a primary psychiatric disorder and then become HIV-infected; and, then, there is a very large group of people who have HIV and what we call common mental disorders, which are depression, anxiety, substance use disorders", said Prof Thom.

Deputy Minister of Public Works, Hendrietta Bogopane-Zulu, attended the meeting. She expressed concern that it has taken the mental health service provider community too long to articulate themselves on the issue even when the inextricable link between mental health illness and HIV was evident for many years.

"Those in the forefront of mental health have actually not rolled up their sleeves and taken up the fight. Three weeks ago I've gone to three funerals of women with mental disabilities in the former Transkei. They are dying. And they are dying because all of us in this room, operating in this field, we have actually not invested enough time. And a lot of people with mental illness that are supposed to be on ARVs are not on ARVs", she said.

As the current National Strategic Plan on HIV and AIDS is coming to an end, mental health professionals resolved that they need to organise themselves to lobby for the recognition of mental health and HIV and AIDS as co-morbidities whose treatment approaches must be integrated in the next National Strategic Plan.

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