Mental illness can leave people living with HIV unable to care for themselves, yet Malawi's mental health services are critically underfunded, denying HIV-positive patients the care they need.
That is the view of staff at Zomba Mental Hospital, Malawi's only government-funded mental health hospital.
Staff feel neglected
According to Harry Kawiya, a psychiatric clinical officer at the facility, patients and even staff feel "neglected and forgotten".
He said: "We feel authorities neglect this hospital and its needs. From trainings to supplies, we are neglected; yet the institution ought to have been given top priority because most of the social ills or diseases in the country would be prevented if mental health was proficiently managed.
"We have tried our level best to advocate and lobby for increased funding and resources but it seems our pleas fall on deaf ears. Authorities need to do something quickly; otherwise, most young professionals will believe that the facility is a dumping ground in their profession."
Kawiya believes people suffering from mental health disorders need special attention to protect them from contracting HIV and to receive care, support and treatment when they are diagnosed with HIV.
"These patients have a higher risk of contracting HIV because they can indulge in unsafe sex without knowing what they are doing due to their condition," explained Kawiya.
Cost of being HIV positive and mentally ill
The antiretroviral treatment (ART) co-ordinator at the facility, Susan Bwanali, said that mental health issues are complex, and so too are the approaches to deal with mental illness.
"We do get records that some patients admitted here were diagnosed HIV positive and are on ART, but due to their conditions they stopped taking their medication," Bwanali said.
She explained that after recovering from psychological treatment, the patients are persuaded to resume their ART.
"After being discharged, the patients continue their antiretroviral treatment within their communities. Only those who are around our catchment area come back to access antiretrovirals here," said Bwanali.
She was quick to say Zomba Mental Hospital personnel do follow up on patients to make sure they are taking their HIV treatments at home, but due to limited resources they do not cater for patients outside their catchment.
Coping with mental illness and HIV
Patients face several challenges as they cope with mental illnesses and HIV. Bwanali said: "Some patients on antiretroviral treatment are reluctant to swallow their drugs and we have to do everything to persuade them to do it. We also sometimes experience shortages of HIV test kits."
Also, despite the fact that food is available for all patients at the facility, highly nutritious food such as peanut butter for sick patients is scarce.
"Patients who are HIV positive with mental health disorders need nutritional support. We do not get any in our facility and we are appealing to well-wishers to help," said Bwanali.
Apart from providing HIV patients with ART, medical personnel at the facility also educate patients with HIV prevention messages.
Some patients admitted to the facility test HIV positive while receiving treatment, as Zomba Mental Hospital ART clerk Misheck Matoga explains.
"First these patients receive treatment and therapy for their mental health disorder. After they have stabilised, there is a lengthy dialogue with them before we conduct testing and counseling on treatment," he said.
Matonga added that compulsory testing is against patients' human rights.
Apart from Zomba Mental Hospital in the old capital, Bwaila in the capital Lilongwe is the only other institution that treats mental health, but on a smaller scale.