Tackling the ‘New Beast’: Mental Health for People Living with HIV
Across the world, developing countries are making progress in tackling the HIV epidemic. According to UNAIDS, in 2012 South Africa registered more than 450,000 new HIV infections, a significant drop from the 640,000 new infections registered in 2001. They’ve achieved this radical progress through the provision of antiretroviral therapy (ART) to more than 2.4 million people. The sense of hope is also founded on the breakthroughs scientists have made in the roll-out of Pre-exposure prophylaxis (or PrEP), a new class of medicines that people at very high risk for HIV can take to lower their chances of getting infected.
On the brink of the post-2015 development agenda, the picture seems hopeful. But something is missing; a dimension of HIV treatment remains in the dark.
The ‘New Beast’: Mental Illness Among People Living with HIV
In South Africa, 38% of people living with HIV have a common mental health disorder. This is more than triple the incidence of mental health conditions for the general South African population1. What’s shocking is that in this era of ART, increased advocacy, and knowledge of the condition, there has not been a decrease in prevalence of mental illness in people living with HIV, but a two-fold increase2.
Depression, anxiety and other mental health disorders are of particular concern in patients with HIV because they can lead to:
- Poor treatment adherence
- Lower CD4 counts
- Increased viral load
- A greater chance of developing drug-resistant strains of HIV3
The problem is that these mental illnesses often go undiagnosed and untreated. A considerable mental health treatment gap exists because the system intervenes too late - mental illness is seen as a medical problem to be treated, rather than a primary care problem to be prevented.
A Meeting of Minds: AIDS 2016
This week, 18 000 healthcare professionals, policy makers and social entrepreneurs will convene in Durban, South Africa for AIDS 2016, the 21st annual International AIDS conference. Themed ‘Access Equity Rights Now,’ the conference will be focused on providing care to the marginalised groups left behind in the race to provide ART: sex workers, men who have sex with men, young people, and transgender people.
Issues such as tackling stigma and discrimination and providing support for people living with HIV/AIDS (PLWHA) will be a priority at the conference. But one organisation stands out from the crowd by focusing on mental health innovation for PLWHA.
Project Khuluma: Making Mental Health a Priority
The conference will feature a number of innovative initiatives aiming to address this ‘new beast’ of mental health for PLWHA. Among those initiatives, the SHM Foundation will present their ‘Khuluma Project,’ which uses SMS text messaging as a tool for increasing access to mental health support for adolescents in South Africa. The Khuluma model facilitates interactive, closed support groups of 10 to 15 participants who are able to communicate amongst themselves, with a facilitator and mentor, via mobile phone about living with HIV. The aim of the Khuluma model is to provide low-cost solutions to the mental health challenge, thus enabling clinics to provide better support to their patients.
The project is currently live in South Africa with 99 adolescent PLWHA. Over a period of 3 months, these adolescents sent over 40 000 text messages about the problems they face in their daily lives – social stigma, isolation, loneliness, difficulties taking medication, relationships, and aspirations for the future.
The results have been highly promising. For those who have taken part in our support groups, there have been significant positive health outcomes:
- Decreased levels of anxiety and depression
- Increased levels of social support
- Decreased feelings of internalised stigma
- Increased knowledge about their health condition and how to access specific services
The findings from Project Khuluma will be presented at the International HIV/AIDS Conference in Durban, July 18th-22nd. The posters will be presented on Tuesday, 19 July from 12:30 - 14:30. Location: Poster Exhibition area, First Level (by the Arena Entrance). We'll also be screening our film on Friday (time TBC) in the Youth Village.
Follow us on Twitter during the conference and beyond, @SHMFoundation, to keep up to date with our findings and insights. To join our live debates on medical adherence and stigma/social isolation, visit the Mental Health Innovation Network Africa Forum, or tweet at them @MHIN_Africa. You can also learn more by visiting our website or our innovation page on the Mental Health Innovation Network.
1. Blank MB, Eisenberg MM. Tailored treatment for HIV + persons with mental illness: The intervention cascade. J Acquir Immune Deficiency Syndr 2013;63:S44-S48.
2. Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry 2001;158:725-730.
3. Cook JA, Cohen MH, Burke J, Grey D, Anastos K, Kirstein L, et al. Effects of depressive symptoms and mental health quality of life on use of highly active antiretroviral therapy among HIV- seropositive women. J Acquir Immune Defic Syndr. 2002;30:401-9.