FACT SHEET ON MENTAL HEALTH AND HIV/AIDS Prepared by Melvyn Freeman Numerous people’s mental health and well-being is negatively affected by HIV/AIDS. These include: •
People living with HIV/AIDS
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People unsure of their status
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Family and caregivers
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People bereaved by (multiple) death
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Children orphaned or otherwise made vulnerable
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Health workers
People living with HIV/AIDS have around twice the prevalence of mental disorder as the general population. Mental disorder is both a risk factor and a consequence of HIV infection. Poor mental health is also a serious risk factor for adherence to anti-retroviral medication and impacts on the course of the disease. Though the increased availability of ART often has a positive impact on mental health (from both a psychological and biological perspective), many people still experience high levels of distress and mental disorder. Difficulties around for example relationships, having children, side-effects of medication are high and are exacerbated by stigma of being HIV positive. Most people are not provided with assistance in negotiating difficult psychological difficulties. However mental disorder can be effectively treated (using a range of medical, individual and group interventions). For some people “positive living” provides meaning to their own lives and provides inspiration to others. Many more people could be helped to function more effectively and achieve high levels of well-being. Millions of children have or are experiencing the deterioration in their parents’ health and death. The “orphanhood” that follows can be psychologically devastating to all ages of children. Many children are forced to themselves become “parents” to their siblings. Support for children, ideally from remaining family and community, is critical for emotion health as well as intellectual and moral development. In many instances extended families are unable (and in some cases are unwilling) to take on parental responsibilities. Interventions that take childrens’ psychological health into account are as important to them personally and to the future social and economic development of societies as interventions that care for their physical needs such as accommodation, food security and education. It is essential that mental health interventions become integrated into all HIV/AIDS treatment programmes, into programmes assisting with orphans and other vulnerable children and must be extended to include a range of other people affected by HIV/AIDS. While “psycho-social needs” are often included in government and donor assistance programmes, in truth the complex mental health needs of people are usually inadequately addressed through such interventions.
Interrelationships between mental health and HIV/AIDS
Quotes from people living with HIV/AIDS •
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“Everything happened very fast. I was really scared, this was weighing heavily on my mind and I couldn't confront him about it…. We stayed this way for about a year. I ended up drinking battery acid.” “I told myself that I was going to die… I was too scared to hang myself or to shoot myself. Drinking was an easier option; I would drink myself to death. I stopped looking after myself and kept drinking. My physical state deteriorated, I couldn’t care less, I was dying anyway but I couldn’t commit suicide, alcohol would do it for me” “I'm still struggling to cope; there is no peace in me... I can say the right things to people; go through the motions... but when it's time to be by myself it's a different story. This thing just takes control whether you like it or not… My fear is about the fact that it changes you so much; it eats away at you until you're unrecognisable even to those who know you well”. “I worry about my children since they are two and I need money to look after them. They have to eat, dress and go to school. Then when I am not working I cannot look after them”. “I don’t want to be blamed for infecting anyone with HIV. I do not want to be seen as a killer… Not all women want you to use a condom, they tell you that ‘if you want to use a condom with me, then there’s no point in going on with the relationship’. I’ve had such an experience. We had to end it because I refused to have sex without it.
For more information, please contact Global Initiative on Psychiatry (GIP) at kassoian@gip-global.org or +31 35 683 8727