Mental Health and HIV Infection (Social Aspects of AIDS)
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Depression is the natural grief response to being diagnosed with a terminal illness and to the chronic disability that may arise from it. It can also be linked to the stigma and discrimination associated with the illness. And new psychiatric symptoms and syndromes may occur as the virus affects the brain, or because of opportunistic diseases or treatment side-effects.
Mental health issues can, in turn, influence treatment outcomes. Co-morbid depression may affect motivation to seek HIV treatment or adhere to antiretroviral therapy. It is also linked to behaviour that may facilitate HIV transmission. People commonly internalise negative stereotypes, expecting discrimination and devaluing themselves.
This can interfere with their ability to choose sexual partners and negotiate safer sexual behaviour. Depression is also associated with reduced coping capacity , poor HIV-related disease prognosis , diminished quality of life, greater social burden , increased health-care costs and higher mortality. Our research focused on rural primary care settings in Uganda where we developed a group support psychotherapy model to treat depression. Group support psychotherapy treats depression by providing emotional and social support, and teaching positive coping and income-generating skills.
High level of engagement
HIV-positive people suffering from depression met in eight weekly, gender-specific sessions. They were provided with information about depression and HIV. They were guided to share personal problems and taught problem-solving and coping skills. These included how to deal with anxiety and unhelpful ways of thinking, and basic livelihood skills.
Mental health and HIV/AIDS | RANZCP
Unlike previous studies of group psychotherapy for depression in sub-Saharan Africa, the participants in our group support psychotherapy sessions were eager to engage in the process. Given the stigma attached to HIV and mental illness, this was surprising. First, the target community was involved in developing the model. Group support psychotherapy had also been piloted prior to the study and word had spread in the community about its benefits. Second, trained mental health workers created a safe environment in which the participants could experience the therapeutic processes of group therapy.
For example, facilitators reported that all participants had powerful cathartic experiences. Such catharsis has been shown to result in immediate and long-lasting change. As sessions progressed, group members also began to provide feedback and support each other, during therapy and later, in their livelihood groups. The opportunity to help others, or altruism , has been shown to restore a sense of significance and increase self esteem. Third, unlike other psychotherapeutic interventions, facilitators taught income-generating skills to mitigate poverty, which has been shown to be a potent risk factor for depression.
Our study provides the first evidence of the success of this kind of group intervention in breaking the negative cycle of poverty and poor mental health in a resource-poor setting. Our findings also suggest that it is possible to roll out this kind of treatment in poorly resourced rural areas.
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Non-mental health professionals can be trained to deliver psychotherapeutic interventions in places where it is not possible to employ sufficient numbers of mental health providers. The shifting of mental health-related tasks from health professionals to para-professionals or non-health professionals has been well-documented in non-HIV populations. Royal Australian and New Zealand College of Psychiatrists Keeping body and mind together: Improving the physical health and life expectancy of people with serious mental illness. Disclaimer: This information is intended to provide general guidance to practitioners, and should not be relied on as a substitute for proper assessment with respect to the merits of each case and the needs of the patient.
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There are now also pre- and post-exposure prophylaxes which can further reduce the risk of transmission when administered. Advances in treatment options may also have led to public complacency about the risk and seriousness of HIV infection. However, in recent years there has been an increase in the number of new HIV diagnoses through sexual transmission and in particular as a result of sexual contact between men The Kirby Institute, ; Ministry of Health, Contributing factors can be: anxiety and depression associated with the HIV diagnosis as well as resulting from possible stigma in their everyday lives Judd and Miljch, ; Judd et al.
Mental Health and HIV
Some medications used to treat HIV can have side effects that cause anxiety, depression and other psychological symptoms American Psychiatric Association, a; American Psychiatric Association, b. There are potentially severe pharmacokinetic and pharmacodynamic interactions between HIV anti-retroviral medication and psychotropic medications.
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There are specific contraindications to the use of some antipsychotic medications when protease inhibitors are prescribed as treatment for HIV. Drug interactions must be considered and monitored when using psychopharmacotherapy in people living with HIV American Psychiatric Association, b. Despite a higher incidence of HIV-related risk behaviours among people living with mental illness, attention to HIV education and prevention for this group of people has been limited to date Thompson et al.
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People with serious mental illness should be identified as a health priority population group. Psychiatrists should consider screening their patients for sexual and drug use risks during routine psychiatric assessments. HIV testing should be offered where indicated by risk histories or other relevant medical findings.