World AIDS Day takes place on the 1st December each year. Learning that you have HIV/AIDS, that you will have to adhere to lifelong treatment in order to maintain optimal health and that you may also have to deal with potential stigma, can be a severe shock to the system, potentially leading to mental distress and disorders.
This said, many mental disorders which arise as a result of HIV/AIDS are treatable and many people recover completely, says Phindile Msomi, a social worker at Akeso Clinic Umhlanga.
“Individuals with HIV/AIDS can – and should – reach out for support,” she advises. “The most important thing to remember is that you are not alone; there are support systems in place to help you, including doctors, psychologists, psychiatrists, family members, friends, support groups, and other services. They may suggest treatment that includes antidepressant drugs or talking therapies.”
She explains that there are a number of biological, psychological and social factors that can cause mental health problems in people diagnosed with HIV.
“People who are diagnosed as HIV positive are at an increased risk of developing a mood, cognitive or anxiety disorder as receiving a chronic diagnosis like HIV is highly stressful, even catastrophic, for some. For example, people living with HIV are twice as likely to have depression compared to those who are not infected with HIV.
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.
Likewise some forms of stress can contribute to mental health problems for people living with HIV, including:
Having trouble getting the services you need;
Experiencing a loss of social support, resulting in isolation;
Experiencing a loss of employment or worries about whether you will be able to perform your work as you did before;
Having to tell others you are HIV-positive;
Managing your HIV medicines;
Going through changes in your physical appearance or abilities due to HIV/AIDS;
Facing the stigma and discrimination associated with HIV/AIDS.
“Over and above, the HIV virus itself also can contribute to mental health problems because it enters and resides in your brain. Some other opportunistic infections can also affect your nervous system and lead to changes in your behaviour and functioning. Similarly, neuropsychological disorders, such as mild cognitive changes or more severe cognitive conditions, such as dementia, are associated with HIV disease,” Msomi points out.
According to Msomi:
• In SA, 26 – 38% of People Living With HIV and AIDS (PLWHA) have comorbid depression (CMD);
• Between 20 and 60% of PLWHA are affected by some form of psychiatric disorder (depressive disorders are most common);
• CMDs often go undiagnosed and untreated in this population;
• Up to 25% of PLWHA in SA are thought to suffer from some form of depression during the course of the illness.
Mental health disorders in HIV-infected patients may also negatively influence the treatment of the HIV-infection, says Msomi.
“Mental health problems in HIV-infected patients may affect public health. Psychopathology, including depression and substance abuse, can increase hazardous sexual behaviour and, with it, the chance of spreading HIV. Therefore, it is important to develop an optimal treatment plan for HIV-infected patients with mental health problems,” she explains.
Stigma, suicidal tendencies
People living with HIV not only experience higher rates of depression and anxiety, but also of suicidal ideation, says Msomi.
“People who have not disclosed their status to anyone are estimated to be twice as likely to have suicidal thoughts as other groups, so the ability to share one’s status with family and friends is crucial”.
“The stigma surrounding disclosure can lead to increased social isolation, and this isolation is a factor that further exacerbates poor mental health. Fear of rejection by family and friends can have a huge impact on a person’s sense of self-worth. It is not hard to see how this vicious cycle of isolation and deteriorating mental health can lead to suicidal thoughts.
Counteracting the stigma
There are a number of actions an individual can take to counter the stigma associated with HIV/Aids, she advises:
Find positive role models:
“The most productive thing to do is find people who have faced it and are doing well,” says Bryce Carter (PhD), a behavioural health consultant at the MacGregor Infectious Diseases Clinic of the Hospital of the University of Pennsylvania. For Carter, basketball star Magic Johnson, who was diagnosed with HIV in 1991, is a role model. “Just because he’s living proof that this is a chronic medical condition which we definitely can manage. It doesn’t need to impact the course of your life in a significant fashion,” Carter says.
The more you know, the better you can stand up to other people’s ignorance about your disease, says, Edward Brooks, MD, an infectious disease specialist and associate clinical professor in medicine-infectious diseases at Stanford University School of Medicine in Stanford, California. It may be cliché, but knowledge is power, especially when it comes to treating HIV and AIDS.
When combating stigma, it helps to connect with others, perhaps at your place of worship or with an HIV and AIDS support group. “Social support is invaluable for facing stigma because then you know, no matter what happens, these people have your back,” Carter says.
Know your rights:
You don’t have to fear losing your job or apartment because your boss or landlord learns that you have HIV, Carter adds. The law is on your side.
Disclose only as needed:
Whom you tell about having HIV, is a personal choice, says J. Wesley Thompson, AAHIV, medical director, physician assistant, and certified HIV specialist at Ballantyne Family Medicine in Charlotte, North Carolina. “Some people feel they have to tell everyone; some prefer to keep it to a select few who will be supportive,” he says. Only you can decide what’s best.
Don’t let HIV define who you are, Carter advises. “The core of stigma is shame, and the antidote to shame is proudly owning it,” he says. Understand that having HIV is only part of who you are — it’s not all of who you are. “Decide, I have HIV and I’m moving forward with my life,” he says.
Staying mentally fit and healthy:
It is completely normal to have an emotional reaction upon learning that you are infected with HIV, such as anxiety, anger, or depression, however, these feelings do not last forever. As noted above, there are many things that you can do to help take care of your emotional needs.
Here are just a few ideas:
Talk about your feelings with your doctor, friends, family members, or other supportive people. They may suggest treatment that includes antidepressant drugs or talking therapies, such as counselling or cognitive behaviour therapy (CBT). “Patients should disclose their status to at least one trustworthy person, advises Prof Robert Remien, a specialist in clinical psychology and director of the HIV Centre for Clinical and Behavioural Studies at Columbia University.
· Try to find activities that relieve your stress, such as exercise or hobbies.
· Try to get enough sleep each night to help you feel rested.
· Learn relaxation methods such as meditation, yoga, or deep breathing.
· Limit the amount of caffeine and nicotine you use.
· Eat small, healthy meals throughout the day.
· Join a support group.
· Adhere to your medication regime, specifically to Anti-retroviral Therapy (ART).