HIV/AIDS Neuropsychiatric Quiz

HIV and Alcohol Consumption

• Several studies, including those in African countries, show a positive association between HIV and alcohol consumption
• Prevalence of HIV infection is higher among people with alcohol-use disorders than in the general population.

HIV and Mental Health

• People living with HIV (PLH) are at higher risk of mental health disorders, particularly depression and anxiety.
• Depression is the leading mental illness among PLH.
• Studies show higher rates of depression in HIV-positive individuals compared to HIV-negative control groups.
• In sub-Saharan Africa, depression rates among PLH vary between 8% and 64%.
• HIV infection can be associated with a high risk of suicide or attempted suicide.
• Psychological predictors of suicidal ideation in HIV-infected individuals include:
  • Concurrent substance-use disorders
  • Past history of depression
  • Presence of hopelessness
• HIV infection has direct effects on the central nervous system, causing neuropsychiatric complications:
  • Dementia
  • Depression
  • Mania
  • Cognitive disorder
• Cognitive impairment in HIV/AIDS is associated with increased mortality.
• Infants and children with HIV infection are more likely to experience motor and cognitive development deficits compared to HIV-negative children.

Mental Health Disorders and Adherence to Treatment

• Mental and substance-use disorders affect help-seeking behaviour for HIV/AIDS.
• Mental illnesses are associated with lower likelihood of receiving antiretroviral medication.
• Drug-use disorders present the greatest barriers to accessing treatment due to societal attitudes and reluctance to seek help.
• Injection drug use is associated with low uptake of highly active antiretroviral therapy (HAART).

Gaps in Mental Health Services for PLH in Botswana

• There is a lack of evidence of effective intervention programs for depressive symptoms and other mental health issues among PLH in Botswana.
• Inadequate provision of integrated services for people with mental-health and substance-use disorders, HIV/AIDS, and related problems creates a barrier to treatment and care.
• Adherence to HAART is crucial for sustained suppression of HIV, and adherence of less than 95% is associated with viral resistance.
• Drug-resistant viruses can be transmitted to others, limiting their treatment options.

Conclusion on Mental Health and HIV

• Mental disorders, including substance use disorders, are risk factors for contracting HIV, and HIV/AIDS increases the risk of mental disorders.
• Integrated treatment of both drug dependence and HIV/AIDS improves adherence rates to treatment regimens.
• Diagnosis of mental health problems in HIV-infected individuals faces barriers:
  • Stigma
  • Lack of skilled healthcare professionals to detect psychological symptoms
  • Difficulty in taking necessary action for assessment and referral

Hope and Meaning Making in HIV

• Living with HIV presents uncertainty and challenges for people living with the virus.
• Finding meaning in life can be a protective factor in mental health and health-related behaviours.
• Meaning-making following an HIV diagnosis affects self-perception and adaptation.
• The meaning of living with HIV/AIDS is described differently by individuals in various contexts.
• Cognitive coping strategies used by PLH:
  • Self-blame
  • Rumination
  • Catastrophizing
  • Other-blame
  • Acceptance
  • Planning
  • Positive re-appraisal
  • Positive refocusing
  • Putting into perspective

Behavioural Coping Strategies

• Behavioural coping strategies are based on modifying an individual's responses to their condition to reduce disability and suffering.
• Emotion-focused coping involves regulating negative emotional reactions to a stressor.
• Problem-focused coping aims to alter the stressful situation.

Studies and Findings in Botswana

• Vavani et al., 2019 study found that coping strategies including rumination, catastrophizing, positive-refocusing, and refocus on planning had a significant correlation with depressive symptoms among PLH.
• People living with HIV who ruminate and/or catastrophize are more likely to be depressed.
• Those who focus on other pleasant experiences or look for ways to cope with HIV are better adjusted.