Summary

This presentation explores the connection between mental health and HIV. It details risk factors, prevalence rates, and the effects of mental health disorders on HIV treatment and outcomes. The presentation also discusses coping strategies and the role of spirituality and religion in the experience of HIV.

Full Transcript

Mental health and HIV    HIV is a chronic illness due to ART  Therefore, many mental health challenges that complicate the illness  Mental health and HIV/AIDS are closely interlinked;  Mental health problems are associated with increased risk of HIV i...

Mental health and HIV    HIV is a chronic illness due to ART  Therefore, many mental health challenges that complicate the illness  Mental health and HIV/AIDS are closely interlinked;  Mental health problems are associated with increased risk of HIV infection and AIDS and interfere with their treatment;  and conversely some mental disorders occur as a direct result of HIV infection.   Studies have demonstrated a high prevalence of HIV infection in people with serious chronic mental illnesses.  Prevalence rates in mentally ill inpatients and outpatients have been reported to be between 1.5% in Asia and up to 19% in Africa.  Studies across 38 countries show that 15% of adults and 25% of adolescents living with HIV reported depression or feeling overwhelmed Risk factors for HIV among people with MI   Some studies have reported behavioural risk factors for transmission of HIV among people with severe mental illnesses.  These risks include:  high rates of sexual contact with multiple partners,  injecting drug use,  sexual contact with injecting drug users,  sexual abuse (in which women are particularly vulnerable to HIV infection),  unprotected sex between men,  and low use of condoms,  Additionally, mental disorders may also interfere with the ability to acquire and/or use information about HIV/AIDS   It is estimated that about three million injecting drug users worldwide might be infected with HIV.  About 10% of HIV cases worldwide are attributable to injecting drug use   Injecting drug users principally acquire HIV through sharing injection equipment,  whereas non-injecting use of drugs, such as cocaine is associated with transmission of HIV through high-risk sexual behaviours.  Some drug users practise unsafe sex with multiple partners in exchange for drugs or money,  providing a bridge for HIV to spread from populations with high HIV prevalence to the general population.   The use of alcohol is known to be associated with an increased risk of unsafe sexual behaviour.  Several studies, including those conducted in African countries, have shown a positive association between HIV and alcohol consumption  prevalence of HIV infection among people with alcohol-use disorders higher than in the general population.   HIV tends to be concentrated in highly vulnerable, marginalized and stigmatized populations; in particular, sex workers, men who have sex with men, drug users and prisoners who have higher levels of mental health disorders than the general population. Depression   Depression found to be the leading mental illness among PLH  Studies in both low- and high income countries have reported higher rates of depression in HIV-positive people compared with HIV negative control groups.  In sub-Saharan Africa depression rate among PLH varies between 8% and 64%   Overall, dearth of literature on prevalence rate in Botswana. (One study (Lewis et al., 2012); 48% prevalence rate on women in Gaborone)  Vavani et al., 2019 study found a prevalence of 43.4% on men and women living with HIV in Botswana   The level of distress often seems to be related to the severity of symptoms of HIV infection.  Coping styles and learnt resourcefulness may shape the experience of depressive symptoms and the ability to care for oneself.  Family relationships and the support of a partner can also influence mental health consequences. Effects of depression   Independent of treatment and comorbid substance use. Chronic depressive symptoms were associated with;  increased AIDS-related mortality,  poor quality of life  and rapid disease progression  Poor ART adherence   People with HIV also often suffer from anxiety as they adjust to the impact of the diagnosis of being infected and face the difficulties of living with a chronic life-threatening illness, for instance;  shortened life expectancy,  complicated therapeutic regimens,  stigmatization,  and loss of social support, family or friends.   HIV infection can be associated with high risk of suicide or attempted suicide.  The psychological predictors of suicidal ideation in HIV-infected individuals include:  concurrent substance-use disorders,  past history of depression  and presence of hopelessness.   Apart from psychological impact, HIV infection has direct effects on the central nervous system, and causes neuropsychiatric complications including:  Dementia (concentration and memory)  Depression  Mania (periods of great excitement or euphoria, delusions, and over activity)  cognitive disorder (affect cognitive abilities including learning, memory, perception, and problem solving).  often in combination.   Cognitive impairment in HIV/AIDS has been independently associated with greatly increased mortality  Infants and children with HIV infection are more likely to experience deficits in motor and cognitive development compared with HIV negative children. Effects of mental health disorders on adherence   Mental and substance-use disorders affect help-seeking behaviour or uptake of diagnostic and treatment services for HIV/AIDS.  Mental illnesses have been associated with lower likelihood of receiving antiretroviral medication.  Among people with HIV/AIDS, those with drug-use disorders typically experience the greatest barriers in accessing treatment because of negative societal attitudes and reluctance to seek any kind of treatment.  Injection drug use has consistently been shown to be associated with low uptake of highly active antiretroviral therapy.   There is no 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 physical, psychological and social problems creates an additional serious barrier to treatment and care for HIV/AIDS.   For sustained suppression of HIV, the highly active antiretroviral therapy regimen must be adhered to.  Moreover, adherence of less than 95% is associated with development of viral resistance.  Drug-resistant viruses can be transmitted to other people, thereby limiting their treatment options.   Several randomized controlled trials have indicated that, with integrated treatment of both drug dependence and HIV/AIDS, rates of adherence approach the rate for the non-drug- dependent population. Conclusion on mental health and HIV   Despite the fact that developing countries carry more than 90% of the burden of HIV/AIDS, little information about the interaction between HIV/AIDS and mental health is available from low and middle-income countries.  Mental disorders, including substance use disorders, are risk factors for contracting HIV, and the presence of HIV/AIDS increases the risk of development of mental disorders.  The resulting comorbidity complicates help-seeking, diagnosis, quality of care provided, treatment and its outcomes, and adherence. Conclusion on mental health and HIV   The diagnosis of mental health problems in HIV-infected individuals faces several barriers.  Patients often do not reveal their psychological state to health- care professionals for fear of being stigmatized further.  Also, health-care professionals are often not skilled in detecting psychological symptoms and, even when they do, they often fail to take the necessary action for further assessment, management and referral.  Effective and readily available treatment and preventive measures for injecting drug users can prevent HIV epidemics among such groups if they reach sufficient proportions of the target populations.  Appropriate policies and programmes should ensure that prevention and treatment services meet the needs of clients.  Treatment of substance-use disorders should be integrated with HIV prevention and treatment interventions.   Integration of HIV into mental health services provides opportunities for identifying individuals at risk of HIV infection, introducing HIV prevention and detecting those who are infected and providing them with appropriate HIV treatment and care.  Mental health services should ensure access to voluntary and confidential HIV testing and counselling for those at risk. Hope and meaning making   In being HIV-positive, one is faced with having to live with uncertainty;  How long will I remain symptom-free and healthy?  who do I tell about my HIV positive status?  Who have I infected?  What if I infect others!  who infected me?  These nagging thoughts of uncertainty and knowing the HIV infection cannot be undone may leave on feeling quite helplessness, depressed and even suicidal   So how do people living with HIV find meaning and hope in life?  Numerous studies demonstrated a protective role of meaning in life in mental health and health-related behaviours  Importantly, in one study, participants who found meaning in response to an HIV-related stressor had less rapid declines in CD4 T cell levels and lower rates of AIDS- related mortality  It has been found that the construction of meaning following a diagnosis affects self perception, which in turn affects individuals’ adaptation.   The construction of meaning can occur in relation to the normalization of illness, the integration of HIV into personal identity, and the recognition of positive effects of HIV  What it means to live with HIV/AIDS has been described differently by people living in different contexts.  Some women have described the meaning of testing positive as an epiphany (that clarified the meaning of life),  a confirmation (that corroborated their suspicions of being HIV-positive),  or a calamity (that caused deep distress, loss, and affliction,  For others it has been described as experiencing a shift of focus from planning for the future to living in the “here and now”   The meaning of living with HIV/AIDS for some can be described as the process of learning how to accept and live with the diagnosis.  In a study in Lebanon that focused on women living with HIV (Kaplan et al., 2016),  women described testing positive for HIV as a major life- changing event and recognized the need to accept their HIV status.  They began a process of accepting their diagnosis from the moment they learned about their HIV test results.  The process is one that unfolds over time and is influenced by a many factors that mitigate or exacerbate the impact of having a chronic illness   Learning how to live with HIV/AIDS is a process comprising the following elements:  receiving the news,  accessing care,  starting treatment,  navigating disclosure decisions,  negotiating stigma,  and maintaining stability.  These elements are the major events that some PLH confront and are often overlapping and continuous.   A study by Plattner and Meiring (2006) found acceptance of being HIV-positive was based on two main beliefs.  Firstly, participants felt personally responsible for having contracted HIV, therefore they had to accept it.  Secondly, the participants felt that their contracting the virus was a test or punishment from God, again this meant they had to accept it.   Some had reported that they had found God and felt closer to him after they contracted the virus and by blaming themselves for getting HIV, they felt a sense of control over their lives.  This had given them meaning in their lives   Spirituality and religion can influence the way patients perceive health and disease and their interaction with other people.  Many patients are spiritual, and religious needs related to their disease can affect their mental health, and failure to meet these needs may impact their quality of life.  It has been previously reported high spirituality /religiosity help HIV/AIDS patients cope with their disease through engaging in behavioural change, reducing anxiety and other mental problems that could arise as a result of their HIV positive status  Believing in a higher power might also provide hope in healing or managing symptoms through prayer Coping with HIV   There are many ways to cope with living with HIV  Coping involves conscious cognitive or behavioral strategies employed by individuals when responding to stress (Lazarus & Folkman, 1984).  Cognitive coping strategies include;  blaming oneself (self-blame)  Ruminating  Catastrophizing  blaming others  Acceptance  Planning  positive re-appraisal  positive-refocusing  putting into perspective Strategy MALADAPTIVE  Definition Self-blame Blaming oneself for the negative getting HIV Rumination Repetitive thinking about the thoughts and feelings about having HIV Catastrophizing Focusing on how terrible it is that one has HIV Other-blame Blaming others for contracting HIV ADAPTIVE Acceptance Resigning to having HIV Positive refocusing Directing thoughts to pleasant matters Refocus on planning Thinking about actions that can help deal with living with HIV Putting into perspective Diminishing the meaning of having HIV (it could have been worse) Positive reappraisal Finding a positive side of living with HIV   Vavani et al., 2019  Coping strategies: rumination, catastrophizing, positive-refocusing, refocus on planning had a significant correlation with depressive symptoms.  People living with HIV who ruminate and/or catastrophize were more likely to be depressed  Those who focused their attention on other pleasant experiences and/or actively looked for ways to cope with HIV were better adjusted Behavioral coping   Behavioural coping strategies are based on the idea that modifying an individual's responses to his or her condition will reduce disability and suffering.  Emotion focused coping  a person focuses on regulating his or her negative emotional reactions to a stressor.  Used often when one realises that they cannot change the stressor itself  the individual tries to control feelings using a variety of techniques such as relaxation techniques, prayer, (or conversely engaging in social withdrawal), and talking with others (including mental health care professionals).  problem-focused coping in PLH have also been linked to depressive symptoms – one seeks to alter the stressful situation

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