Making matters worse: links between HIV/AIDS and mental health

HIV/AIDS sufferers and children whose families are infected with the virus may suffer mental health problems arising directly or indirectly from living with the virus. HIV infected people have to deal with the stigma attached in some communities to being HIV positive. Partners, family and friends, may experience psychological stress from having to nurse sick relatives and deal with multiple deaths.

Mental illnesscan arise as a direct consequence of HIV infection. For example, HIV enters thecentral nervous system in the early stages of infection and a significantnumber of people with HIV develop a reduction or impairment of the brain'scognitive function, such as HIV dementia or minor-cognitive disorder. Impairmentincreases as the disease progresses. Antiretroviral therapy can reduce theprevalence of HIV related dementia by stopping the spread of infection.

Mooddisorders are common in people with HIV/AIDS:

• In three South African studies majordepression was diagnosed in between 35 and 38 percent of HIV/AIDS sufferers.
• In one study an additional 22percent were diagnosed with dysthymia - a form of mood disorder characterisedby a lack of enjoyment in life.
• 'AIDS mania' (usually featuringinappropriate excitement) appears in the late stages of AIDS and is estimated to occur inaround 1.4 percent of cases.

People whoabuse substances and suffer from severe mental illness are at increased risk ofinfection. Moreover some HIV/AIDS sufferers may be at risk of becoming substanceabusers or developing severe mental illness. Infected people may turn toalcohol and drugs to psychologically manage their disease. Psychosis may occurin late stage AIDS, though this is rare.

Coping withbeing HIV positive can be made more difficult by the reactions of communitiesand even friends and family. People who are rejected or discriminated against maybecome more depressed. This can result in a more rapid progression of thedisease. Even where people have not been discriminated against, fear ofrejection and discrimination can lead to them being unable to live a normallife.

Manychildren will lose their parents to HIV/AIDS. This is not only traumatic initself but many of these children may not be integrated into new families. Thiscould have devastating consequences for their mental health, both as childrenand as adults:

• In a Zambian study 82 percentof people who care for children of AIDS sufferers noted changes in thechildren's behaviour during their parents' illness. Children stoppedplaying, became worried, sad and too tired to help at home.
• In Uganda children were reported to feeldespair or anger and were scared their parents would die. Once the parent died,orphans in Uganda and Mozambique suffered more depression.
• In Tanzania 34 percent of orphans hadcontemplated suicide.
• In South Africa AIDS orphans experienced morephysical symptoms and were likely to have nightmares. 73 percent sufferedfrom post traumatic stress disorder.
• Because of the ongoing presenceof HIV/AIDS within families and communities, these traumatic consequences mayoccur many times over.

Mentalhealth problems are a critical aspect of the HIV/AIDS epidemic for both infected andaffected people. As mental health problems often hinder effective adherence toantiretroviral treatment, it is necessary to include mental health care as partof HIV/AIDS treatment. Equally, mental health practitionersneed to understand that patients increasingly have HIV/AIDS related symptoms.

Programmesare needed to deal with mental health in vulnerable or orphaned children. Whilework with children who have developed mental health problems is vital, the mostimportant thing is preventing children from developing mental health problems. Families shouldbe supported to take in and care for orphans, whilst orphans themselves needhelp to adjust to new and sometimes difficult situations.