A collection of articles that addresses the advocacy seen within young communities responding to HIV. The aim of this section is to showcase narratives that create change and raise awareness of topics that are dismissed.

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The Dangerous Comorbidity: how should WLWH and mental illness be assisted?

By Lucca Munnik

In 2018, there were 18.8 million women living with HIV (WLWH)[1] with many of them facing issues of mental health, gender-based violence, SRHR, and human rights. Despite evidence suggesting mental health plays a large role in the experiences of WLWH, this issue is either lacking in policy change or rarely addressed in policy guidelines. Understanding the existence of mental illness amongst WLWH can direct healthcare providers towards the types of services and treatment that is needed for WLWH with mental health difficulties[2].

The Impact of HIV on Mental Health

There are various impacts that HIV has on women’s mental health. The common mental illnesses experienced by WLWH are depression and anxiety with symptoms ranging from shame, self-blame to low self-esteem, and insomnia2. Excessive worry is also common and is often related to fretting over future partners or worrying about the reaction from family regarding an HIV-positive status. Further, negative self-talk is common amongst WLWH and mental illness and results in the development of a low self-esteem[3].

Research suggests that many WLWH and mental illness socially withdraw, and this causes them to feel socially isolated[4]. Another impact of HIV on mental health is rejection and this is related to HIV-stigma as well as linked to a lack of disclosure and lower social support24. Moreover, it has been noted that partner rejection, abuse, and abandonment is also a common occurrence amongst this key population where unfaithfulness and being disregarded by romantic partners triggers mental health difficulties, such as low self-esteem and anxiety4. Reproductive health barriers and human rights violations also play a large role in exacerbating mental illness amongst WLWH. Most commonly, WLWH are discouraged from having children, mistreated during pregnancy, or face discriminatory acts, such as forced sterilisation2.

The impacts mentioned above demonstrate that mental health and HIV are very interrelated; they both influence each other in many ways. Due to this, intervention strategies must be explored to assist this key population in the prevention and treatment of the comorbidity.

Interventions

Although it is evident through literature that WLWH often struggle with mental illness, there are still little interventions or healthcare strategies that cater to this specific comorbidity2. There is some research, however, that explored the characteristics needed in healthcare services to treat WLWH and this can also be applied to treating mental illness amongst this key population. Treatment can be addressed in three ways; through psychological support, challenging stigma, and via the community.

Psychological Support

Counseling or psychosocial support is a way of providing support for WLWH and mental illness. Types of counseling include; Cognitive Behavioural Therapy, Only-Women Support Groups, and Problem-Solving Therapy2.

It is recommended that these counseling strategies should be integrated into other HIV interventions, and should be affordable, holistic, and accessible. Moreover, HIV and mental health services should collaborate so that mental health specialists can offer services in the HIV setting[5]. There is also a need for screening for mental illness amongst WLWH and this should be included in the collaborative care approach4. Finally, the healthcare setting should involve the treatment of other issues or comorbidities, such as substance abuse2.

Interventions at home, including individual counseling, has been recommended for WLWH who cannot attend the clinic due to sickness or due to poverty in low-income countries4. Further, it is suggested that women are “met where they are”3 where support is provided to WLWH by meeting her needs and doing so without judgment.

HIV-related stigma is an issue seen in healthcare settings, even amongst healthcare providers. Compounded with HIV-related stigma, WLWH are also troubled by the stigma of mental illness. Therefore, there is a massive need to approach this issue to reduce discrimination in both the healthcare and communal setting.

Challenging Stigma

In order to challenge and reduce stigma and discrimination, educational interventions are required. Mental health promotion intervention is needed to promote gender equity (as this will assist with reducing GBV too)4. It will also help foster social support from the community which is needed to uplift WLWH and their families4.

At a healthcare level, service providers should be trained to not discriminate against HIV as well as their comorbid mental illnesses. This should be done through culture – illness- and gender-sensitive training which should assist service providers in understanding the various backgrounds from which WLWH come. Moreover, this will reduce the stigmatized assumptions service providers often have when treating WLWH3.

The Role of Community

The community plays a large role in HIV treatment where family and partners are often included in the interventions. Most WLWH have families and they often make decisions about their house according to their family unit3. This is seen in services such as family planning and is the main indicator of the importance of SRHR services. It is recommended that health services should provide for WLWH and their families, such as through supervised playroom for children, pregnancy planning, family therapies, and counseling for partners3.

When dealing with mental illness, it is important to ensure the community is involved.  One study suggested that community caregivers and lay counselors provide psychosocial interventions and that group-based therapy is important when fostering support and resilience4. This would create a support system as well as build on strengthening communal support4.

WLWH and mental illness struggle with various issues, but among many of them, lies the issue of treatment and prevention. By improving and discovering ways to ensure psychosocial support, end stigma, and empower the community, this will aid us in treating and preventing the harsh reality of both HIV and mental illness.

 

[1] UNAIDS, 2019

[2] Petersen, I., Bhana, A., Fairall, L., Selohilwe, O., Kathree, T., Baron, E., Rathod, S. and Lund, C., 2019. Evaluation of a collaborative care model for integrated primary care of common mental disorders comorbid with chronic conditions in South Africa. BMC Psychiatry, 19(1).

[3] Orza, L., Bewley, S., Logie, C., Crone, E., Moroz, S., Strachan, S., Vazquez, M. and Welbourn, A., 2015. How does living with HIV impact on women’s mental health? Voices from a global survey. Journal of the International AIDS Society, 18, p.20289.

[4] Carter, A., Bourgeois, S., O’Brien, N., Abelsohn, K., Tharao, W., Greene, S., Margolese, S., Kaida, A., Sanchez, M., Palmer, A., Cescon, A., de Pokomandy, A. and Loutfy, M., 2013. Women-specific HIV/AIDS services: identifying and defining the components of holistic service delivery for women living with HIV/AIDS. Journal of the International AIDS Society, 16(1), p.17433.

[5] Collins, P., Holman, A., Freeman, M. and Patel, V., 2006. What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review. AIDS, 20(12), pp.1571-1582.

 

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The Role of Social Media in the Fight against HIV & AIDS

The Role of Social Media in the Fight against HIV & AIDS  

By Gift Banda

 

On the 28th of January 2011, the former President of Egypt, Hosni Mubarak, shut off the Internet across the entire country. This unprecedented blackout lasted for five days. Mubarak’s decision came after days of protests by many Egyptians who were mostly gathered in Cairo’s Tahrir Square (or “Liberation Square”). Most protestors coordinated via social media platforms and in the weeks leading up to the protests, Egyptians created 32,000 Facebook Groups and 14,000 Facebook Pages. Mubarak’s desperate attempt to halt the flow of communication further invigorated protests. Following the five-day blackout, over one million Egyptians joined demonstrations across the country—up to a tenfold increase. When the Internet was finally restored, Facebook had its highest-ever number of users from Egypt. After 18 days of protest, President Mubarak resigned from office, ending his 30 years of authoritarian rule. In the wake of the blackout, President Barack Obama stated, “Once more, we’ve seen the incredible potential for technology to empower citizens and the dignity of those who stand up for a better future.”

In this Tahrir Square example, social media not only served as a vital channel for communication, but also brought individual citizens a sense of self-empowerment through the capacity to express, discuss, participate, and assemble.

 

Social Media as a Tool

In this article, social media is defined as platforms that connect people online based on a common topic or goal. This definition focuses on the connection between people and the sharing of information through text, photos, or videos. It is a known fact that the daily users of social media are young people[1]. The popularity of social is because it is inexpensive, accessible, and easy to use. Due to young people often being dependent on the financial assistance of their family, they are also likely to use social media more frequently[2].

Social media has the potential for young people to connect, express, learn, engage, and act with the simple push of a button; the power of social media is undeniable and cannot be ignored. With this tremendous power that resides in social media, it can be used as a tool in global health initiatives, especially for the fight against HIV. The social interaction that social media offers can be mainstreamed with other health-related initiatives to offer double benefits to the people. HIV prevention is a widely discussed topic and we often ignore that HIV prevention relates to information provision[3].

 

Behaviour Appropriate

In behavioral change models, information provision is highly emphasized. For a person to change his or her behaviors that are risky, it is of paramount importance that such behavioral modifications must be parallel with relevant information for proper decision-making. Effective health information delivery must be engaging and must be in line with the behaviors of the target population. As mentioned earlier, almost 80% of young people across the globe use social media for their daily communication endeavors[4]. Therefore, integrating HIV prevention messages on social media will likely meet this 80% of young people who use social media.

It is also important that we consider using platforms or strategies that are appropriate to young people and so they can easily understand the message. Young people are sensitive to what is around them and so by using platforms that are unacceptable or inappropriate to youth, it may not be enough in the fight against HIV & AIDS[5].

 

Health Promotion and Stigma

The benefits of social media are also used in health promotion. As defined by the Ottawa charter for health promotion, health promotion is the process of enabling people to increase their control and improvement of health[6]. Social media is engaging as it allows young people to state their views on a particular topic of discussion and this makes them develop a sense of ownership towards the message. This brings out an empowerment element that is very vital in health-related messages[7]. Social media can act as a platform for sharing information that will help individuals and communities to combat HIV-related stigma. This is because it allows people to access information about the importance of accepting PLHIV and the knowledge that being HIV positive does not warrant a defined difference to those who are negative.

As it was the case in the Tahrir Square scenario, social media has the greatest potential of making serious modification in our societies, especially in the fight against HIV and the stigma that PLHIV face daily. If social media can be innovatively utilized by individuals and organizations, it will be able to meet a huge number of young people across the globe.

 

 

[1] A. M Kaplan and M. Haenlein.  “Users of the world, unite! The challenges and opportunities of Social Media”. (Bus Horiz, 2014)
[2] ibid
[3] S. S Bull, et al. Social Media–Delivered Sexual Health Intervention: A Cluster Randomized Controlled Trial. (PubMed: 23079168)
[4] L. Yonker, et al. “Friending teens: a systematic review of social media in adolescent and young adult health care. (J Med Internet Res. PubMed: 25560751)
[5] J Rothwell. “In the company of others: An introduction to social psychology” (New York: McGraw-Hill, 1999)
[6] S. Ottawa Charter (1986). For Health Promotion
[7] http://www.tandfonline.com/doi/pdf/10.1080/17290 376.2011.9724996 (uploaded: September 2011. Accessed March 2020)

 

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HIV Disclosure: Benefits, Challenges and Behaviors

By Austin Okumu

There continues to be various issues associated with HIV & AIDS that need to be explored in-depth. One of these issues concerns HIV disclosure, which refers to when someone living with HIV tells another person their HIV status. Although this comes with a sense of relief and potential support, it also bears many challenges – ones that can affect self-esteem and cause fear. As a result of the negative part of status disclosure, people living with HIV (PLHIV) can be reluctant to disclosing their status[1]. Moreover, HIV disclosure can also be challenging when someone enters into a serodiscordant relationship. This refers to a relationship that involves a person who is HIV positive and another person who is HIV negative[2]. This article will explore why specifically youth are not disclosing their HIV status as well as the challenges and benefits to status disclosure. 

Why is Youth Not Disclosing?

When addressing local and global HIV prevention efforts, understanding serostatus disclosure to sexual partners also needs to be included. This is because a large number of children living with HIV are entering adolescence and becoming sexually active[1]. Moreover, young people are engaging in sex, including condomless sex, with same-age peers who are living with HIV and this can be problematic if there has been no act of HIV disclosure. However, disclosure to PLHIV, can also be risky, and carries many threats of rejection, humiliation, and even sometimes violence. The fear of potentially adverse outcomes, such as rejection and stigma, can amplify transmission rates and this is seen in the fact that many adolescents and young people are choosing not to disclose their status despite continuing to engage in sexual activity[2],[3].

Numerous factors are associated with lack of disclosure which is demonstrated in literature. Lack of disclosure to partners has consistently been affected by sexual activity. For instance, YPLHIV are less likely to disclose to casual sex partners[4] whereas regular sexual activity amongst long-term couples acts as a reason for HIV discordance. However, inherent resistance to HIV in some individuals may be another reason for HIV discordance[5].

[1] Melvin D, Donaghy S. (2014) Talking to children about HIV in healthcare settings.

[2] HIV in Young People Network (HYPNET), Children’s HIV Association CHIVA / British Association of Sexual Health and HIV (BASSH) / British HIV Association BHIVA (2011) Guidance on the management of sexual and reproductive Health of adolescents with HIV.

[3] Corrigan, P., Kosyluk, K. and Rüsch, N. (2013). Reducing Self-Stigma by Coming Out Proud. American Journal of Public Health, 103(5), pp.794-800.

[4] Evangeli M, Wroe L. (2016) HIV disclosure anxiety: A systematic review and theoretical synthesis.

[5] Pettifor, A., Bekker, L., Hosek, S., DiClemente, R., Rosenberg, M., Bull, S., Allison, S., Delany-Moretlwe, S., Kapogiannis, B. and Cowan, F. (2013). Preventing HIV Among Young People. JAIDS Journal of Acquired Immune Deficiency Syndromes, 63, pp.S155-S160.

Challenges and Benefits of Disclosing HIV Status

In deciding as to whether or not to disclose, there is a considerable amount of evidence demonstrating the barriers that individuals experience, ones that are often fraught with emotional challenges. Currently, literature suggests that the majority of children and youth were only disclosed to during a health facility consultation where they were told the names of the drugs they were to take or were currently taking[1]. Due to this, it is recommended that children and young people are told their serostatus early so that they are prepared for the outcome. HIV disclosure is also influenced by stigma. This is because disclosing an HIV status might increase the likelihood of being alienated by peers and so it may also carry greater risks for many young people which to them, could outweigh any perceived benefits and overall gains[2]. HIV-related stigma, by its very definition, accentuates disapproval and can have negative effects on self-esteem and social support[3]. Despite the negatives, there remains benefits to status disclosure. Some of these include a sense of relief, fostering closeness to loved ones and a feeling of empowerment. Important benefits that should be noted is that by disclosing, YPLHIV can receive effective treatment and have a higher chance of being supported by loved ones and partners1.

Current literature on the topic of young people’s sexual health and behaviors explores the various factors that impact their lives as well as their relationships. It is suggested that disclosure is not a one-off event and is rather a sequential process that requires enabling opportunities for individuals to access appropriate physical and psychological support[4] which is a fundamental part of secondary prevention. In understanding the reasons why young people are reluctant to share their status throughout the disclosure journey it is important to provide adequate support. This may create interventions that aim to support and facilitate young people through the disclosure process[5]. Moreover, it is also important to raise awareness of the benefits of HIV disclosure because this can not only make the disclosure process easier but also can break the stigma attached to disclosing1.

[1]Fernet, M., Wong, K., Richard, M., Otis, J., Lévy, J., Lapointe, N., Samson, J., Morin, G., Thériault, J. and Trottier, G. (2011). Romantic relationships and sexual activities of the first generation of youth living with HIV since birth. AIDS Care, 23(4), pp.393-400.

[2] Hogwood J, Campbell T, Butler S. (2012) I wish I could tell you but I can’t: Adolescents with perinatally acquired HIV and their dilemmas around self-disclosure. Clinical Child Psychology and Psychiatry 18: 44–60.

[3] Wiener, L., Battles, H., Ryder, C. and Pao, M. (2006). Psychotropic Medication Use in Human Immunodeficiency Virus-Infected Youth Receiving Treatment at a Single Institution. Journal of Child and Adolescent Psychopharmacology, 16(6), pp.747-753.

[4] Conserve, D., Groves, A. and Maman, S. (2015). Effectiveness of Interventions Promoting HIV Serostatus Disclosure to Sexual Partners: A Systematic Review. AIDS and Behavior, 19(10), pp.1763-1772.

[5] Ravikumar, B. and Balakrishna, P. (2013). Discordant HIV couple: Analysis of the possible contributing factors. Indian Journal of Dermatology, 58(5), p.405.

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The Psychological Impact of HIV

By Rosa Tariro Mahlasera

When one is tested positive for HIV, one can think that the whole world has ended and that there is no hope for the future, whilst others see it as stepping stone to a better life. It is true that with the correct care and support, living with HIV can be made easier. However without this, the results can be catastrophic. One of the reasons for this is that emotional and mental stress experienced by people living with HIV (PLHIV) can cause different types of psychological problems[1]. HIV/AIDS imposes a significant psychological burden. PLHIV often suffer from depression and anxiety as they adjust to the impact of the HIV diagnosis and face the difficulties of living with a chronic illness. Living with HIV is challenging as it is associated with a number of significant and recurrent stressors including physical pain, side effects of ART, social stigma, and discrimination. ​

Mental Illness

The psychological impact  of HIV are synonymous with mental and emotional disorders. Mental health disorders are amongst the leading cause of health-related disability, affecting 10–20% of children worldwide and is predictive of mental health disorders and other morbidities in adulthood[2]. Mental disorders, if kept unmanaged, can claim more lives than actually recorded.

People living with HIV/AIDS are among those who are known to have great emotional needs and require enormous support for coming to terms with dire affliction status. The need for a better understanding of mental and emotional effects are essential, especially when it comes to its assessment and treatment. Children and adolescents living with HIV may face an increased burden of mental and behavioural health disorders compared to their adult counterparts. Other challenges faced by young people include; access to mental health services, the role of mental health challenges during transition from paediatric to adult care services and responsibilities, and the impact of mental health interventions[3].

Depression
Depression is the most commonly known and reported psychiatric disorder. Despite its high prevalence, depression is commonly underdiagnosed and consequently untreated in the general medical population. In primary care, physicians miss between one half to two-thirds of patients having depression. This is because depression is often viewed as an expected reaction to a medical disease[4]. Depression is a menace in the lives of adolescents and young people living with HIV[5] ​and is often triggered by various elements which include high cost of medication, stress, difficult life events, side effects of medications and disease progression.[6]

The prevalence of depression increases with the severity of symptoms. Thus, the more severe the disease is the more its effect on the patient’s mental health. However, the prevalence of depression decreases with the help of therapeutic interventions.

Depression is also a very important factor in the adherence of ART (medication that is used to treat HIV).  There is a high likelihood that depressed patients are more likely to miss at least one dose of ART regimen. Therefore early detection and effective treatment of depression goes a long way in improving the adherence to ART and improving the quality of life. ​Similar to how medical advancements help HIV-positive individuals live more productive lives, treatment for depression can also help patients better manage both diseases. These treatments can enhance both survival rates and quality of life in individuals suffering from both HIV and depression.

Fear and Isolation

Another psychological impact of HIV is fear. After a person is diagnosed with HIV, he or she often suffers from fear of being stigmatized or fear to disclose. This usually has traumatic effects. Therefore support groups and peer groups are necessary to control the effects of fear. Fear has resulted in many deaths of PLHIV.[7] This is so due to the unprecedented number of adolescents who have died in fear of failure to disclose and receive treatment. There is often fear of disclosure amongst PLHIV at the time of diagnosis.[8] When a person is found to be HIV positive it usually takes some time for them to come to terms with their HIV status. This period is characterised with emphatic, trauma and fear and this can overwhelm the personal living with HIV.

Stigma and Discrimination

Negative social consequences like stigmatization and discrimination is another problem that the patient also faces when disclosing his or her status[9] and can often lead to restricted options for marriage, employment and may even lead to divorce. The stigmatization and discrimination attached to the HIV is often a leading cause of patient landing up with severe fear of disclosure which can be disastrous.

HIV-related stigma is a key issue that impacts adolescents living with HIV across country-income settings by affecting quality of life, healthcare access, and the quality of the health care administered. Stigma and discrimination in the communities and as well as in clinics, are significant barriers to HIV treatment, often leading to negative consequences and poor adherence to medication[10]. Furthermore, HIV-related stigma is often intertwined with other sources of stigma, including those associated with mental health and/or substance use disorders. Depression and anxiety, which are two common disorders associated with HIV, are stigmatized on their own. Thus, a person living with both HIV and a mental disorder is considered to be compounded by a double burden of stigma.

Recommendations

Reflecting on statements mentioned above, it can be argued that the psychological impact of HIV arise mostly from a lack of support, care, knowledge and acknowledgment from family, friends and healthcare workers. Family and peer group support is very important because not only does it provide mental, economic and social stability to the PLHIV, it also decreases the stresses faced by them. Thus, it is recommended that countries around the globe should engage in policies that accommodate the social, economic needs of people living with HIV/AIDS. Involving more vulnerable communities is also important and this can be done through awareness campaigns that educate people on the psychological impact of HIV. There is also a need for schools that train healthcare workers who are specialists in psychological support of HIV patients as well as a need for facilities that can be utilised by any patient regardless of the illness for psychological support. Further, NGOs have play a big role in the overall health of patients living with HIV/AIDS. They form a bridge between government health services and PLHIV and also provide counselling and support to them. A person living with HIV needs support from the family members, friends and HCWs in order for him or her to overcome the psychological impact of HIV/AIDS. The support from these different groups of people will assist in being able to understand his or her HIV status, and also assist in enabling the PLHIV to adhere well to medication and accepting their HIV status. Due to this, it is recommended that more NGOs who are mostly active in the eradication of HIV/AIDS also engage in the psychological support and mental health of PLHIV.

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