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.
