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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