By Lucca Munnik
In the previous article on HIV and mental health, there was a discussion on various influences and psychosocial issues associated with the virus (the causes and effects). Now, by using the concepts discussed, we can examine the notions of psychological interventions used to treat and support people living with both HIV (PLWH) and mental disorders. These interventions focus on the individual or HIV-community in order to improve their well-being and solve psychological issues. They are imperative in empowering PLWH and also serve against the challenges faced by them.
Treatment is vital in enhancing the physical and psychological well-being of PLWH1. It consists mainly of psychotherapy and medication in order to manage the relation between HIV and mental health. Some of the various psychotherapies include: CBT (cognitive-behavioural therapy), IPT (interpersonal therapy) and psychodynamic psychotherapy2. The purpose of these therapies with regard to HIV is to empower PLWH and assist them in developing effective ways of coping. Furthermore, there is pre-test and post-test counselling of HIV tests. The purpose of pre-test counselling is to question the person testing for HIV as well as inform them of the implications of a diagnosis (either positive or negative). Post-test counselling is used to inform the person of their diagnosis and if positive, assist them in coping with it1. Furthermore, there are advantages of pre-test and post-test counselling. These include, helping facilitate change, empowerment and improved acceptance of status. Thus, it is important to offer services of counselling as it is beneficial to the individual being tested. However, it is not available in all countries.3
In combination with psychotherapy, medication is used to treat psychiatric disorders. The most commonly used medications to treat depression, PTSD and other anxiety symptoms are SSRIs (selective serotonin reuptake inhibitors)2. Although this must not be a discouragement to PLWH, some medication used to treat HIV might have neuropsychiatric effects of depression, sleep disturbance and cognitive impairment4. In addition, there are possible drug-drug interactions between SSRIs and antiretrovirals (ARVs). One of the interactions reported was serotonin syndrome which includes symptoms of confusion, agitation and anxiety. Evidently, these types of interactions further demonstrate the need for care workers to be vigilant when treating PLWH and the need for PLWH to feel comfortable enough to approach their doctors about such complications5. Approaching one’s care provider allows for the discussion of other possible treatment regimens and this proves beneficial if the neuropsychiatric effects are adverse.
PLWH require social support in order to cope and manage HIV and mental health. Social support refers to friends, family, partners and other PLWH who play a large role in supporting the individual. It works as a protective coping mechanism that reduces psychological distress by allowing PLWH to express their emotions and solve their problems6. Furthermore, social support can increase the feeling of belonging and self-worth, promoting positive mental health. With regards to friends and family, studies have demonstrated that just the thought of social support being available can work as a buffer against situational stress, proving the power of social support. Despite this, PLWH continue to feel a sense of rejection when it comes to status disclosure7. The notion of communities (in reference to HIV support groups) reflects positive results. PLWH who participate in a support group are less likely to experience depression. Furthermore, support groups can decrease feelings of isolation and stigmatization. PLWH find relating to one another establishes a community and demonstrates that self-comparison can be beneficial. There is little stigma involved in support groups due to individuals experiencing HIV themselves. Thus, proving to be a safe space of understanding and encouragement8.
Youth in context
Similar to the previous article, we can examine the psychological interventions and other issues associated with youth living with HIV. With regards to treatment, youth living with HIV face certain coping strategies. Social comparison is proven to be an extremely beneficial coping mechanism and is related to the idea that youth living with HIV feel comfort in knowing that they are not alone. This could also possibly be demonstrated in support groups or support therapy. They also face coping strategies of avoidance and distraction. Studies suggest that health counselors have encouraged youth to avoid worrying about their HIV and rather focus on managing it by finding distractions. In terms of HIV medication (and possibly psychiatric medication), it is noted that there can be little medication adherence due to the avoidance of taking medication in front of peers. Youth living with HIV fear being ridiculed or questioned9. And in terms of social support, youth living with HIV are more likely to disclose to family members while less likely to disclose to friends due to seeking positive peer approval1. As mentioned in the previous article, these reasons are very much related to social and self-stigma but are also due to other psychosocial issues9.
With regards to both articles, focus has been placed on the relation between HIV and mental health. Evidently, there are many psychosocial influences and results that challenge PLWH. However, with treatment and social support there are ways of conquering these barriers. By using these interventions in combination with the fight towards ending HIV & AIDS stigma, we can strive towards achieving a just and inclusive society.
1 Fabianova, L. (2011). Psychosocial Aspects of People Living with HIV/AIDS. In: Social and Psychological Aspects of HIV/AIDS and Their Ramifications. Croatia: InTech, pp.175-203.
2 HIV Clinicians Society, S. (2013). Management of mental health disorders in HIV-positive patients. Southern African Journal of HIV Medicine, 14(4).
3 National Institute of Health (2001). Counseling for HIV/AIDS: The National Guidelines. Joint UN Programme on HIV/AIDS (UNAIDS), pp.35.
4 Nascimento, S., Mendes, M., Solana, C., Croca, M. and Reis, J. (2017). Neuropsychiatric adverse effects of HIV antiviral medication. European Psychiatry, 41, pp.S697-S698.
5 Caballero, J. and Nahata, M. (2005). Use of Selective Serotonin-Reuptake Inhibitors in the Treatment of Depression in Adults with HIV. Annals of Pharmacotherapy, 39(1), pp.141-145.
6 Pappin, M., Wouters, E. and Booysen, F. (2012). Anxiety and depression amongst patients enrolled in a public sector antiretroviral treatment programme in South Africa: a cross-sectional study. BMC Public Health, 12(1).
7 Turner-Cobb, J., Gore-Felton, C., Marouf, F., Koopman, C., Kim, P., Israelski, D. and Spiegel, D. (2002). Coping, Social support, and Attachment style as Psychosocial correlates of Adjustment in Men and Women with HIV/AIDS. Journal of Behavioural Medicine, 25(4).
8 Lam, P., Naar-King, S. and Wright, K. (2007). Social Support and Disclosure as Predictors of Mental Health in HIV-Positive Youth. AIDS Patient Care and STDs, 21(1), pp.20-29.
9 Mutumba, M., Bauermeister, J., Musiime, V., Byaruhanga, J., Francis, K., Snow, R. and Tsai, A. (2015). Psychosocial Challenges and Strategies for Coping with HIV Among Adolescents in Uganda: A Qualitative Study. AIDS Patient Care and STDs, 29(2), pp.86-94.