Beyond the physical

2008-12-01 00:00

The emphasis in awareness campaigns about HIV/Aids tends to be on testing and access to antiretroviral medication, in other words, physical health. Mental health receives little or no attention, and yet many HIV and Aids patients experience mental health problems.

“The most common mental health problem experienced by more than half of HIV-positive people (57%) is depression,” said Dr Jayshree Naidoo of Town Hill Hospital Department of Psychiatry and Nelson R. Mandela School of Medicine. “It is also the condition that has the biggest impact on the economy. It’s a problem of national scale because many people living with HIV and functioning ‘normally’ are actually depressed. This can lead to poor productivity in the workplace and repeated absenteeism.”

People living with HIV can become depressed at any stage from initial diagnosis onwards. “When people first test positive it is often a huge shock. They may become depressed because of their status although they can function normally for years. Many also experience losses of different kinds that can cause depression: social and emotional loss through stigma, rejection and isolation, financial loss through losing a job or financial support from a partner and, as the disease progresses, loss of health and physical capabilities.”

Many people living with HIV also experience anxiety, which can also occur at any stage of the disease. “Although anxiety disorder can be difficult to diagnose, a form of the condition serious enough to be diagnosed as a disorder may be present in up to 40% of patients. However, the prevalence of anxiety symptoms not serious enough to be a disorder may be present in as many as 72% of HIV-positive people.

“The U.S. Diagnostic and Statistical Manual of Mental Disorders defines anxiety as ‘an unpleasant emotional state … frequently accompanied by physiological symptoms that may lead to fatigue or even exhaustion’. The kind of symptoms that people can experience include restlessness, being easily tired, difficulty concentrating, irritability, muscle tension and sleep disturbances. Panic attacks are also an issue, and these are twice as common in women as in men.”

The danger of suicide is another problem that arises from the moment someone is diagnosed as HIV-positive. “This is especially a threat at the time of first diagnosis if the patient has had previous mental health problems. Many do not know how they will manage to live with the condition and experience despair and hopelessness.

“Other crisis points come later when they experience loss of relationships or income and again when they start to develop diseases such as tuberculosis (TB) and Kaposi’s sarcoma that are often associated with full-blown Aids. This is particularly the case in communities where the stigma of being positive is still strong and people get little or no support, and can be rejected and ostracised.”

Naidoo said that substance abuse is also a problem linked to mental health in people with HIV/Aids. “Patients may try to self-medicate with alcohol or drugs in order to cope with their difficulties. It is also common when people experience another mental health problem on which there is no emphasis at all: pain disorders. People will go to health care facilities for physical problems, but will not talk about the pain they experience unless they are asked. Pain is often severe and under-diagnosed, and can itself cause depression and increased suicide risk. The pain people experience can progress from the mild pains that healthy people experience such as headaches or muscle pains, to the severe pain of cancer, lung infections or skin conditions, which are often experienced in more advanced stages. Chronic pain occurs in up to 80% of Aids patients.

“A frequent condition in HIV patients that arises from the HIV infection is peripheral neuropathy, damage to the peripheral nervous system, which is difficult to treat. This can cause constant pain that really impacts on people’s day-to-day functioning. It is important for medical practitioners to be aware of this issue of pain; specifically ask about it and treat it aggressively.”

Another HIV-related mental health issue that receives little attention is post traumatic stress disorder (PTSD). Naidoo explained: “This is particularly the case when a patient has contracted the disease under traumatic circumstances such as rape or abuse, which is common, unfortunately. People have a ‘golden hour’ to take ARVs to prevent transmission. However, in the case of rape, many often wait for up to a week, until others persuade them to get help. In instances of abuse, they may never seek help and the abuse sometimes comes to light only as a consequence of the victim being diagnosed with HIV.”

Naidoo said awareness among the families and communities of people living with HIV and Aids could help them manage mental health problems. “To gain access to ARVs, patients are required to have a ‘buddy’ who helps ensure that they take their medication. It also helps if their family becomes involved too. These people could also help look out for symptoms of psychological difficulties and encourage family or friends to get help [see box for mental health care facilities].

“After that, they can help make sure they co-operate with whatever treatment is prescribed, whether medication and/or therapy. However, the most important things for someone diagnosed with HIV are acceptance and support. Whether it is dealing with mental or physical or emotional health issues, patients need loving, supportive people around them.”

• Depression

If you have a family member or friend who is living with HIV or Aids, who has some of the following symptoms for two weeks or more, encourage that person to seek help:

• depressed or “low” mood;

• looking sad;

• feeling hopeless, worthless or guilty;

• loss of interest in things that used to interest them;

• loss of appetite;

• weight loss or gain;

• loss of energy;

• difficulty thinking, concentrating or making decisions;

• trouble sleeping or sleeping a lot; and

• thoughts of death or suicide.


• Aids Hot Line phone number: 0800 012 322.

• Find the nearest clinic where you can get help and information on HIV and Aids at the website:

• All local clinics and state hospitals in Pietermaritzburg (Grey’s, Northdale and Edendale) have affiliated voluntary counselling and testing clinics (VCT). —

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