by Dr Anna Walder, Psychiatry Trainee
South Africa has a 12-month prevalence of depression of 4.9%[1]. The prevalence of HIV in South Africa is 19.2%[2]. Depression is the most common psychiatric disorder experienced by people living with HIV. Understanding the interplay between the two disorders and the challenges, when assessing and managing both the HIV and depression is vital to ensure the needs of the person are addressed.
For people living with HIV who have depression, there are many issues that arise. Depression can be misdiagnosed as HIV apathy and vice versa. Depression in a person living with HIV can present with predominantly somatic symptoms. These may be attributed to the HIV illness rather than depression, which then goes undiagnosed and untreated. Untreated depression leads to poor compliance with treatment; missed clinic and hospital appointments, isolation from family and communities, all factors that are known to lead to a poor prognosis.
Depression is one of the known risk factors for poor antiretrovirals (ARV) adherence. Studies have shown that successful treatment of depression with medication or psychological intervention improves adherence with anti-retroviral treatment[3]. Appropriately managing the depression has a vital role to play in managing the HIV condition.
However, the ARV treatment does come with its own risks, it is known that anti-retroviral medications may lead to neuropsychiatric side-effects, Efaverenz being the most high-risk. This must be taken into consideration when deciding on treatment regime.
The needs of people living with HIV and severe mental illnesses such as depression have been increasingly identified as requiring specialist input. In 2006 the Neuropsychiatric Division of the Department of Psychiatry and Mental Health in Groote Schuur Hospital, Cape Town, was opened. It has since grown to encompass much more with clinical, teaching and research programs.
Despite awareness campaigns addressing stigma and discrimination, people suffering from depression often are unable to access care. The fear of being stigmatised can often prevent people with HIV accessing care for their depressive illness. The South African Depression and Anxiety Group[4] is the country’s largest advocacy group. They provide awareness services, advocacy, support groups and outreach work. This is a vital part of identifying people in the communities living with HIV and Depression and ensuring they get the treatment they need.
Telephone hotlines:
Childline South Africa Hotline: 08000 55 555
Befrienders South Africa Hotline: 051 444 5691, e–
Lifeline Southern Africa Hotline: 0861 322 322
The South African Depression and Anxiety Group (SADAG) Hotline: 0800 567 567, SMS: 31393
OUT (LGBT) Helpline: 0860 688 688
References
[1] Herman, A.A., et al. (2009) The South African Stress and Health (SASH) study: 12- month and lifetime prevalence of common mental disorders. S Afr Med J 99: 339-344.
[2] http://aidsinfo.unaids.org/
[3] Moosa et al. (2012). Treating Depression in HIV-positive Patients Affects Adherence. Southern African Journal of HIV Medicine. 13:3
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