Background: In South Africa the rising comorbidity of mental disorders
with other non-communicable and communicable diseases, particularly in
people living with HIV/AIDS (PLWHA), has helped raise the public health
priority of mental ill-health. Depression, in particular, compromises
anti-retroviral treatment (ART) adherence and virological suppression,
thus threatening the effectiveness of South Africa’s ART programme.
Given that evidence-based treatment for depression comprises medication
and/ or Western-derived psychotherapies, responding to the current
interest in expanding mental health services for PLWHA demands an
understanding of how best to provide culturally competent care within
existing resource constraints.
Aim: To explore the context and local understandings of depression in
women living with HIV to inform the development of contextually
appropriate mental health services that could be delivered within
existing resource constraints inSouth Africa.
Method: Semi-structured qualitative interviews were held with 35 women
living with HIV in South Africa who met the diagnostic criteria for a
major depressive disorder.
Results: Being HIV-positive per se was not reported to be a major cause
of depression. Instead, a number of social factors were reported. These
included stigma and discrimination, poverty, and stressful life events.
Symptoms of depression, especially social withdrawal, negative
ruminating thoughts and excessive worry suggestive of comorbid anxiety,
functioned to exacerbate and trap women in a negative depressive cycle.
Social support emerged as a dominant coping strategy. Group-based
interventions, which afford greater opportunities for improved social
support, were mooted as the most appropriate intervention by the
majority of participants. Individual counselling provided through a home
visitation programme was suggested for those who were too ill or too
poor to attend clinics. Task sharing was also endorsed.
Conclusion: The need for multi-sector engagement in mental health
promotion to address factors that trigger, maintain and exacerbate
depression at a community level in PL-WHA is highlighted. The triggers,
symptoms and local coping strategies employed by afflicted women in this
study suggest a resonance with Western derived evidence-based
psychological therapies. In relation to delivery channels, there was
support for the provision of group interventions or home-based
individual counselling using a task sharing model.
Petersen, I.; Hancock, J.H.; Bhana, A.; Govender, K. Closing the treatment gap for depression co-morbid with HIV in South Africa: Voices of afflicted women. Health (2013) 05 (03) 557-566. [DOI: 10.4236/health.2013.53A074]
Closing the treatment gap for depression co-morbid with HIV in South Africa: Voices of afflicted women