YOLISA: In a study conducted at Wits University’€™s School of Neurosciences it has emerged that mental disorders in people who are attending HIV treatment are quite widespread.

DR RITA THOM: If one looks at the current diagnostic profile, what we found was that just over 30 percent of the people we interviewed had a current mental disorder.

YOLISA: Dr Rita Thom, who conducted the study, says it was done to determine the occurrence of mental disorders in patients attending various HIV-treatment sites in South Africa. The study was conducted at four sites in two provinces, Limpopo and Gauteng. A sample of over 300 people was used. Thom says international studies have shown significant increases in mental disorders in HIV infected people. But in Africa research has been limited.

DR RITA THOM:   There’€™s very little epidemiological data on mental disorders in South Africa in the general public. So, in order to compare what is happening in people who are HIV infected attending treatment sites, there isn’€™t really anything that one can compare that against. You know, to say that in the general community the prevalence is actually the same or it’€™s less.

YOLISA: Thom says even so, one thing is clear – intervention is needed.      

DR RITA THOM: I think one of the primary things is to give the generalists, or the people working in the physical health services that are seeing people with HIV, to make them more aware of the fact that people are very likely to have mental disorder, to give them tools to assess and to screen for mental disorder. That would be the primary thing because I think what is happening is that a lot of these are being missed so people are going untreated.

YOLISA: Dr Rita Thom is also the convener of HIV Special Interest Group for the South African Society of Psychiatrists (SASOP). Last month the society released a statement highlighting that HIV infection and mental health are intimately connected in a number of ways.   Depression and dementia are just some of the illnesses mentioned. But the illnesses are not confined to psychiatric problems. A large number of the people who were sampled for Thom’€™s study fell into a category they refer to as ‘€œV code’€.

DR RITA THOM: The V code in psychiatry is a problem or condition that is not a mental illness or mental disorder but it requires intervention. For example; a relationship problem or bereavement or a school problem. So it’€™s not a mental disorder but is something that still needs attention. Almost half of the participants had some problem that required an intervention, psychosocial or psychiatric intervention.    

YOLISA: Even though there’€™s clearly no extensive research that has been done regarding this, there is general acceptance of the need to pay close attention.

DR RITA THOM: Ideally, what should happen is that, at HIV treatment sites, there should be access to mental health care, as in a one-stop kind of service. That’€™s ideal. However we don’€™t have an ideal setting. So we have to look at ways to make it easier. Some of the ways that we can do that is to make people who are working with HIV more aware of how significant the mental disorders are, so that they can identify them as the first step. Provide training so that they are able to manage the mental disorders at a primary level and then to know who to refer to, where to refer, if the problems are beyond their capacity.  

YOLISA: The current setting is far from ideal though. Even those caring for the HIV positive people have mental health problems. A recent research project by the largest mental health NGO ‘€“ South African Depression and Anxiety Group; SADAG reflects that 89% of Home Based Care workers are themselves suffering from depression.  

Thom says that if a disorder is identified, a person will be referred to a psychiatric service or to a community mental health clinic.      

DR RITA THOM: The person has to go somewhere else and make an appointment to be seen somewhere else. Very often you find that it’€™s not possible and so that disorder ends up being untreated.

YOLISA: The SA Society of Psychiatrists emphasizes that both the public and people treating HIV infection should be aware of the mental manifestations of HIV infection. These range from minor intellectual difficulties such as poor concentration, to serious memory problems and sudden onset of psychiatric symptoms such as psychosis.

So it seems even though Dr Thom’€™s study was done on a relatively small scale, it highlights a much larger problem.

DR RITA THOM: The conclusions that we can get from this study is that a significant number of people with HIV infection who are attending HIV treatment sites, do have a mental disorder that needs treatment and that depression in particular is a significant problem, and that significant numbers of people need mental health intervention