‘At first I couldn’t understand what was happening to me’, says Henry. I was working for a hardware store. So, something just came into my mind that ‘let me not go to work’. I couldn’t understand. I would wake up early in the morning, wash myself, get ready for work, but when I go out something just told me, ‘no, go back’. Then I’d go back. Then, I would undress, then, get into bed. It continued like that. Every time I woke up I said, ‘no, I’ll go back the next day. I’ll go back’. I couldn’t go to work for almost two months up until the 2nd of November. I was dismissed’, he says.
Nkululeko Ndebele, also from Meadowlands, Soweto, was admitted for psychiatric care at Chris Hani Baragwanath Hospital in December last year after an episode of hallucinations. While at the hospital, the now unemployed hair-stylist tested positive for HIV.
‘I was just talking things that do not exist. I would just talk and talk and talk. It seemed like I was a healer, like prophesising. Then they took me to Bara. They tested my blood and I was HIV-positive’, he says.
Both Henry and Nkululeko are receiving AIDS treatment and psychiatric care at the Luthando Psychiatric and HIV Clinic at Chris Hani Baragwanath Hospital. Luthando is the only specialised health facility that provides comprehensive AIDS care for people with mental disorders.
‘What we are trying to do is deal with the HIV within a mentally ill positive patient, make sure that their psychiatric condition has been properly diagnosed and is being properly treated, and in that way ensure that they remain within care. But, then, also to include all the other things, like TB treatment, identifying TB in these patients’, says head of clinic, Dr Greg Jonsson.
Since it started in 2008, about 450 HIV-positive psychiatric patients are taking treatment at Luthando. Nkululeko Ndebele started taking his treatment in December last year. He says his condition has ‘vastly improved’ and he’s only worried about one thing.
‘I’m worried about a job only. No, I’m no longer talking alone. I’m just worried about a job’.
Henry Nkosi reckons that he’s doing well, too.
‘Up until now I’m taking anti-depressant medication. I’m also taking ARVs. I can say I have improved a lot because I was taking’¦ for anti-depressants, I had to take two medications, but now I’m taking only one tablet a day. Before, it was three times a day’, he says.
The need for this clinic came about after it was discovered that public sector ARV clinics were failing to provide appropriate treatment to mentally ill patients who have HIV. One of the reasons was that doctors at these clinics believed that such patients could never adhere to taking their antiretroviral therapy. But Luthando Clinic has shown that there is no truth in the argument.
‘Our loss to follow-up rate is very similar to the loss to follow-up rates of every other ARV clinic. So, I think in terms of that we’re doing quite a good job. Patients are adherent to their treatment, they are engaged in their therapy and in many ways we’ve proved all those doctor biases wrong’, says Dr Greg Jonsson.