By Lucca Munnik
An HIV diagnosis has huge effects on an individual’s life, not only physically but also psychologically. This is demonstrated by the fact that 50% of PLWH (people living with HIV) develop one or more psychiatric disorders1. This concept has been researched in terms of cause and effect between the virus and mental health. HIV-stigma, discrimination and trauma cause psychosocial issues to arise thereby strengthening the negative effect of HIV on mental health. Thus, it is important to understand this relation in order to create change to those living with both HIV and mental health issues.
Influences on mental health
There are various suggested causes of mental health issues in which enacted stigma and self-stigma are core influences. Enacted stigma refers to a misconceived societal image of the virus. This is the external negative understanding that society has of HIV and often results in prejudice. Self-stigma is the negative internal perception experienced by PLWH. It is based around perceptions of themselves and often these are due to societal rejection (enacted stigma) of HIV1,2. In relation to these concepts, research has discovered stigma to be linked to lower help-seeking behaviour as well as decrease in medication adherence. This is partly due to the stigma of taking medication and the fact that in order to seek help, one has to disclose their diagnosis, making one vulnerable to societal rejection1.
Discrimination serves as another influence and is a result of enacted stigma. One of the major reasons for discrimination is the irrational fear of the virus itself and contracting the virus by contacting PLWH.2 Majority of the time, society is uniformed thereby developing misconceptions. Some forms of discrimination include refusal to help, unwillingness to accept PLWH and ignoring their concerns. This deeply affects them as they feel isolated and alone in their suffering. Furthermore, it is possible for loved ones to reject PLWH, intensifying their loneliness and guilt. When we analyse the discrimination of PLWH, we notice that it is based on ignorance and irrationality, serving as further reasoning for educational campaigns about HIV & AIDS2. Finally, trauma is often prevalent in PLWH and can create a negative effect on them. Studies demonstrate that individuals who have a history of trauma are more likely to view their HIV diagnosis as a form of trauma itself. This becomes problematic when PLWH are more likely to engage in risky behaviours and less likely to engage in healthy behaviours3. Thus, stigma, discrimination and trauma are major influences of psychosocial issues.
Psychosocial issues
As a result of the above influences, there are many psychosocial issues affecting PLWH. Emotions, including loss, grief and hopelessness, are all responses to HIV. PLWH experience loss of privacy and control over their lives. They experience grief due to these losses and subsequently, feel hopeless. In relation to this, guilt and self-esteem are indicators of HIV stigma and shame. PLWH may feel responsible for the possibility of infecting others as well as feel guilty for contracting the virus thereby blaming themselves. These are irrational reactions and one of the reasons for them is social stigma. Furthermore, PLWH develop a low self-esteem influenced by social rejection, creating a sense of worthlessness. Thus, low self-esteem is exacerbated by HIV symptoms2.
There are some psychiatric disorders that are considered psychosocial issues brought on by HIV. PTSD (Post-Traumatic Stress Disorder) is a common psychiatric disorder associated with HIV. PTSD is a trauma and stress-related disorder in which the individual develops characteristic symptoms in response to a traumatic event. Symptoms include avoiding thoughts and memories towards the event and a persistent negative emotional state4. With regards to PTSD experienced by PLWH, the stress of coping with the virus can sometimes increase negative progression of the infection1 and can also be associated with less social support and more traumatic experiences.
Depression is another common disorder associated with HIV. It is a mood disorder in which the individual experiences persistent sadness. Other symptoms include lack of desire to partake in pleasurable activities and feelings of worthlessness. It is considered a complex mind and body disorder but can be treated with therapy and medication4. Research has been conducted on the symptoms of depression and their relation to HIV. PLWH often blame themselves as a way to cope with the virus, leading to the increase of depression symptoms. However, this is not a healthy coping strategy, further demonstrating why treatment is vital. Depression has also been linked to negative medication adherence1 and the less likelihood of starting antiretroviral medication3. Furthermore, there is an increase of the individual developing low self-worth which is enhanced by the misconceptions of HIV1. Finally, anxiety symptoms often co-occur with depression and PTSD and develop for various reasons: lack of social support, stigma, and the reoccurrence of physical HIV symptoms. As a result of these psychiatric disorders, PLWH experience the threat of suicide; an unfair reality of the challenges brought upon by HIV stigma and discrimination5.
Youth in context
We can examine the relation between HIV and mental health in the context of youth. This is important because they make up nearly half of new HIV infections worldwide. Major difficulties experienced by youth living with HIV include: psychological distress, social aspects (friends, partners and family) and HIV-status disclosure. It is also noted that mental health, specifically depression, affects youths’ adherence to HIV medication6. Furthermore, research suggests that young adults face general challenges towards treatment as they are least likely to be diagnosed and prescribed ARV7. Youth living with HIV also experience stigma. This stigma influences lack of disclosure as young people fear being ostracized by peers and sexual partners. This lack of disclosure reinforces isolation and avoidance of seeking support8. Subsequently, youth living with HIV face suicide risks and are in fact, the most common population to experience this risk2.
Due to the research mentioned above, it is evident that there is a strong correlation between HIV and mental health in terms of influences and their results. This proves to be a major obstacle to PLWH. Thus, it is important to implement interventions to support PLWH in the response to HIV and psychosocial issues. These psychological interventions (including treatment and support) will be discussed in the next article.
1 Blashill, A., Perry, N. and Safren, S. (2011). Mental Health: A Focus on Stress, Coping, and Mental Illness as it Relates to Treatment Retention, Adherence, and Other Health Outcomes. Current HIV/AIDS Reports, 8(4), pp.215-222.
2 Fabianova, L. (2011). Psychosocial Aspects of People Living with HIV/AIDS. In: Social and Psychological Aspects of HIV/AIDS and Their Ramifications. Croatia: InTech, pp.175-203.
3 Whetten, K., Reif, S., Whetten, R. and Murphy-McMillan, L. (2008). Trauma, Mental Health, Distrust, and Stigma Among HIV-Positive Persons: Implications for Effective Care. Psychosomatic Medicine, 70(5), pp.531-538.
4 Diagnostic and statistical manual of mental disorders. (2013). 5th ed. Arlington, VA: American Psychiatric Association.
5 Kemppainen, J., MacKain, S. and Reyes, D. (2013). Anxiety Symptoms in HIV-Infected Individuals. Journal of the Association of Nurses in AIDS Care, 24(1), pp.S29-S39.
6 Lam, P., Naar-King, S. and Wright, K. (2007). Social Support and Disclosure as Predictors of Mental Health in HIV-Positive Youth. AIDS Patient Care and STDs, 21(1), pp.20-29.
7 Shacham, E., Estlund, A., Tanner, A. and Presti, R. (2016). Challenges to HIV management among youth engaged in HIV care. AIDS Care, 29(2), pp.189-196.
8 Mutumba, M., Bauermeister, J., Musiime, V., Byaruhanga, J., Francis, K., Snow, R. and Tsai, A. (2015). Psychosocial Challenges and Strategies for Coping with HIV Among Adolescents in Uganda: A Qualitative Study. AIDS Patient Care and STDs, 29(2), pp.86-94.