Treating HIV and mental health in Malawi

 

Zomba – There is a direct relationship between HIV and mental health, says Harry Kawiya, a clinical officer and psychologist at Zomba Mental Hospital in Malawi’s colonial seat of government, Zomba.

Zomba Mental Hospital is the country’s largest referral mental health facility. The psychologist says sometimes mental health leads to the progression of HIV through stress and anxiety.

“Anxiety and emotional stress about property, family, community rejection and poverty as well as just the mere knowledge of having the virus that causes AIDS lead to negative chemical changes in the body thereby reducing immunity and subsequently hastening the onset of HIV-related problems,” Kawiya said.

He added that that stress also reduces appetite, leading to missing meals, and so causes food to be burned up too fast.

Studies indicate that people facing health stressors are likely to have their HIV status progress to full blown AIDS and die sooner, leaving children orphaned at a young age.

“If they can be assisted to reduce these stress factors, their whole family and community will gain,” says a report by Helen Jackson, who adds that helping HIV-positive people survive longer is not only an exercise in humanitarian relief but also a sound developmental strategy.

Kawiya says that the hospital knows patients with HIV through information obtained from their guardians at the time of admitting the patients to be treated as in-patients.

“But where the wardens do not disclose, the patients themselves reveal their status or are diagnosed through diagnostic testing which is done after a mental patient is found not to be responding to other treatments of opportunistic infections,” he says.

Susan Bwanali, the ART Coordinator at the referral psychiatric facility, says that in most cases patients are brought to the facility without ARTs, “a situation which aggravates opportunistic infections”.

Bwanali says mostly patients likely to be HIV positive are those with persistent syphilis acquired outside the facility before being confined to be treated for mental illness.

Strong links exist between STI and HIV programmes in Malawi. 

The prevalence of syphilis, for example, is monitored together with HIV through the sentinel surveillance surveys.

As part of STI services, patients are treated, counselled and tested for HIV. A 2006 study report states that 12.5 percent of female sex workers tested positive for syphilis ‑ with prevalence of syphilis estimated at 36 percent.

Kawiya explains that after patients are stabilised from their mental illnesses, a counselling session is held to get as much information about their health condition including the patients’ possibility of having HIV.

“Those found to be positive as well as the ones found eligible for medication for treatment are put on ART,” says Bwanali.

In Malawi, HIV positive individuals move through CD4 compartments, selected on the basis of eligibility criteria and mortality patterns.

Many HIV-related parameters vary as a function of CD4 count: progression to lower CD4 counts, HIV-related mortality, probability of initiating ART and infectiousness.

“Depending on the eligibility criterion and the level of first line ART coverage, a percentage of those eligible for treatment will start first line ART,” she says explaining that the hospital does not have a CD4 testing machine, which requires patients to be taken kilometres away to Zomba Central Hospital.

By the fourth quarter of 2012, CD4 testing machines were available in less than 15 percent of HIV services sites in Malawi. The sites with CD4 testing capabilities are likely located in sites of highest need for treatment, and they likely serve more than 15 percent of CD4 testing needs.

But efforts in the country are being put that ART should be provided to all adults, irrespective of CD4 count, without an intermediate CD4 < 500 step, as the additional treatment costs would be outweighed by impact benefits, and by the cost of strengthening the pre-ART program in terms of CD4 monitoring.

Bwanali says that since the inception of the ART Clinic at the psychiatric hospital in 2010, about 72 patients have been treated for HIV with 27 active members still receiving the treatment at the facility.

Meanwhile, Kawiya bemoans that the mental hospital is being excluded from most national HIV programming.

“We struggle to find supplements for the patients on ART and since they require special kind of nutritional diets, not much is done to improve on this,” he says explaining that the hospital only manages to provide porridge with grounded groundnuts twice a day to patients living with the virus and in need of nutritional support.

November 2013
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