Exploring how PLWHA with co-morbid depression perceive depression and mental health services.

Abstract

Background: South Africa, like many low and middle income countries (LMICs) continue to bear the excessive burden of HIV/AIDS. This problem has been further compounded by the growing prevalence of common mental disorders such as depression, which are often comorbid with HIV/AIDS. There is growing recognition of the seriousness of the co-morbidity of common mental disorders, primarily depression with HIV/AIDS. Literature suggests that co-morbidity between depression and HIV leads to reduced adherence to Anti- Retro-Viral Therapy (ART) and Accelerate the progression of HIV. In the context of a scarcity of mental health services, this is of particular concern. Aim: The aim of this study is to explore how PLWHA with co-morbid depression perceive depression and mental health services. The secondary aim of the study is to learn about their perceptions of acceptable interventions. Method: This study used a qualitative design. Qualitative data was obtained from 15 participants attending a large primary health facility through semi-structured interviews. The participants were recruited through a two stepped process with initial inclusion criteria being that participants were HIV-positive and had to meet the diagnostic criteria for major depressive disorder (MDD) using the Structured Clinical Interview for DSMIV Diagnosis (SCID). Thematic analysis, specifically the Framework approach was used to analyze the collected data. Results: Findings from the study attest to the lack of mental health services for PLWHA who suffer from depression. It emerged from the findings that all the participants had no knowledge of any mental health services that might be available. A factor that stood out was that of low levels of mental health literacy as a strong barrier to seeking or even inquiring about mental health services. With regard to appropriate interventions, participants expressed a strong preference for support groups as compared to being helped as individuals. Conclusion: The scarcity of mental health services for people suffering from mental illness continues to be a pressing challenge in South Africa. Depression co-morbid with HIV poses numerous challenges that continue to threaten the wellbeing of PLWHA with co-morbid depression. Further, some determinants of depression such as poverty also pose a great threat to the ART programme by interfering with ART medication adherence. In attempts to address the problem of the shortage of specialized mental health personnel, many writers and researchers have advocated and called for task shifting as a possible relief to the scarcity of these vital services. However more studies are needed that demonstrate the effectiveness and feasibility of task shifting.