With the passing of Nelson Mandela, the world's attention has turned to South Africa and the important work he did to fight apartheid and inequality. Mr. Mandela also worked tirelessly to reverse the catastrophic effects of rampant HIV infection among South Africans. Up to 20% of women of reproductive age are HIV positive there, and overall estimates put 11% of the population infected. Those rates are staggering compared to the rest of the world - here in the U.S. HIV prevalence is estimated at 0.4% and European rates are around 0.3%.
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| Image via Kaiser Family Foundation |
Thankfully, anti-viral medications like HAART have changed HIV from a death sentence to a chronic condition that, with proper treatment, many people are able to live with for decades. Because I'm old, I remember when AIDS first appeared in the early 1980s in the mainstream consciousness, including watching the story of Ryan White unfold up until he died at the young age of 18. People were afraid and HIV stigma was rampant.
Simply getting diagnosed with HIV is traumatic. The negative social fallout that many people experience only compounds the emotional response. Even 30 years later, ignorance about HIV remains and about a quarter of people with HIV/AIDS report discrimination or stigmatizing experiences, even from healthcare providers.
Now that people are living longer with HIV, what are some of the mental health effects we see?
- Approximately 22% of people living with HIV/AIDS will develop depression. This can come from several factors - emotional reactions to having the diagnosis and all that goes with it, side effects from HIV medications, or changes that happen to structures in the brain from the disease itself.
- Around 16% of people with HIV/AIDS have significant anxiety. 11% have had recurrent panic attacks. Women seem to be more affected than men. Researchers have found that as people live longer, rates of anxiety are increasing.
- Sleep problems and insomnia are a real problem for many people with HIV/AIDS. Up to 40% say they've had trouble sleeping in the previous year, sleeping less than 6 hours per night. 10-20% say their insomnia is severe.
- Suicide rates among people with HIV/AIDS are 3 times that of the average population, which is a significant reduction from before effective medications were discovered.
- Mental health issues are predictive of poorer outcomes but the reasons for this are complex. People may skip medication doses or engage in other risky behavior. Stress has direct effects on the immune system, and may play a role in exacerbating HIV.
We've come a long way in the past 3 decades in treating HIV and reversing the fate of people who become infected by this virus. Stigma has improved but remains a significant problem, and people living with HIV/AIDS are showing many of the same mental health effects we've seen with other chronic illnesses. There's still much to be done.
"Difficulties break some men but make others. No axe is sharp enough to cut the soul of a sinner who keeps on trying, one armed with the hope that he will rise even in the end." ~ Nelson Mandela
Best,
Dr. T.