We were having a drink at Taidys restaurant in Nakuru town with my friend Charity (not her real name) when a friend popped in unannounced and took a seat next to her.
Charity seemed excited to meet Jane (not her real name) though I was uncomfortable because my real intention was to have an official discussion with Charity about our work at PDO.
Jane did not waste time and she ordered a coconut flavored spirit on Charity’s bill. That immediately triggered Charity to ask me to “talk to her”! A bit confused by her coded message, she came to my rescue by adding, “unajua huyu anakunywa dawa” (you know she is taking drugs).
From my experience working as a mental health advocate at PDO, I did not need further clarification to decode the message. Jane is a person living with HIV/AIDS. Charity felt I stood the best chance in helping Jane with her alcohol addiction, which was reacting badly with her ARVs.
I turned on to Jane, reassured her that she was in safe hands. Before I could compose myself and switched my mind from the planned meeting with Charity to now an assessment of substance abuse addiction, Jane was animatedly sharing with me her life story.
She definitely has been looking for someone she can talk to about her psychological challenges, a problem many People Living with HIV/AIDS (PLWHA) face after collapse of many donor funded HIV/AIDS project in the last few years.
Jane explained that she had married an older man after college, attracted by the financial security it provided. She was desperate after a few months of tarmacking.
She had two options, to go back to the village and wait for whatever opportunity life brings or to give in to a man who had pursued her without success since college days.
She went with the second option and entered into a come-we-stay marriage with a man she had turned down many times only now to become the first man in her life.
In a few months, she was pregnant and in two years, she was kicked out with one child, after many months of neglect and domestic abuse. To feed her son, Jane took odd jobs hawking second hands clothes and working as a bartender.
Unfortunately, when she was thrown out, Jane not only left with one child but she also carried the HIV. The psychological trauma of being thrown out with the two ‘burdens’ took a toll on her and soon alcohol became her consolation.
That was eight years ago. Today, Jane like many PLWHAs is battling four psychological challenges – depression, anxiety, alcohol addiction and suicidal behavior. She is facing the ‘new beast’ in the fight against HIV/AIDS – psychological sequelae (a condition resulting from a disease).
HIV infection affects all dimensions of a person’s life: physical, psychological, social and spiritual. Counselling and social support can help people and their careers cope more effectively with each stage of the infection and enhance quality of life.
With adequate support, PLWHA are more likely to be able to respond adequately to the stress of being infected and are less likely to develop serious mental health problems.
However, this is not happening as complacency takes root in the fight against the pandemic in Kenya.
It is not surprising that Kenya has experienced a dramatic rise in HIV infection in the last decade, according study by Global Burden of Disease collaborative network, published last month in The Lancet HIV.
Between 2005 and 2015, the number of new HIV cases rose by an average of 7 per cent per year, one of the highest increases in the world.
The study showed that the number of new HIV infections in Kenya is rising faster than in any other country in sub-Saharan Africa.
“In the early 1990s everyone knew what HIV was all about because they were investing significantly in marketing testing and counselling,” said Nduku Kilonzo, the Director of the National Aids Control Council (NACC).
She added, “We must fund HIV prevention, care and treatment. Currently, there is no government budget for the same. We need to put systems in place and not just rely on projects”.
According to Financing Global Health 2015, a report published in April by IHME, annual funding globally for HIV/AIDS peaked at US$11.2 billion in 2013, but dropped to US$10.8 billion in 2015.
In Nakuru, many HIV/AIDS projects have wound up leaving many PLWHA without the psychosocial support they received earlier. Programs on peer support groups, home visits by community volunteers, peer counselors and other outreach activities are the most affected.
It may not be clear whether we are experiencing burn out by practitioners, donors or the community, but what is clear is that this complacency is costing us dearly.
Studies have shown that a range of psychological interventions can make a considerable difference to the long-term health and well-being of someone living with HIV, including how well they manage their condition and adhere to treatment.
There is a powerful public health argument for investing in psychological support services for people living with HIV; those receiving appropriate support are less likely to miss medication or engage in unsafe sex – both scenarios in which increase the risk of onward HIV transmission to other people.
People with mental health problems are at greater risk of HIV infection, and people who have been diagnosed with HIV are more likely to develop a mental health problem, for example anxiety or depression.
Sadly, there is strong evidence that there is higher prevalence of mental health problems amongst people living with HIV compared with the general population.
In South Africa, 38% of people living with HIV have a common mental health disorder. This is more than triple the incidence of mental health conditions for the general South African population.
A study in India found that 58.7% of PLWHA were depressed. The prevalence of depression was higher in females (61.3%) as compared to males (58.1%) and transgender (50%).
Some ART drugs are known to cause depression as a side effect. This explains the high rates recorded in India.
In July, the government announced it would provide all persons infected with the virus access to Antiretroviral Therapy free of charge at public health facilities throughout the country.
Very good news indeed but again, the government proved that it was only interested is tackling on one half of the problem – the physical health.
This emphasis on attacking the virus in the body and leaving the sequelae that it causes means that the objectives of the treatment will not be fully met, for obvious reasons that the government is ignoring.
The psychological conditions associated with the HIV/AIDS lead to less adherence to treatment, engagement in risky sexual behavior and predisposes one to substance abuse.
Other problems include the impact of mental ill health on the body’s immunity, the general well-being of the patient and their families, and the support system – the family, caregivers and peers.
Until we attack the virus and the ‘new beast’ - it sequelae together, we are fighting a losing battle as the new infection rates are stubbornly telling us.
At PDO, we are looking forward to collaborating with partners who believe that providing psychosocial support to PLWHA enhances their well-being and ultimately reduces the spread of the virus.
Please visit our Facebook page below and engage with our counselors. Do not suffer in silence.
The Author is the Founder/CEO of Psychiatric Disability Organization, which campaigns for compassion and support to people suffering from mental illnesses including addictions. He can be reached on: iregim@gmail.com, Website: http://www.pdokenya.org/ Facebook: https://www.facebook.com/Psychiatricdisability/