Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) some of the most overwhelming illnesses in the history of mankind. Global HIV statistics shows that out of 37.9 million [32.7 million–44.0 million] people were living with HIV (end of 2018), 24.5 million [21.6 million–25.5 million] people were accessing antiretroviral therapy at the end of June 2019. About 1.7 million [1.4 million–2.3 million] people became newly infected with HIV (end of 2018), 770 000 [570 000–1.1 million] people died from AIDS-related illnesses same year1.
It is no longer news that South Africa is one of the countries with highest number of people living with HIV globally. According to Department of Statistics South Africa2, the estimated overall HIV prevalence rate is approximately 13. 50% among the South African population. The total number of people living with HIV (PLWHIV) is estimated at approximately 7. 97 million in 2019. For adults aged 15–49 years, an estimated 19. 07% of the population is HIV positive. The disease, like any other chronic illness, can have an effect not only on the immune system of the body but also on the psychiatry state of the infected individual.
Epidemiological analysis of reported HIV/AIDS cases reveals that HIV/AIDS is affecting mainly young people in the sexually active age group (18 to 30 years). Women are disproportionately affected by HIV in South Africa. In 2017, 26% of women were estimated to be living with HIV, compared to around 15% of men3. In 2018, 140,000 women and 86,000 men became HIV positive. In the same year, 4.7 million women were living with HIV compared to 2.8 million men4. Poverty, the low status of women and gender-based violence have all been cited as reasons for this disparity in HIV prevalence5. The HIV prevalence among young women is nearly four times greater than that of young men6.
In most developing countries, stigmatization of people who have terminal illnesses associated with social behaviors viewed by the society as negative, does not only push the patients to being reclusive, but denied them the urge to seek necessary required medical attention; in some extreme cases, depression. Stigmatized people often show psychiatric symptoms7, a situation which leads to the definition of depression in some cases to be misinterpreted, even among clinicians, especially when symptoms and diagnosis are considered. This leads to a confounding confusion that often results to patients and family members portraying different things when they use the word depression, and some clinicians do find themselves using the same word but lack a common understanding.
According to Alan and Heather7, depression is considered a pathological and pervasive state of mood, where a depressed individual sees everything—self, world, and future—through a dark prism. These pathological signs include feelings of helplessness, hopelessness, and worthlessness, among many. However, depression is not sadness, given that patients who recover from depression often report being relieved to feel normal sadness again, though some of the depressive symptoms include persistent sad, anxious, or “empty” mood7.
Depression is associated with both genetic (scientific) and negative life experiences (social). The two factors play parts in an individual’s vulnerability to become depressed. This study however, considered HIV as some social aspects of etiology of depression. Stigmatization, arising from HIV, constitutes part of negative life experiences which may leave traces on the brain that adversely affect future responses to life circumstances and the probability of developing anxiety and depression. However, HIV infection itself does not cause depression, nor does the progression of the disease automatically lead to depression. Critical “crisis points” are common “entry” points of a depressive state in HIV-infected individuals. These crisis points include but not limited to level of tolerance to discrimination, abuse and difficulties in accessing HIV-related therapy such as easy access to ARVs, among many.
Depression is a mental disorder that is pervasive in the world affecting everybody irrespective of gender, race or age. It does not only pose a substantial public health challenge at social and economic level, but is also a significant contributor to global burden of disease affecting all communities across the world8. The correlation of HIV and depression is viewed from the perspective that, HIV disease, like any other chronic illness, can have an effect not only in the body but also in the mind. A number of reasons are cited for the presence of psychiatric disorders among people with HIV. The HIV infection enforces a considerable psychological burden with depression seen as the most common psychiatric disorder among HIV-positive adults8. In fact, the combined effects of the virus on the central nervous system, the psychological impact of living with HIV, side effects of medication9 and results of social stigma and discrimination constitute some of the reasons for the high level of mental disorders affecting people living with HIV. In addition, economic cost of treating the HIV disease and the difficulties in accessing ART can trigger depression in HIV population. Two decades ago, WHO10 findings show that mental health disorders are common and affect one in four individuals (24%) at some time in their life, though prevalence may vary from country to country with the overall prevalence of depression at approximately 10%. In Africa, prevalence rates of major depressive disorder11 ranges from 3% to 54%, meanwhile the prevalence of depression in HIV-positive individuals in South Africa12 range from 5% to 20%. Among South Africans living in rural communities, the prevalence of mental disorders is reported to be 23.90%, and 4.80%, and depression is one of the major disorders13. Moosa and Jeenah14 have reported a high prevalence of comorbid depression among HIV positive individuals. The HIV-infected South African population could then be in danger of added burden of mental disorders in their lives.
Depressed persons with HIV frequently become non-adherent with their treatment, which may lead to higher HIV viral loads, higher infectiousness and poorer clinical outcomes15. When depressed, a patient exhibits symptoms associated with risky behavior, non-adherence to medications and shortened survival16. Failure to recognize depression may endanger both the patient and others in the community.
Despite the huge impact of HIV/AIDS on public health, there is limited information about the prevalence of depression among HIV-patients on ART and the factors associated with depression. Therefore, this study was conducted to establish the prevalence of depression and associated factors such as demographics, difficulties in accessing ARV, economic cost of treating HIV and alexithymia among HIV patients receiving ART in the rural communities of O.R. Tambo municipality of Eastern Cape, South Africa.