HIV/AIDS: Depression “overlooked” in treating HIV patients

Photo: Eva-Lotta Jansson/IRIN

Depression is the most common psychiatric disorder among HIV-positive people

ADDIS ABABA,  – HIV patients in Africa frequently suffer shame and depression but the continent’s health systems are ill-equipped to handle the issue, which not only affects their quality of life, but can lead to poor adherence to HIV treatment regimens.

While HIV programmes focus heavily on reducing externalized stigma and ill-treatment of HIV patients by society, little is done to deal with a patients’ self-perception and how that might deteriorate following an HIV diagnosis, speakers said at a session on stigma at the 16th International Conference on AIDS and Sexually transmitted infections in Africa in Addis Ababa.

Studies show that depression is the most common psychiatric disorder among people living with HIV, and is more prevalent among HIV-positive people than the general population.

“Operational research carried out in Zambia has found a positive correlation between patients who self-stigmatized and failure to adhere to treatment,” said Sikazwe Izukanyi from Zambia’s Ministry of Health. “Self-stigma was often found in patients who did not disclose their status to partners or family members – making it difficult to maintain strict adherence to regimens while trying to hide the drugs.”

Izukanyi noted that while counselling was a standard part of HIV care in Zambia, counsellors needed to be made aware of the prevalence of self-stigma and how to deal with it.

A 2010 Ugandan study by Makerere University found that HIV-positive patients were more critical of themselves, had significantly greater problems making decisions, poorer sleep, tired more easily, experienced more appetite changes and had more cognitive impairment.

ARVs and self-stigma

According to a study by Yordanos Tiruneh, an Ethiopian academic with US-based Northwestern University, antiretroviral (ARV) therapy has been key to reducing external stigma by minimizing the visibility of physical imperfections and restoring functional daily activities such as the ability to work. The study, which used 105 interviews with Ethiopian men and women on ARVs, also found that the support networks formed by people living with HIV gave them much-needed social capital.

However, according to Yordanos, while ARVs were linked to a reduction in external stigma, the study found that they tended to increase internalized stigma, sometimes resulting in failure to properly adhere to ARVs.

“When I think of the two tablets that keep me alive, I hate myself and I feel that I am dead,” one of the study’s interviewees is quoted as saying. “Sometimes I get furious to see myself like a walking corpse, and other times I see myself as a doll that functions with a battery. I would say, without these batteries [pills], I am nothing.”

According to a US study, adherence to ARVs was higher in patients for whom anti-depressants were prescribed.

A severe shortage of mental health professionals in Africa means that HIV-associated depression is largely ignored. For instance, according to the UN World Health Organization, Burundi has just one psychosocial care provider per 100,000, against a target of at least eight, while Ethiopia has less than one, against a similar target.

“The problem is largely a human resources one; while strengthening health systems, governments should remember to focus on mental-health issues,” said Izukanyi. “As it is, we have no systems for screening, diagnosing and treating patients with mental-health issues.”

Among other things, experts recommend integrating mental-health services into primary healthcare activities, developing mechanisms to ensure a good supply of psychotropic medication and more research into mental-health issues in Africa.

kr/mw
source www.irinnews.org

PHILIPPINES: Shelter key issue for Washi survivors

Photo: Courtesy of UNICEF

One month on, thousands of survivors are still in need

MANILA,  – One month after tropical storm Washi pummelled parts of the southern island of Mindanao, shelter remains the key challenge facing tens of thousands of survivors.

Tropical storm Washi hit two major cities, Cagayan de Oro and Iligan in northern Mindanao, and 800 neighbouring villages on 16-18 December, triggering large-scale flooding and landslides that affected more than one million people.

With more than 50,000 houses damaged or destroyed, some 26,000 survivors remain in 56 overcrowded evacuation centres, the country’s National Disaster Risk Reduction and Management Council (NDRRMC) reported on 17 January.
 
According to the UN Office for the Coordination of Humanitarian Affairs (OCHA), another 200,000 are in makeshift shelters or staying with host families.

“Our top priority at the moment is to ensure that shelter solutions are provided to all the displaced, including families from informal settlements and those living in areas deemed the danger zone,” Jacqui Badcock, UN Humanitarian Coordinator for the Philippines, told IRIN.

In the aftermath of the storm, the government declared strips of land within 20m of the Cagayan River, the country’s longest, and its surrounding islets as “no-build zones”. Many of the displaced lived in these areas.

The government and aid groups are now working to identify available land that could be used as temporary relocation sites while permanent sites are being constructed.

“We [the humanitarian community] are working closely with the government to ensure the relocations are voluntary, safe and dignified,” Badcock added.

Relocation is being done on a staggered basis. An initial 350 of the most vulnerable families, who were living along the riverbanks, have been moved to tents at a temporary relocation site in Cagayan de Oro.

Permanent relocation sites for those who lost their homes and those who cannot return to their areas of origin (declared by the government as “no build” zones) are due to open in July 2012, according to OCHA; however, the exact number of people to be provided with shelter or shelter-repair assistance remains unconfirmed.

Availability of land and property rights are an additional challenge, shelter experts say.

“Although a few relocation sites have already been identified and are being prepared, acquiring land for temporary and permanent shelters is a huge challenge,” Anna Pont, International Federation of the Red Cross (IFRC) shelter cluster coordinator in Mindanao, said.

“The land secured should optimally be close to people’s livelihoods or has to provide them with new livelihood opportunities,” Pont said.

Accessing remote areas

Photo: OCHA/The Philippines

Tents at a temporary shelter site in Cagayan de Oro

Meanwhile, local government and aid agencies are still struggling to reach those outside evacuation centres, particularly in remote and isolated areas.

One month on, communities outside Iligan and in parts of the Autonomous Region of Muslim Mindanao (ARMM) remain cut off and accessible only by air. Already affected by internal conflict, Washi has aggravated the vulnerability of these areas, aid workers confirm.

“The urgent needs are food, clothing and shelter,” Ben Aspera, head of the sub-office for the International Organization for Migration (IOM) in Iligan, confirmed.

Helicopters provided by the Philippine Army fly in supplies twice daily; however, their capacity is largely limited by both quantity and weight.

“We are able to fly in food, clothing and sleeping supplies. We cannot bring in heavy shelter supplies at the moment,” Aspera said.

And while local and national authorities continue to work to clear roads to better access those affected, incessant rains are making that difficult.

“We are continuously working on clearing the roads, but we are hampered by rains. We need to be careful because this area is prone to floods and landslides. Likewise, rains sometimes delay us from airlifting supplies,” Benito Ramos, head of the NDRRMC, told IRIN.

“Our immediate concern is to sustain these communities until they can be given permanent shelter,” Ramos stressed.

The government declared a state of national calamity in the most devastated areas on 20 December to hasten relief and rehabilitation efforts as well as facilitate international aid.

On 22 December, the UN and humanitarian partners called for US$28.6 million to support the government.

To date, $7.4 million (26 percent) has been provided for shelter, food, water, sanitation and hygiene and logistics. This includes a $3 million disbursement from the UN Central Emergency Response Fund (CERF). 

An estimated $9 million is needed for shelter requirements alone, of which $2.7 million or 30 percent has been funded.

as/ds/mw source www.irinnews.org