On the 10th of October, 2017, we celebrate World Mental Health Day with the theme; Mental health in the workplace. Mental health in workplace is critical for delivery of quality services and improved productivity. Hospitals and clinics are workplaces for medical staff; schools are workplaces for education staff. Both medical and educational environments are a critical source of psychosocial wellbeing and mental health for adolescents living with HIV (ALWH). It therefore means that for better quality of service provision to ALWH, there is need to enhance the capacity of medical and education personnel to deal with emotional, mental and physical needs presented to them by this group of adolescents.
Adolescence is generally understood to be a transitional phase between childhood and adulthood characterised by extensive physical, cognitive, social and psychological development. Identity formation comes to the fore and adolescents may engage in exploration and experimentation, resulting in various risk behaviours. Frequently changing relationships and an increased interest in sexual activity with related concerns about physical or sexual appeal is common. Peer group and romantic attachments are also a hallmark of this stage as dependence on the family gradually diminishes and adolescents seek more autonomy.
These shifts are often associated with the “normative stress” that adolescents experience (Barker, 2007). However, for thousands who are infected with HIV, the challenge of coping with the ordinary developmental issues of this stage are greatly increased. Development is significantly complicated by the infection and there are considerable implications for social, emotional and physical development.
Some of the most common mental health issues affecting adolescents living with HIV include depression and anxiety, transition from paediatric to adult HIV care and its impact on adherence[1]. In addition to this, is HIV related stigma and discrimination which affects access to and uptake of services while affecting the overall mental well-being of adolescents living with HIV. Evidence show that HIV-positive adolescents experience a range of vulnerabilities that reduce the efficacy of generalised prevention programmes, including cognitive and mental health issues[2]. The contexts in which stigma and discrimination manifests itself are varied and there is a need for interventions to address these issues. Effects of HIV- related stigma and discrimination include social isolation and loneliness which affects an individual’s self-worth. Stigma and discrimination causes mood swings which is a form of mental imbalance which can result in adolescents isolating themselves from family or community activities. Stigma and discrimination can result in adolescents developing withdrawal attitudes which can be complicated and develop into serious depression.
Investments have been made towards addressing mental health challenges but there are still gaps. Critically, gaps exist around measuring the impact of mental health challenges for adolescents living with HIV. This raises challenges around replicating efficacious approaches and adjusting/discontinuing less efficacious ones. The fact that mental health issues affecting adolescents are not well documented and efficacious interventions are not documented means some adolescents living with HIV who need support are not documented. This may result in them feeling neglected, adoption of negative coping mechanisms like drug abuse which leads to induced psychosis.
REPSSI is advocating for communities and families to provide social support to adolescents living with HIV as this improves their mental health and wellbeing. Strengthening families and communities is also key as it contributes towards improving adherence and retention in care. There is also need to invest in capacity building for medical and education personnel so that they have skills and knowledge to provide ALWH with appropriate support. A nurse or teacher who is well supported and skilled will perform their duties with a better attitude and motivation. The benefits of this investment far outweighs the cost as psychosocial and mental wellbeing of medical and education personnel results in improved resilience of adolescents living with HIV.
For more information, contact Tabeth Monde: tabeth.mhonde@repssi.org
[1] Bailey H, Cruz MLS, Songtaweesin WN, Puthanakit T. J Int AIDS Soc. 2017 May 16; 20(Suppl 3):21475.
[2] Sherr L, Croome N, Parra Castaneda K, Bradshaw K, Herrero Romero R. Developmental challenges in HIV infected children—An updated systematic review. Child Youth Serv Rev. 2014;45: 74–89.