Mental Health Aspects in HIV/AIDS:      An Indian Perspective              Kasi Sekar*          Sudeep Jacob Joseph       ...
HIV in India: An Overview –   India profile –   NIMHANS at a glance –   HIV profile –   Essentials of Mental Health –   Co...
India Profile        Area: 3.2 m sq.kms.        States: 30        Union Territories: 7        Population: 1.2 billion     ...
India Profile                   •   Multi   climatic                   •   Multi   agro                   •   Multi   ling...
NIMHANS HIV/AIDS a glance                •   Nearly three decades of                •   service,                •   capaci...
NIMHANS at a glance
NIMHANS at a glance
NIMHANS at a glance
HIV/AIDS in India: An Overview  • India is a country with low HIV    prevalence (0.31%)  • However, third largest populati...
• The estimates  highlight an  overall reduction  in adult HIV  prevalence, HIV  incidence as well  as AIDS related  morta...
“Mental health issues are anessential for both prevention      and care in HIV” Several psycho-social factors impinge upon...
Why Address Mental Health         Issues in HIV?•    Decreased access to health care•    May increase high risk behavior• ...
Contributory Factors• Impact of HIV infection    – “psychosocial factors like chronic depression and      stressful life e...
Contributory Factors• Alcohol and drug use   – Contribution in aetiology and outcome of     psychiatric problems among PLH...
HIV in the Brain• HIV is neurotropic• The virus invades and infects the CSF early,  possibly before or at the time of  ser...
Psychiatric Manifestations in           HIV/AIDS• Depression                              • Substance Use Disorders    – P...
Psychiatric Emergencies in             HIV/AIDS• HIV infection can be                    • Periods when risk of  associate...
Psychosocial Factors• In families:    – 19% of the PLWHIV were told not to      touch children out of fear of infection   ...
Psychosocial Factors• In health care settings:    – 22% of the HCW refused to touch PLHIV      because of their HIV status...
Psychosocial Factors• Punitive attitude of general society is  evident as    – 70% people felt PLHIV had engaged in      ‘...
Psychosocial Factors• Clinical depression was correlated with    – Higher felt stigma    – Higher internalized stigma    –...
Special Groups• Special groups have special health and  mental health needs• The key risk groups covered include      – Fe...
Special Groups  • HIV/AIDS epidemic has added     recognition of male to male sex (MSM)     as a vulnerable group  • Limit...
Interventions in Mental Health  • Capacity Building        – Andhra Pradesh        – GFATM R7 training of Master Trainers ...
Interventions in Mental Health • Services       – Counsellors in VCTC/ICTC       – NGO initiatives            • Drop-in-ce...
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Mental health issues in HIV/AIDS - Indian Perspective by Kasi Sekar

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Mental health issues in HIV/AIDS - Indian Perspective by Kasi Sekar

  1. 1. Mental Health Aspects in HIV/AIDS: An Indian Perspective Kasi Sekar* Sudeep Jacob Joseph Arthur Julian Joseph *Professor of PSW National Institute of Mental Health and Neuro Sciences Bangalore 560 029, India +91 98452 14397 sekarkasi@gmail.com
  2. 2. HIV in India: An Overview – India profile – NIMHANS at a glance – HIV profile – Essentials of Mental Health – Contributory factors – HIV in the brain – Psychiatric manifestations – Psychiatric emergencies – Psychosocial factors – Special groups – Interventions 2
  3. 3. India Profile Area: 3.2 m sq.kms. States: 30 Union Territories: 7 Population: 1.2 billion (2011) Urban population:25.7% Growth Rate:21.34% Sex Ratio: 933 /1000 Literacy rate :65.38% Coastline :> 8000 Kms
  4. 4. India Profile • Multi climatic • Multi agro • Multi lingual • Multi ethnic • Multi religious • 6 Religions • 6 Ethnic groups • 29 Major festivals • 618 Languages • 6400 CastesYET one proud country!!! India No the continent by itself
  5. 5. NIMHANS HIV/AIDS a glance • Nearly three decades of • service, • capacity building • research in the area of HIV AIDS • Neurology, Virology • Psychiatry • Clinical Psychology • Psychiatric Social Work • Psychiatric Nursing • Mental Health Education • Epidemiology
  6. 6. NIMHANS at a glance
  7. 7. NIMHANS at a glance
  8. 8. NIMHANS at a glance
  9. 9. HIV/AIDS in India: An Overview • India is a country with low HIV prevalence (0.31%) • However, third largest population of PLHIV (2.39 million in 2008 – 2009) – 57.5% male – 39% female – 3.5% childrenSource: National AIDS Control Organisation. (2011). Annual Report 2010 –2011. Ministry of Health and Family Welfare, Govt. Of India. New Delhi. 9
  10. 10. • The estimates highlight an overall reduction in adult HIV prevalence, HIV incidence as well as AIDS related mortality in India• Decline by more than 50% percent during the last decade in new annual HIV Infections Source: NACO, 2011 10
  11. 11. “Mental health issues are anessential for both prevention and care in HIV” Several psycho-social factors impinge upon HIV progression: •Emotional Well-being •Types and Levels of Stressors •Coping Skills •Psychosocial SupportSource: Ramakrishnan, J and Chandra P.S (2010). Mental Healthand HIV/AIDS in South Asia. NIMHANS Journal. Bangalore
  12. 12. Why Address Mental Health Issues in HIV?• Decreased access to health care• May increase high risk behavior• Decrease treatment adherence• May affect nutrition and impaired Quality of LifeSources:Ramakrishnan, J. and Chandra P., S. 2010. Mental Health and HIV/AIDSin South Asia. NIMHANS Journal. BangaloreChandra, P., S. 2011. Psychiatric Aspects of HIV/AIDS. in Kasi, S. 2011Manual for Training of Trainers on Mental Health Aspects of HIV/AIDS.NIMHANS, Saksham. BangaloreWorld Health Organisation. 2003. Investing in Mental Health. Genevaaccessed from www.who.int/mental_health on 10th August 2011 12
  13. 13. Contributory Factors• Impact of HIV infection – “psychosocial factors like chronic depression and stressful life events affect clinical and immunological progression of HIV/AIDS”• Effects of virus – “brain pathology arises early in the infection as a consequence of viral damage of central nervous system”• HIV drug treatment – ART drugs known to cause psychological problems as side effects Sources: Ramakrishnan, J. and Chandra P., S. 2010. Mental Health and HIV/AIDS in South Asia. NIMHANS Journal. Bangalore Kasi, S. et al. (eds.) 2011 Manual for Training of Trainers on Mental Health Aspects of HIV/AIDS. NIMHANS, Saksham. Bangalore 13
  14. 14. Contributory Factors• Alcohol and drug use – Contribution in aetiology and outcome of psychiatric problems among PLHIV• Poor social support – Associated with faster disease progression and several mental health problems Sources: Ramakrishnan, J. and Chandra P., S. 2010. Mental Health and HIV/AIDS in South Asia. NIMHANS Journal. Bangalore Kasi, S. et al. (eds.) 2011 Manual for Training of Trainers on Mental Health Aspects of HIV/AIDS. NIMHANS, Saksham. Bangalore 14
  15. 15. HIV in the Brain• HIV is neurotropic• The virus invades and infects the CSF early, possibly before or at the time of seroconversion• CNS conditions over the course of the disease include – HIV Encephalopathy – AIDS Dementia Complex• Prevalence of AIDS Dementia Complex less than 20%• Prevalence among those on HAART 1-2% Source: Satishchandra, P., Nalini, A., Gourie-Devi, M., Khanna, N., Santosh, V., Ravi, V., Desai, A., Chandramuki, A., Jayakumar, P. N., and Shankar, S. K. (2000). "Profile of neurologic disorders associated with HIV/AIDS from Bangalore, south India (1989-96)". Indian J. Med. Res. 11: 14–23 15
  16. 16. Psychiatric Manifestations in HIV/AIDS• Depression • Substance Use Disorders – Prevalence up to 60% – As independent• Anxiety Disorders diagnosis or part of other – Found among one- psychiatric syndrome third of PLHIV• Delirium • Sleep Disorders – Prevalence of 40- – As part of psychiatric 60%. syndrome or emotional• Psychosis reaction to stress – Found in 4-10% PLHIVSource: Chandra, P., S. 2011. Psychiatric Aspects of HIV/AIDS. in Kasi, S. etal. (eds.) 2011 Manual for Training of Trainers on Mental Health Aspects ofHIV/AIDS. NIMHANS, Saksham. Bangalore 16
  17. 17. Psychiatric Emergencies in HIV/AIDS• HIV infection can be • Periods when risk of associated with suicidal suicide is high ideas and/or attempts – Following a positive test• Risk Factors for suicide – Following bereavement, especially loss of an – Past history of infected partner suicidal attempt – Failure of response to – Psychiatric illness treatment – Feeling Hopeless – Severe physical – Uncontrolled Pain complications – Alcohol or drug use – During an episode of – Social Isolation depressionSource: Mehrotra, S. et al.2011. Understanding and Responding toSuicidalityIn People Living with HIV/AIDS. in Kasi, S. et al. (eds.) 2011Manual for Training of Trainers on Mental Health Aspects of HIV/AIDS.NIMHANS, Saksham. Bangalore 17
  18. 18. Psychosocial Factors• In families: – 19% of the PLWHIV were told not to touch children out of fear of infection – 18% were not allowed to use /share the same utensils – 15% had been thrown out of their homes – 7 % were threatened with physical abuse – 6 % were evicted out from landlordSource: Ramakrishnan, J. et al.2011. Overview of Mental Health Needs ofPLHIV. in Kasi, S. et al. (eds.) 2011 Manual for Training of Trainers onMental Health Aspects of HIV/AIDS. NIMHANS, Saksham. Bangalore 18
  19. 19. Psychosocial Factors• In health care settings: – 22% of the HCW refused to touch PLHIV because of their HIV status – 22% used gloves for procedures, which did not warrant wearing gloves like taking height-weight, temperature – 6% HCW broke confidentiality of HIV status without client’s knowledge or consent – 33 % nurses took extra precaution while dispensing the medicinesSource: Ramakrishnan, J. et al.2011. Overview of Mental Health Needs ofPLHIV. in Kasi, S. et al. (eds.) 2011 Manual for Training of Trainers onMental Health Aspects of HIV/AIDS. NIMHANS, Saksham. Bangalore 19
  20. 20. Psychosocial Factors• Punitive attitude of general society is evident as – 70% people felt PLHIV had engaged in ‘wrong’ behaviour – More than half thought that PLHIV are disgusting – 48 % felt that PLHIV had brought dishonour to their families – 42% believed that PLHIV should feel guilty for being positiveSource: Ramakrishnan, J. et al.2011. Overview of Mental Health Needs ofPLHIV. in Kasi, S. et al. (eds.) 2011 Manual for Training of Trainers onMental Health Aspects of HIV/AIDS. NIMHANS, Saksham. Bangalore 20
  21. 21. Psychosocial Factors• Clinical depression was correlated with – Higher felt stigma – Higher internalized stigma – Avoidance of disclosure – Less coping – Higher impact on social relationshipsSource: Ramakrishnan, J. et al.2011. Overview of Mental Health Needs ofPLHIV. in Kasi, S. et al. (eds.) 2011 Manual for Training of Trainers onMental Health Aspects of HIV/AIDS. NIMHANS, Saksham. Bangalore 21
  22. 22. Special Groups• Special groups have special health and mental health needs• The key risk groups covered include – Female Sex Workers – Men who have Sex with Men and Transgenders – Injecting Drug Users • Though sexual minorities have always existed in India, their issues have never seriously been articulatedSources:National AIDS Control Organisation. (2011). Annual Report 2010 – 2011.Ministry of Health and Family Welfare, Govt. Of India. New Delhi.Parekh, S. 2003. “Homosexuality in India: The light at the end of the tunnel,”Journal of Gay & Lesbian Psychotherapy, 7 (1/2): 153. 22
  23. 23. Special Groups • HIV/AIDS epidemic has added recognition of male to male sex (MSM) as a vulnerable group • Limited literature on the mental health needs • Further empirical research in this area needs to be conductedSources:Parekh, S. 2003. “Homosexuality in India: The light at the end of the tunnel,”Journal of Gay & Lesbian Psychotherapy, 7 (1/2): 153.Ranade, K. 2003. “Stigma, stress and coping among gay, lesbian, bisexualindividuals – A qualitative study.” Dissertation submitted in partial fulfillment forMPhil in Psychiatric Social Work, NIMHANS (Unpublished). 23
  24. 24. Interventions in Mental Health • Capacity Building – Andhra Pradesh – GFATM R7 training of Master Trainers on Mental Health Aspects of HIV/AIDS • Research – NIMHANS based multi-centric study on stigma and HIV/AIDS almost unitary study focusing on mental health – Ample empirical experience – Adequate documentation – More research and publication on mental health aspects is warrantedSources:Kasi, S. et al. (eds.) 2011 Manual for Training of Trainers on Mental HealthAspects of HIV/AIDS. NIMHANS, Saksham. BangaloreRamakrishnan, J and Chandra P., S. 2010. Mental Health and HIV/AIDS in SouthAsia. NIMHANS Journal. Bangalore 24
  25. 25. Interventions in Mental Health • Services – Counsellors in VCTC/ICTC – NGO initiatives • Drop-in-centres • Crisis Intervention hotlines and points – Ministry of Health to ensure presence of trained counsellors in all VCTCs/ICTCs and ART centres.Source: National AIDS Control Organisation. (2011). Annual Report 2010 – 2011.Ministry of Health and Family Welfare, Govt. Of India. New Delhi. 25
  26. 26. Thank You

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