Mental health in the era of HIV. Investigating mental distress, its determinants, conceptual models and the impact of HIV in Zambia

• Main Author: Chipimo, Peter Jay
• Format: Dissertation
• Language: English

The world health organisation drew attention to the growing global burden of mental disorders. Current estimates comprised 12% of the Global Burden of Disease and estimated to rise to 15% by the year 2020 which would then make them the second leading cause of health disability in the world. This burden is thought to be worse in low income countries where poverty and other communicable diseases abounds. It is thought that in these regions, the poor are particularly vulnerable through a mechanism mediated by high intensity of social stressors, social marginalisation and the overwhelming burden of communicable and noncommunicable diseases. Additionally, mental distress is known to interact and alter the course of many other diseases. Of particular interest to this thesis is it interaction with HIV. HIV is currently considered to be among the major cause of deaths in the most affected sub-Saharan countries. Here HIV infection is compounded by poor access to health services and high stigmatisation. Changes in socioeconomic transmission patterns are interesting in this regard. In the early stages of the epidemic HIV transmission appeared highest among the highest socioeconomic groups. However, this pattern changed dramatically over years, and HIV transmission rates are now highest among the low socio-economic position groups. Assuming that HIV has a negative impact on mental distress, it would suggest that the two disease entities are entangled in a self-perpetuating cycle of increasing morbidity where; poor mental health prevents people from engaging productively in their own lives and also might predispose them to risky sexual behaviour and substance abuse while in turn HIV increases the risk for poor mental health via its biological and psychological impact thereby impeding access to preventive, promotive and even curative health interventions. This ushers in the need for routine screening for mental distress in general medical patients and especially among HIV-infected patients. However, due to inadequacies in medical staffing, providing mental health services in Primary Health Care centres involves diagnosing and treating people with mental distress within the currently existing general framework of the available services and personnel. Therefore there is need for a valid screening instrument that is psychometrically sound and sufficiently short (less time consuming) and can be used without specialised training to achieve routine screening. Furthermore, it