Category Archives: HIV/AIDS
On World Mental Health Day many have thought about mental health status in their countries and the treatment gaps all over the world.
Our blog focuses on articles and statistics around mental health care and in particular around maternal mental health care globally and in low- and middle-income countries.
“Mental health matters because it affects everyone”
“Around 30% of women in low-income countries and 10-15% in high-income countries have a significant mental health problem during pregnancy and after childbirth. And yet most of these women never get diagnosed or receive any treatment” Maternal Mental Health-Global Challenge
“South Africa needs sustainable solutions to deal with its mental health treatment gap, delegates heard at a roundtable discussion ahead of World Mental Health Day (WMHD) – “Economy, Equality and Access to Mental Health Services” Close the mental health treatment gap
“The mental health of pregnant women can be affected by a range of factors, including partner violence and unemployment. But one of the key drivers that adversely affect a pregnant woman’s mental health is food insecurity. Being food insecure is when someone doesn’t have food or has the wrong kinds of food.” How hunger affects the mental health of pregnant mothers
Image: Robin Hammond
“Lack of food security is driving depression, anxiety and suicidal behaviour in poor communities” How hunger erodes mental health
“From OCD to suicide and depression, these numbers will alarm you.” (South Africa focus) 10 Mental Health stats South Africa
“South African children may be affected by a myriad of traumas. According to the South African Journal of Psychiatry, children and adolescents can suffer from post-traumatic stress disorder (PTSD) after being exposed to a range of traumatic events.” Here’s how the Sesame Street’s Muppets help kids
“Crisis issue needs to be priority among developing nations” Mental health treatment a human right
“World Mental Health Day: the need for conversations on the subject in India is as strong as ever, because despite a start, not enough of them are taking place.” A poignant series of films relates the stories of people who fought and won
Sick link between hunger and mental health – linking food insecurity and mental health.
“Future actions should focus on better identification of people in vulnerable situations who may require specific support including people experiencing mental distress, early intervention and culturally appropriate mental health training for all frontline staff.” Mental health is not the problem, it’s the solution
“Children whose mothers are depressed during pregnancy have a small increased risk of depression in adulthood, according to a UK study.” Depression risk ‘starts in the womb’
“What more needs to be done to make mental health care a reality for people worldwide.” Making mental health a cultural priority
“Mental health needs a new narrative. citiesRISE is a global platform committed to transforming the state of mental health policy and practice in cities and beyond to meet the mental health needs of populations across the world.” citiesRISE new website
Screening for Traumatic Experiences and Mental Health Distress Among Women in HIV Care in Cape Town, South Africa
“Traumatic events can negatively affect clinical outcomes among HIV positive women, particularly when those events result in ongoing psychological distress. Consequently, there have been calls to integrate screening and treatment of traumatic experiences and associated mental health disorders into HIV care. In South Africa, screening for traumatic experiences and mental health is not a routine part of HIV care. […]
Participants [of this study] almost unanimously agreed that it would be appropriate and acceptable to screen all women in the clinic setting for trauma and mental health symptoms. […]
The high prevalence of traumatic experiences and psychological distress in this study highlights an urgent need to integrate screening into routine HIV care. The study provides evidence of the acceptability of screening for trauma and mental health symptoms among HIV positive women, at the critical points of care engagement when they are initiating ART or have defaulted on ART. In addition, there is need to link women screened to interventions and services, as part of trauma informed HIV care.”
Full text available on Sage Journals
Intimate partner violence (IPV) during or before pregnancy is associated with many adverse health outcomes.
Pregnancy-related complications or poor infant health outcomes can arise from direct trauma as well as physiological effects of stress, both of which impact maternal health and fetal growth and development.
Antenatal care can be a key entry point within the health system for many women, particularly in low-resource settings. Interventions to identify violence during pregnancy and offer women support and counselling may reduce the occurrence of violence and mitigate its consequences.
This research will provide much-needed evidence on whether a short counselling intervention delivered by nurses is efficacious and feasible in low-resource settings that have a high prevalence of IPV and HIV.
Source: BMC Health Services ResearchBMC series
Follow the project: BioMed Central
It’s Teen Pregnancy Prevention Month in some parts of the world
We want to emphasise that sex-education can prevent teenage pregnancy, but let’s not forget a teen mom is not only struggling with the normal issues of being a teenager, yet another part is facing the responsibilities of an adult!
Teenage pregnancy rates in South Africa are high, with around 30% of teenagers in the country reporting ever having been pregnant. According to the 2015 annual school survey, over 15,000 pupils fell pregnant during the academic year. This is nearly triple the worldwide rate of pregnancy in teenagers.
The psychological impact of pregnancy on teenagers is pronounced; adolescents are twice as likely as adults to experience postpartum depression. Another concern is the lack of education, with only about a third of pregnant girls in South Africa going on to finish their schooling. Incomplete education and lack of skills make it difficult for these young women to find work in order to support themselves and their children.
There are a number of physical ramifications to teenage pregnancy – unsafe abortions, for example, can cause injury or death. As a whole, complications during pregnancy and birth are the second leading cause of death for adolescent girls worldwide. But it’s not only them that face serious risks during this period – their babies also have a much higher risk of dying than those born to older mothers.
One way of decreasing the risks to both mother and child is by making skilled antenatal, childbirth and postnatal care available in a safe, teen-friendly environment. This should include counselling with the intent of providing emotional support, mobilising potential resources, and teaching important information about childcare.
Further readings: Pregnancy – a guide for teens
A guide to pregnancy, giving birth, and life as a mom for teens
Written by: Meagan Dill, PMHP volunteer
In low- and middle-income countries (LMICs), competing health priorities, civil conflict, and a lack of political will mean that expenditure on mental health is a fraction of that needed to meet the mental health care needs of the population.
For mothers, this treatment gap is most notable in regions where health agendas focus on maternal mortality indicators.
Who is at risk of perinatal mental health disorder?
Common mental disorders during pregnancy and in the first year after birth are associated with certain risk factors. These include poverty, migration, extreme stress, exposure to violence (domestic, sexual and gender-based), previous history of mental disorders, alcohol and other drug use as well as low social support.
In South Africa, there is a very high prevalence of adolescent pregnancies with 39% of 15- to 19-year old girls being pregnant at least once. When adolescent mothers suffer from depression, the likelihood of a subsequent teenage pregnancy nearly doubles.
How to address maternal mental illness among economically disadvantaged parents?
Integration of services!
Mothers in many settings are using maternal and child health services as well as social services. Thus, detection and access will increase if maternal health screening and services are integrated into these public care platforms.
How to implement a maternal mental health intervention in low-resource settings?
We are sharing our lessons learned in this learning brief.
We have also developed a Service Development Guidelines which demonstrates how to develop a mental health intervention at your facility, even with limited resources.
Find more free & open access resources for professionals on our website
And what about dads?
Postnatal depression can affect dads too. Find out about common concerns for new dads and discover helpful tips on how they can become more involved. We compiled a leaflet with information that could help you be better prepared for what is happening. The leaflets are available in
Abuse at the hands of one’s partner is rife across the world. And even though South Africa has the highest levels of this type of violence, healthcare providers are not trained to deal with it and it is still regarded as a taboo subject.
In South Africa, shocking statistics reveal that:
– half of all women killed are slain by their intimate partners
– this is the highest femicide rate in the world
– more than 50% of women report experiencing intimate partner violence, often during pregnancy
– 20% of women surveyed in antenatal clinics in Soweto reported sexual violence by an intimate partner
– 68% reported psychological abuse and
– more than a third of girls report having been sexually violated and
– 45% of children have witnessed their mothers being beaten
Simone Honikman, director of the Perinatal Mental Health Project (PMHP) in Cape Town, has hailed the new open-source curriculum, saying it will be very useful in South Africa. “I think this is an excellent resource for capacity building that may be easily adapted for our local setting. Over the years of working with health and social development workers of all types, we at the PMHP, have been struck by the need for improved access to accessible, competency-based training on addressing intimate partner violence and sexual violence.”
To commemorate International Youth Day we advocate for better mental health for vulnerable teenagers
Across the world, developing countries are making progress in tackling the HIV epidemic. According to UNAIDS, in 2012 South Africa registered more than 450,000 new HIV infections, a significant drop from the 640,000 new infections registered in 2001. They’ve achieved this radical progress through the provision of antiretroviral therapy (ART) to more than 2.4 million people.
The ‘New Beast’: Mental Illness Among People Living with HIV
In South Africa, 38% of people living with HIV have a common mental health disorder. This is more than triple the incidence of mental health conditions for the general South African population. What’s shocking is that in this era of ART, increased advocacy, and knowledge of the condition, there has not been a decrease in prevalence of mental illness in people living with HIV, but a two-fold increase.
Depression, anxiety and other mental health disorders are of particular concern in patients with HIV because they can lead to:
• Poor treatment adherence
• Lower CD4 counts
• Increased viral load
• A greater chance of developing drug-resistant strains of HIV
Source: Mental Health Innovation Network
HIV and Maternal Mental illness
The enormous emotional strain of living with HIV, including its social and financial consequences, makes women vulnerable to depression and anxiety. On the other hand, those women with mental illness are more vulnerable to becoming HIV positive. A depressed woman is less likely to be able to negotiate safe sex due to low self-esteem, a sense of hopelessness or financial dependency.
Women at risk
• HIV+ mothers are particularly vulnerable to mental illness during and after pregnancy
• Mental illness affects how women use maternity, child health services and HIV services
• Mental illness has been found to have negative impacts on how HIV+ women adhere to their own and their child’s HIV treatment
• Mental health support and social support for HIV+ mothers is vital for the general health of women, their babies and families
Read more on the subject in our Issue Brief
Teenage pregnancy and mental illness
Approximately 30% of teenagers in South Africa report ‘ever having been pregnant’, the majority, unplanned. The likelihood of a subsequent teenage pregnancy nearly doubles when adolescent mothers suffer from depression.
Adolescents at risk
• Adolescents who become pregnant are more likely to have relationships that are coercive and abusive
• They are more likely to have had a forced first sexual experience, or physical or sexual abuse, and tend to experience a loss of support from family, friends or school
• They are also more likely to engage in high risk sexual behaviour or be using substances and alcohol
• Adolescent and young pregnant women are at increased risk of mother-to-child transmission of HIV
Read more on the subject in our Issue Brief
There is growing awareness that HIV/AIDS affected and infected adolescents may be at increased risk of mental health problems and distress. Depression and anxiety are associated with treatment non-compliance, which can have a significant impact on health status.
Moreover, HIV positive adolescents’ support structures can be weakened by challenging home environments and stigma in the community.
The goal of Khuluma is to provide psychosocial support for HIV positive adolescents in South Africa using mobile technology.
Read more about the the Khuluma model on the Mental Health Innovation Network pages.
Gender Differences and Relationship Power Could be Key in Preventing HIV Among South African Adolescents
This study is the first known to examine gender differences in intimate partner violence and relationship power among adolescents in South Africa.
Millions of those infected with HIV worldwide are young women, ages 15-24, according to the World Health Organization. Because the HIV epidemic overlaps with an epidemic of intimate partner violence (IPV) against women and girls, researchers have suspected a correlation between inequities in relationship power and the risky sexual behavior that can lead to HIV transmission.
The research was conducted in South Africa, where the prevalence of both HIV and IPV is high and men often have more power in relationships than women. The team assessed data from more than 700 sexually experienced adolescents in Eastern Cape Province, South Africa who had been followed at regular intervals for 54 months as part of a separate NIH-funded trial.
Prevalence and Risk Factors in South Africa
Violence against women is a global problem which exacts a high burden of suffering on millions of women and families, including women who are pregnant and postpartum.
In South Africa, studies have shown that 36-40% of pregnant women experience physical IPV, while 15-19% experience sexual IPV.
In this vulnerable population, IPV is associated with a range of physical and mental health consequences for the mother including pregnancy loss, depression and post-traumatic stress disorder.
South African data have suggested a direct link between violence and HIV infection, where HIV-positive women are more likely than HIV-negative women to have experienced physical violence perpetrated by their partner. Alcohol and other drug use have been identified as another risk factor for IPV during pregnancy, as intoxication may lead to irresponsible behaviour such as violence
In South Africa, the mortality rate attributed to IPV is the highest globally and is double that of the United States. For the infant, there are increased risks associated with preterm delivery and low birth weight.
Read our policy brief on violence against women in South Africa and how to break the cycle on our website