As well as being a disease that is associated with a number of physical malfunctions and progressive discomforts like pain, shortness of breath, altered sexual functioning and disfigurement, HIV/AIDS is also a highly stigmatized disease. This stigmatization can lead to a progression of other grievous psychosocial stressors including unemployment, homelessness, financial losses and the breakup of relationships. These, in turn, can precipitate a wide range of other disorders, such as depression, anxiety, psychosis and paranoia.
Therefore it should not be surprising to find a suicide rate amongst this population that greatly exceeds that of the general population. As early as 1989, it was reported that there was an increased risk of suicide among people with AIDS, and even then it was identified as a suicide risk 36 times the suicide risk in the general population. The average statistic cited, is that the rate is twenty times higher for people with AIDS, although a study funded by the American Foundation for Suicide Prevention was the first to ascertain the rate for men between the ages of 20 and 59 with AIDS was in fact 36 times higher than the rate of men without AIDS in this age-group.
The question of exactly how HIV/AIDS causes depression sparked a controversy. Some support the "pre-infection psychopathology" argument, and feel HIV/AIDS merely acts as a trigger and that only people with a vulnerability to depression before contracting HIV/AIDS become depressed, while others believe in the ability of the HI virus to create new suicide prone organic mental syndromes.
Over the past two decades the "typical" HIV/AIDS picture has changed. HIV/AIDS is no longer associated only with homosexual men and intravenous drug users, but now is seen rather as a non-discriminatory disease. The "HIV/AIDS" population is widely varied, and so the argument that most people who contract HIV/AIDS had some form of mental illness previously has not held. In most cases, HIV/AIDS does not raise the risk of suicide simply by acting as a catalyst provoking self-destruction in people who were already at a high risk.
The argument that HIV/AIDS creates depression in people who formerly had no history of the illness, seems more feasible. This can occur in a number of different ways, the first being the social stress argument. The stigmatization, alienation and breakdown of social support systems contribute greatly to the feelings of helplessness experienced by the individuals with HIV/AIDS. According to Northern Province psychiatrist, Dr Mabeba, one of the main social factors that contributes to the development of depression in people diagnosed with HIV, is a lack of education. She states: “People are not informed about what being diagnosed with HIV means. Many people overreact and think that this is it, they are going to die tomorrow. For this reason many people develop depression and anxiety disorders.”
Then there is the organic argument, where it is believed that the actual HI virus, its related infections and the anti-viral drugs used in its treatment can produce depression, among a number of other psychiatric disorders. Studies have shown that depression and helplessness in this population have been linked to suicidal feelings, and while it is likely that almost all people with HIV/AIDS who commit suicide are depressed, a smaller percentage may also have organic confusion or psychosis.
In both the social stress as well as the organic argument, it is believed that the depression, as in ordinary cases of depression, is linked to low levels of the chemical messenger in the brain, or neurotransmitter, serotonin. According to the American Suicide Foundation: "It is conceivable that the human immunodeficiency virus disrupts serotonergic transmission in the brain in a way that intensifies suicidal behaviour. Some anecdotal studies have found that persons with AIDS have decreased blood serotonin levels when compared with healthy controls and cancer patients."
Whatever the cause, the fact depression co-occurs with the illness, complicates its treatment. It is necessary for research to identify the social factors that put people at the highest risk for suicide and it is essential that both illnesses be treated at the same time. In South Africa, especially, the stigma surrounding this disease discourages people from speaking out for fear of alienation from their communities, which, in turn, prevents them from seeking and receiving the correct help and support.
Although few studies have directly examined the relative importance of individual stressors, social isolation has been identified as one of the main contributing factors for suicide, and so increasing social support for people with HIV/AIDS and countering their social isolation may be important suicide prevention strategies. For more information, telephone counselling and referrals the Depression and Anxiety Support Group can be contacted Monday to Friday, between 8am and 7pm, and on Saturdays, between 8am and 5pm, on (011) 783-1474/6. According to Therry Nhlapo, Outreach Co-ordinator for the Depression and anxiety Support Group: “People diagnosed with HIV have to live with the illness, they have no choice, but that doesn’t mean they have to live with depression. Depression is treatable, and whatever the cause of your depression, AIDS or marital conflict, our group does not discriminate. We work with the depressed person to find the best treatment possible.”
According to Dr Mabeba: “The depression experienced by people with HIV/AIDS is treated like any other depression. There are various treatment options like psychotherapy, as well as certain pharmacological options.” It is recommended though that certain types of antidepressant medications should not be taken in conjunction with some of the antiviral drugs. It is advisable to consult your doctor before beginning any medication.
Another complication is that it is very difficult to identify and diagnose depression in people who are medically ill, as often the signs and symptoms of depression, like appetite loss and insomnia, are also a cause of the serious physical illness. Another sign of depression is talk of death, but in people with fatal illnesses, talking about and planning for their deaths is common and normal.
Some people even feel that depression is normal and should be expected in cases like this, but it is not. Just because someone has HIV/AIDS does not mean they should also have to suffer from depression. Depression is treatable. If you suspect someone you know who has AIDS is depressed, even if you are not sure, it is advisable to seek professional help. A better quality of life is possible.