Zimbabwe’s HIV prevalence is among the highest in Sub-Saharan Africa, with an estimated 1.3 million people living with HIV. The epidemic remains largely driven by unprotected heterosexual intercourse. The populations at highest risk of acquiring HIV are young women, adolescent girls, sex workers and men who have sex with men. The consequences of HIV go beyond physical health as the stigma and shame associated may isolate individuals, tear apart families and make seeking out and adherence to treatment difficult. For these reasons, a diagnosis of HIV/AIDS is inextricably linked to mental health.
The relationship between mental health and HIV is cyclical: it may both contribute to risky behaviors that lead to contraction of the virus, as well as become a consequence of living with HIV. Regardless of which came first, Research in Zimbabwe shows that people living with HIV have higher rates of depression and other common mental health disorders, presenting as a mixture of somatic, depressive and anxious symptoms. Additional data shows that Zimbabwean youth whom are HIV positive report disproportionately higher rates of distress markers: ‘pain,’ feelings of isolation, kufungisisa, darkness, and lack of hope for the future. Those who have HIV and do not seek or adhere to treatment due to their depression remain largely underrepresented and unseen, he true burden of mental illness in those living with HIV may be much greater.
As mentioned, depression has a negative impact on the progression of HIV. Poor mental health limits compliance with HIV care, contributing to lower rates of testing, engagement with primary health care, and adherence to antiretroviral therapy. Studies show that individuals are 42% less likely to achieve adequate antiretroviral adherence if they have depressive symptoms. A study in Tanzania showed that mortality rates were nearly doubled among women living with HIV who have depression relative to those who do not. There is even preliminary exacerbating the effects of HIV, but more research needs to be done here. Appropriately managing depression will improve HIV outcomes.
Psychological and behavioral interventions using principles of cognitive behavioral therapy are often effective, and combination antiretroviral therapy with depression screening and treatment are ideal for reversing the negative impact depression has on HIV. Additionally, de-stigmatizing this disease via education and resource accessibility will help lower Zimbabwe's prevalence of HIV. Currently, Zimbabwe stands as the first country in Southern Africa with a high HIV prevalence to record a significant decline in new cases. This declining number is largely due to the lower rates of incidence in Zimbabwe’s youth. Additional interventions specifically targeted at our youth may be the future of our country’s success in fighting the epidemic.
Although these data offer hope for the success of future interventions, it cannot be ignored that continuity of depression management is difficult in many LMIC. There exists a great need for continued research and interventional efforts in our country and countries suffering similarly to Zimbabwe. Here at Kushinga, we see this gap and are actively striving o close it through our efforts in mental health systems strengthening.
Projects
Creative Arts Hub
Creative arts hub Zimbabwe uses a combination of music, movement, drama and meditation to encourage self-expression and connectedness for young people living with HIV with the aim of improving their engagement in HIV care.
HIV status disclosure to perinatally-infected adolescents
Ethnographic project to explore the lived experiences of adolescents living with HIV/AIDS, with a focus on disclosure and other psychosocial issues.
Funded by: Rhodes Trust (Oxford), Godfrey Lienhardt Research Fellowship (Institute of Social and Cultural Anthropology & Wolfson College - Oxford), St. Hugh's College Research Fellowship (Oxford)
Fellowship (Oxford)- PI Kidia
Featured in the media, including on BBC News:
HIV Teens Survive against the odds
TENDAI: Treatment to improve depression and adherence to antiretroviral therapy in people living with HIV/AIDS in Zimbabwe
A study at the largest primary HIV clinic in Zimbabwe (over 8000 patients on ART) to integrate a behavioral intervention for antiretroviral adherence with a stepped care intervention for depression in adults living with HIV who also have clinical depression.
Funded by: NIH R21 (PI= Abas)
Collaboration with Harvard Medical School, Massachussetts General Hospital, University of Zimbabwe College of Health Sciences, King's College London
Stigma and Skin disease among HIV-positive adolescents
Mixed methods study at Parirenyatwa Hospital OI Clinical to assess the psychosocial impact and clinical characteristics of skin disease in perinatally-infected HIV+ adolescents
Funded by: ZATA - Zimbabwe AIDS Treatment Assistance Project PI (Kidia and Makadzange)
Collaboration with Harvard Medical School, Massachussetts General Hospital, University of Zimbabwe College of Health Sciences, Dept of Medicine
Website
Outputs
Kidia K, Mupambireyi Z, Cluver L, Ndhlovu CE, Borok M, Ferrand RA, HIV Status Disclosure to Perinatally-Infected Adolescents in Zimbabwe: A Qualitative Study of Adolescent and Healthcare Worker Perspectives, PLoS ONE 9(1): e87322. doi:10.1371/journal.pone.0087322
Bere T, Nyamayaro P, Magidson J, Chibanda D, Chingono A, Munjoma R, Macpherson K, Ndhlovu CE, O'Cleirigh C, Kidia K, Safren S, Abas M, Cultural adaptation of a cognitive-behavioural intervention to improve adherence to antiretroviral therapy among people living with HIV/AIDS in Zimbabwe: Nzira Itsva, Journal of Health Psychology, Feb 2016
Kidia K, Machando D, Bere T, Macpherson K, Nyamayaro P, Potter L, Makadzange T, Munjoma R, Marufu M, Araya R, Safren S, O'Cleirigh C, Chibanda D, Abas M, ‘I was thinking too much’: experiences of HIV-positive adults with common mental disorders and poor adherence to antiretroviral therapy in Zimbabwe, Tropical Medicine and International Health, 20(7): 903-913, Jul 2015
Toska, E., Cluver, L. D., Hodes, R., & Kidia, K. K. (2015). Sex and secrecy: How HIV-status disclosure affects safe sex among HIV-positive adolescents. AIDS care, 27(sup1), 47-58.
Cluver, L. D., Hodes, R. J., Toska, E., Kidia, K. K., Orkin, F. M., Sherr, L., & Meinck, F. (2015). ‘HIV is like a tsotsi. ARVs are your guns’: associations between HIV-disclosure and adherence to antiretroviral treatment among adolescents in South Africa. Aids, 29, S57-S65.
Ferrand, R. A., Meghji, J., Kidia, K., Dauya, E., Bandason, T., Mujuru, H., . . . Kranzer, K. (2015). The effectiveness of Routine Opt-out HIV Testing for children in Harare, Zimbabwe. JAIDS Journal of acquired immune deficiency syndromes.
Kidia, K., Kranzer, K., Dauya, E., Mungofa, S., Hatzold, K., Bandason, T., & Ferrand, R. (2014). Missed opportunities for HIV testing of children in a high prevalence setting. International Journal of Infectious Diseases, 21, 135.
Kidia, K., Kranzer, K., Dauya, E., Mungofa, S., Hatzold, K., Busza, J., . . . Ferrand, R. (2014). Provider-initiated HIV testing & counseling (PITC) in children: Tackling the P of PITC. International Journal of Infectious Diseases, 21, 134.
Kranzer, K., Meghji, J., Bandason, T., Dauya, E., Mungofa, S., Busza, J., . . . Ferrand, R. A. (2014). Barriers to provider-initiated testing and counselling for children in a high HIV prevalence setting: a mixed methods study. PLoS Medicine, 11(5), e1001649.
The relationship between mental health and HIV is cyclical: it may both contribute to risky behaviors that lead to contraction of the virus, as well as become a consequence of living with HIV. Regardless of which came first, Research in Zimbabwe shows that people living with HIV have higher rates of depression and other common mental health disorders, presenting as a mixture of somatic, depressive and anxious symptoms. Additional data shows that Zimbabwean youth whom are HIV positive report disproportionately higher rates of distress markers: ‘pain,’ feelings of isolation, kufungisisa, darkness, and lack of hope for the future. Those who have HIV and do not seek or adhere to treatment due to their depression remain largely underrepresented and unseen, he true burden of mental illness in those living with HIV may be much greater.
As mentioned, depression has a negative impact on the progression of HIV. Poor mental health limits compliance with HIV care, contributing to lower rates of testing, engagement with primary health care, and adherence to antiretroviral therapy. Studies show that individuals are 42% less likely to achieve adequate antiretroviral adherence if they have depressive symptoms. A study in Tanzania showed that mortality rates were nearly doubled among women living with HIV who have depression relative to those who do not. There is even preliminary exacerbating the effects of HIV, but more research needs to be done here. Appropriately managing depression will improve HIV outcomes.
Psychological and behavioral interventions using principles of cognitive behavioral therapy are often effective, and combination antiretroviral therapy with depression screening and treatment are ideal for reversing the negative impact depression has on HIV. Additionally, de-stigmatizing this disease via education and resource accessibility will help lower Zimbabwe's prevalence of HIV. Currently, Zimbabwe stands as the first country in Southern Africa with a high HIV prevalence to record a significant decline in new cases. This declining number is largely due to the lower rates of incidence in Zimbabwe’s youth. Additional interventions specifically targeted at our youth may be the future of our country’s success in fighting the epidemic.
Although these data offer hope for the success of future interventions, it cannot be ignored that continuity of depression management is difficult in many LMIC. There exists a great need for continued research and interventional efforts in our country and countries suffering similarly to Zimbabwe. Here at Kushinga, we see this gap and are actively striving o close it through our efforts in mental health systems strengthening.
Projects
Creative Arts Hub
Creative arts hub Zimbabwe uses a combination of music, movement, drama and meditation to encourage self-expression and connectedness for young people living with HIV with the aim of improving their engagement in HIV care.
HIV status disclosure to perinatally-infected adolescents
Ethnographic project to explore the lived experiences of adolescents living with HIV/AIDS, with a focus on disclosure and other psychosocial issues.
Funded by: Rhodes Trust (Oxford), Godfrey Lienhardt Research Fellowship (Institute of Social and Cultural Anthropology & Wolfson College - Oxford), St. Hugh's College Research Fellowship (Oxford)
Fellowship (Oxford)- PI Kidia
Featured in the media, including on BBC News:
HIV Teens Survive against the odds
TENDAI: Treatment to improve depression and adherence to antiretroviral therapy in people living with HIV/AIDS in Zimbabwe
A study at the largest primary HIV clinic in Zimbabwe (over 8000 patients on ART) to integrate a behavioral intervention for antiretroviral adherence with a stepped care intervention for depression in adults living with HIV who also have clinical depression.
Funded by: NIH R21 (PI= Abas)
Collaboration with Harvard Medical School, Massachussetts General Hospital, University of Zimbabwe College of Health Sciences, King's College London
Stigma and Skin disease among HIV-positive adolescents
Mixed methods study at Parirenyatwa Hospital OI Clinical to assess the psychosocial impact and clinical characteristics of skin disease in perinatally-infected HIV+ adolescents
Funded by: ZATA - Zimbabwe AIDS Treatment Assistance Project PI (Kidia and Makadzange)
Collaboration with Harvard Medical School, Massachussetts General Hospital, University of Zimbabwe College of Health Sciences, Dept of Medicine
Website
Outputs
Kidia K, Mupambireyi Z, Cluver L, Ndhlovu CE, Borok M, Ferrand RA, HIV Status Disclosure to Perinatally-Infected Adolescents in Zimbabwe: A Qualitative Study of Adolescent and Healthcare Worker Perspectives, PLoS ONE 9(1): e87322. doi:10.1371/journal.pone.0087322
Bere T, Nyamayaro P, Magidson J, Chibanda D, Chingono A, Munjoma R, Macpherson K, Ndhlovu CE, O'Cleirigh C, Kidia K, Safren S, Abas M, Cultural adaptation of a cognitive-behavioural intervention to improve adherence to antiretroviral therapy among people living with HIV/AIDS in Zimbabwe: Nzira Itsva, Journal of Health Psychology, Feb 2016
Kidia K, Machando D, Bere T, Macpherson K, Nyamayaro P, Potter L, Makadzange T, Munjoma R, Marufu M, Araya R, Safren S, O'Cleirigh C, Chibanda D, Abas M, ‘I was thinking too much’: experiences of HIV-positive adults with common mental disorders and poor adherence to antiretroviral therapy in Zimbabwe, Tropical Medicine and International Health, 20(7): 903-913, Jul 2015
Toska, E., Cluver, L. D., Hodes, R., & Kidia, K. K. (2015). Sex and secrecy: How HIV-status disclosure affects safe sex among HIV-positive adolescents. AIDS care, 27(sup1), 47-58.
Cluver, L. D., Hodes, R. J., Toska, E., Kidia, K. K., Orkin, F. M., Sherr, L., & Meinck, F. (2015). ‘HIV is like a tsotsi. ARVs are your guns’: associations between HIV-disclosure and adherence to antiretroviral treatment among adolescents in South Africa. Aids, 29, S57-S65.
Ferrand, R. A., Meghji, J., Kidia, K., Dauya, E., Bandason, T., Mujuru, H., . . . Kranzer, K. (2015). The effectiveness of Routine Opt-out HIV Testing for children in Harare, Zimbabwe. JAIDS Journal of acquired immune deficiency syndromes.
Kidia, K., Kranzer, K., Dauya, E., Mungofa, S., Hatzold, K., Bandason, T., & Ferrand, R. (2014). Missed opportunities for HIV testing of children in a high prevalence setting. International Journal of Infectious Diseases, 21, 135.
Kidia, K., Kranzer, K., Dauya, E., Mungofa, S., Hatzold, K., Busza, J., . . . Ferrand, R. (2014). Provider-initiated HIV testing & counseling (PITC) in children: Tackling the P of PITC. International Journal of Infectious Diseases, 21, 134.
Kranzer, K., Meghji, J., Bandason, T., Dauya, E., Mungofa, S., Busza, J., . . . Ferrand, R. A. (2014). Barriers to provider-initiated testing and counselling for children in a high HIV prevalence setting: a mixed methods study. PLoS Medicine, 11(5), e1001649.