Impilo Yonke: Mental Health and HIV/AIDS

Mental health correlates of HIV and AIDS remains a rather unacknowledged and unexplored domain in Sub-Saharan Africa. What we do know from limited research is that people with mental illness are more likely to become infected with HIV as they may be vulnerable to abuse and may engage in risky sexual behavior. Conversely, people living with HIV/AIDS are more likely to develop some form of mental illness. The rates of mental disorder are as much as two to three times higher than the general population. Bottom line: mental health problems are both a precursor to and a consequence of HIV/AIDS. 

The implications for mental health status can be far-reaching and the consequences can significantly impact HIV/AIDS treatment outcomes. For example, a person with poor mental health status is more likely to have poor adherence to medications and antiretrovirals (ARVs). Health services directed towards this vulnerable population is lacking in South Africa, further magnifying the considerable health burdens of this group.

Impilo Yonke, a collaboration between Mpilonhle and Ladysmith Provincial Hospital, is one of the STF projects I've been working on in Ladysmith that aims to provide a coordinated and comprehensive care model by integrating health services for mental health disorders, substance abuse, and HIV/AIDS. The project has 4 components:

1. Promoting and providing HIV counseling and testing (HCT) in persons suffering from a mental health disorder

2. Screening for substance abuse in youth who are being treated for HIV

3. Providing psychosocial support and budgeting skills training to patients who are receiving government disability grants 

4. Training and educating health care workers to tailor care and HCT specifically to patients with mental health disorder  

There are currently no services that specifically address HIV testing in the mentally ill. Substance use run rampant in the community, especially with young people, and patients accessing ARV treatment are not formally screened for drug abuse, thereby jeopardizing their treatment. All patients who have been diagnosed with a serious mental illness or who have a CD4 count <350 are eligible for a governmental disability grant. Often this is the primary source of income for patients and their dependents. Providers have observed that many patients often have difficulty budgeting this money, and they frequently default on their treatment due to not being able to afford food and transport. The government issues disability grants without equipping patients with the necessary knowledge or skill to budget that money. 

My role in this project has really pushed me outside my comfort zone and let me dabble in areas that I previously had limited (really no) experience in. I came on board in the initial stage of the project when it was still trying to set up and gain momentum. I've been working with the Mpilonhle director in managing the project and mentoring her through various processes (e.g. improving communication with all parties involved in project, streamlining implementation procedures, increasing financial transparency of grant money). I had my first exposure to the realm of Monitoring and Evaluation (M&E) and helped the team develop an M&E structure and plan to capture data and outcomes. Putting on a more academic hat, I taught the physicians and nurses about the model for planning and evaluating continuing medical education and helped them develop assessments to capture the impact of the HIV/Mental Health training workshops they were giving. All this said however, I think I've made the greatest impact on the data capturer. I've worked with him very closely and mentored him on things like development of these assessments, analysis of the data, and writing of reports summarizing that data. 

There are many little things that seem quite simple to me and for which I take for granted (e.g. creating agendas to increase efficiency in meetings). But this mentoring and management experience has reminded me that someone at some point had to teach me about these "simple things," and now it's my turn to teach another.