By Abraham Ngor Achiek.
Why do we loss the struggle against HIV/AIDS in South Sudan?
HIV/AIDS infection continues to multiply massively among innocent citizens of newly born country of South Sudan despites joint effort in eradication of this killer disease by Government of South Sudan, and International NGOs, still the epidemic remained out of control. In a speech given on1 December 2011 by Director of HIV/AIDS commission in Bor Jonglei State Ms Christine Maurren Onyango. Onyango said HIV/AIDS commission had conducted a voluntary counselling and testing exercise in eight counties in the state this year in which out of 9,823 people that accessed the services, 182 were found to be HIV positive; 102 female and 82 male. She said the commission targeted commercial sex workers, boda-boda (motorbike taxi) riders and prisoners.
IMA on the other hand stated that HIV/AIDS prevalence is 2.7% in Jonglei State, while quoting Bor town as 7% and Pochalla as 8% respectively. The poor network in awareness raising to people in villages as the compaign stick to town centres and particularly to sex workers and neglecting the rest of the population within and outskirt of the town resulted to wider spread other than control of HIV/AIDS in the country of South Sudan.
The government, Organizations and private sectors failed the struggle against HIV because of not understanding HIV epidemic holistically as to address and restore the healing, rather they make plans and decisions in isolation of mental health.
It is perceptible that the government, NGOs and HIV/AIDS service providers put high consideration to life maintenance treatment of HIV by providing Antiretroviral and little attention to awareness raising, but forget the serious underlying factors of this killer disease known as psychological wellbeing.
As the theory says prevention is better than cure, why don’t we together with our government and organisation reach out to the villages to raise awareness on HIV/Aids to prevention further infection.
Well, I don’t deny the fact that antiretroviral help in life maintenance in HIV intervention, but my point is that providing ARV to HIV sufferers is not enough. We must consider prevention and treatment of mental health related problems which are accompanying HIV/AIDS infection to make complete intervention.
“No health without mental health”.
HIV/AIDS is discovered to have much more negative impact on mental health of people. This ranges from infected person to affected relatives, children, siblings, parents neighbours and community as whole. HIV sufferers have been discovered to suffer vast variety of psychiatric syndrome than you can imagine.
Surprisingly, HIV/AIDS is found to increase chances of mental illness while mental illness likewise increases risk of contracting HIV/AIDS.
It is apparent that physical, psychological, social, cultural, and economical factors have been neglected in the fight against HIV/AIDS.
However, failure to recognise, include and address all of these factors will mean nothing other than negligence and ignorance to the prevalence of HIV and AIDS.
Psychological impact
As mentioned already that “no health without mental health”, we will not and will never win the fight against HIV if we do not consider patients` psychological wellbeing and affected persons. It’s noticeable that HIV/AIDS Commission in South Sudan and their partners in the fight against AIDS are ignorance and negligence of HIV/AIDS psychological ramification, but care only for physical symptom in which they provide ARVs to relief the symptom and leaving the patient to suffer mental agony.
This however, can be proved in many cases where HIV/AIDS patients abused substances severely, but nothing is done to detoxificate and rehabilitates the patient to resume normal life.
HIV infections have vast negative psychological implications in human life. Its inflicts severe suffering in the life of infected person leading to premature death, leaving behind orphans, widow or widower. This eventually affects the family mentally, socially and economically as its drain resources to treat and care for the patient as well as funeral services.
This however, instigates loss of hope, helplessness, social withdrawal, anxiety, depression which resort to suicidal thought where infected person either murder or commit suicide in some cases.
Depression emerges to severe substance abuse in order to die quickly or to forget the incidence and make one busy to push life.
Hence, this lead to alcohol addiction or substance dependence that dumb or caused brain retardation, lung cancer, high blood pressure and many other related diseases caused by substance abuse. In this event, the patient become weak and weaker and dies.
Cultural impact
HIV/AIDS has vast negative impact toward our beloved cultures of South Sudan, this include facial scarification, body mark, and wife inheritance. These were good practices in our culture of difference societies of South Sudan. But HIV/ASIDS however, have taken these scarification and wife inheritance and use them as tools to accelerate HIV prevalence among us.
Economical impact
HIV/AIDS setback our economic as its waste resources to treat and take care of infected person. This include no or low production due to physical weakness and other mental instabilities depending on the severity, perception and psychological reaction from the infected and the affected persons. HIV/AIDS is a disease of poor people although there are many circumstances where rich ones are trapped, the poor communities suffer severely. The poverty caused vulnerability and setback of which the poor get poorer and become more susceptible to HIV infection. However, to prove this right, commercial sex workers are in most cases from the background of poor families. Therefore poverty eradication program need to be considered in the fight against HIV/AIDS.
Social impact
HIV/AIDS infected persons suffer severe stigma and discrimination from societies to where they belong in South Sudan. Despite the fact that AIDS can also be gotten within marriage such as accidences, needle, body scarification and unsterilized syringes, still there are many circumstances where people living with HIV/AIDS are judged morally that they are prostitute, adulterers, commercial sex worker, out curse, and evildoers and that God inflicted HIV/AIDS in them as a divine retribution for their evil behaviour. For this reasons, psychological intervention is highly needed to restore mental healing.
American Psychiatric Association (APA) provides standard criteria for classification for mental disorders known as Diagnostic Statistical Manual for mental disorders DSM-IV.
HIV/AIDS and mental health category in DSM IV.
DSM IV axis I clinical syndrome
Major depressive disorder (sadness, loss of interest in social and other activities because of untimely death which is underway)
Bipolar disorder. Substance use abuse disorder (alcohol addict as result of depression)
DSM IV Axis II Personality and developmental disorders
Anxiety disorder (because you are dying)
Dissociative disorders
Mood disorders
DSM IV axis IIIPhysical conditions
Malnourishment
Physical Weakness
Hopelessness, sadness, helplessness
DSM IV axis IV. Psychosocial and environmental stressors
Feeling guilty
Feeling stress
Depress
Stigma and Discrimination
No employment because of discrimination
Feeling of loneliness
DSM IV axis V Highest Global functioning
Global functioning of HIV infected person is ranging from 0 to 45 % depending on individual reaction to the status.
I would therefore conclude that unless we consider treatment of psychiatric disorders in people living with HIV/AIDS, we cannot and will never succeed in the fight against HIV prevalence.
Treatment HIV/AIDS without recognizing psychological disorders is very real and undermines the success of the treatment whatsoever the case.
Whereas, there are many alcohol dependence who use ARVs because of their positive status. As a result, there are possibilities of lossing the drug or inconsistence to the prescription due to intoxication and causes virus to develop resistance against ARVs and therefore endanger his (patient) life.
Therefore, HIV/AIDS commission and their partners in fight against AIDS must ensure that they address alcohol dependence in person living with HIV/AIDS, whether it developed as a result of HIV positive or it’s preceded the status. Holistic approach of HIV/AIDS that includes physical, psychological, social, cultural and spiritual factors will help bring solution in the fight against HIV/AIDS if we put it in consideration and make it practically.
*Abraham Ngor Achiek is a 3r-Year BA student in counselling psychology.
at Christian Teaching Community College CTCC in Bor town.