Kenya: Double-Edged Stigma for People With Mental Illness and HIV

By David Njagi

People with mental illnesses who are also living with HIV face the worst kind of stigma within Kenyan society, experts have warned.

Reports by the Kenya AIDS Response Progress Report 2014, confirm that stigma against people living with HIV is still high, despite Kenya making progress in cutting HIV infections. And mental illness, argues the Africa Mental Health Research Foundation (AMHR), is associated with witchcraft, a situation that places people living with mental health problems as outcasts.

"It is like double edged stigma," argues Samuel Macharia Njoroge, Users and Survivors of Psychiatry in Kenya programmes officer. "Society shuns these patients fearing they might spread the sickness."

But it is the emerging scenario, where a growing number of mental health patients are testing HIV positive, which worries pressure groups.

Cases have been reported where mentally ill patients are locked indoors by their families. If they are also HIV positive, there are chances that they will be thrown out and deserted, observes an official with the Kenya National Commission on Human Rights.

Hard to access treatment

The way in which this group of patients is stigmatized makes it very difficult for them to access the right treatment, according to Macharia. While medication may be available in a few treatment centres, patients do not have access to adequate nutrition, hygiene and psychosocial support, he says.

"These patients cannot afford a therapist," argues Macharia. "Where a patient is mentally ill and is living with HIV, resources are very scarce. Most of them are not employable, they cannot access opportunities, and so they have to be supported."

At the Mathari National Teaching and Referral Hospital (MNTRH), where mentally ill patients are treated, medics acknowledge the number of patients with mental illnesses who are also living with HIV is growing. They say it is frustrating to reach these patients because of society's stigma against them.

According to Dr Mercy Karanja, the hospital has received cases of people who are living with HIV and mental illness, but for them to be treated, the patient's guardian has to give consent.

"The capacity to give consent is very limited because in many cases the guardians would not like the public to know about their situation," says Dr Karanja. "It becomes a challenge to do follow ups for this group of patients and adherence to treatment because when the mental condition relapses they forget they are on treatment."

At the same time, MNTRH does not routinely test every patient at the hospital for HIV, she says.

Lack of data on mental illness

But it is not only stigma and poor treatment that leads to this vulnerable group being ignored. There is a lack of data to establish the extent of HIV infection among people with mental illnesses, which means it is difficult to prepare a policy that can address the problem.

Njoroge argues that it is possible to get data for HIV and AIDS, but for psychosocial disabilities, the statistics are very scanty. A few checks with national institutions confirmed the widespread lack of data on mental health patients who are also living with HIV.

According to AMHR, the problem is compounded by the fact that the current Mental Health Act, passed in the 1980s, is out of date.

Rhodah Mwangi, communication officer at AMHR, says the Act has little relevance in today's setting, further weakening legislation that serves this group of patients.

There are also huge gaps in training mental health workers. According to Mwangi, in Kenya there are about 87 psychiatrists, one for every 500,000 people.

"This is a big gap which means that mental health has long been neglected in Kenya," she says. "The situation becomes worse when coupled with the twin burden of HIV."

Link with drug use

The National AIDS and STI Control Programme (NASCOP), links the growing cases of mental health patients living with HIV to drug use.

In many cases, Helgar Musyoki, NASCOP's programme manager for key populations says, a patient begins with drug use before becoming mentally ill, followed by HIV infection.

According to her, 80 per cent of injecting drug users do not know their HIV status. A third of new HIV infections are attributed to most at risk populations, where four per cent of these are injecting drug users, she says.

But there is a silver lining to the cloud, if an ongoing study by AMHR, which seeks to rehabilitate drug users to prevent HIV infection, is anything to go by.

"There is hope because County governments have been very supportive of our work," argues Mwangi. "They have finally realised that the burden of mental disorders will cost the country economically if not addressed."

Source: All Africa

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