This Background: In South Africa the rising comorbidity of mental
disorders with other non-communicable and
communicable diseases, particularly in people living with HIV/AIDS
(PLWHA), has helped raise the public health priority of mental ill-health.
Depression, in particular, compromises anti-retroviral treatment (ART) adherence and virological suppression, thus threatening the effectiveness of South
Africa’s ART programme. Given that evidence-based treatment for depression comprises
medication and/ or Western-derived psychotherapies, responding to the current
interest in expanding mental health services for PLWHA demands an understanding
of how best to provide culturally competent care within existing resource
constraints. Aim: To explore the context and local understandings of depression
in women living with HIV to inform the development of contextually appropriate
mental health services that could be delivered within existing resource
constraints inSouth Africa. Method: Semi-structured qualitative interviews were held
with 35 women living with HIV in South Africa who met the diagnostic criteria
for a major depressive disorder. Results: Being HIV-positive per se was not
reported to be a major cause of depression. Instead, a number of social factors
were reported. These included stigma and
discrimination, poverty, and stressful life events. Symptoms of depression, especially social withdrawal, negative ruminating thoughts and excessive
worry suggestive of comorbid anxiety, functioned to exacerbate and trap women
in a negative depressive cycle. Social support emerged as a dominant coping
strategy. Group-based interventions, which afford greater opportunities for
improved social support, were mooted as the most appropriate intervention by the
majority of participants. Individual counselling provided through a home
visitation programme was suggested for those who were too ill or too poor to
attend clinics. Task sharing was also endorsed. Conclusion: The need for multi-sector engagement in mental health promotion to address factors that trigger,
maintain and exacerbate depression at a community level in PL-WHA is
highlighted. The triggers, symptoms and local coping strategies employed by
afflicted women in this study suggest a resonance with Western derived
evidence-based psychological therapies. In relation to delivery channels, there
was support for the provision of group interventions or home-based individual
counselling using a task sharing model.