Social illness

A successful intervention for people living with HIV and depression in sub-Saharan Africa

In sub-Saharan Africa, people living with HIV are more vulnerable to developing depression than the general population. HIV can directly affect the brain leading to complications that affect mood and the way we think.  Further, many related factors such as social isolation, lack of socio-economic opportunities and feeling stigmatised can all impact mental health.

In areas such as post-conflict Uganda, rates of depression among people with HIV are estimated to be as high as 70%. In low-resource settings such as this, extreme poverty, food insecurity and limited health care provision make it extremely hard for people to get the help they need.

Previous research has shown that untreated depression among people living with HIV can mean individuals don’t adhere to their HIV medication properly and are more likely to pass away prematurely.

MQ researcher Ethel Nakimuli-Mpungu, who was one of MQ’s very first Fellows, decided to work on a new way of providing treatment to these hard-to-reach communities in Uganda.

Ethel and her team developed a culturally sensitive group psychotherapy programme that can be run by lay health workers from local clinics, reducing the need for scarce specialist resources to address these pressing issues.

The programme, called SEEK-GSP – Social, Emotional and Economic empowerment Knowledge through Group Support Psychotherapy- has a strong focus on helping people to build supportive relationships, develop coping skills and learn new income generating skills to help break cycles of poverty.

Early results from Ethel’s work indicated a marked improvement for the vast majority of the recipients of this intervention, who not only became free from depression, but also improved their adherence to HIV treatment and started to exhibit reduced viral loads.

Now a new paper has been published that examines the longer-term impact of SEEK-GSP,and shows that both the physical and mental health benefits are sustained over the long term.

Dr. Nakimuli says that “The people living with HIV participating in the SEEKGSP program will be less likely to transmit the HIV virus to others”.

Two years after the end of the programme GSP sessions the prevalence of major depression remained at extremely low levels among those who received treatment (1%), and the number of participants who were adhering to their HIV medication was still significantly higher than the control groups who did not take part in the sessions. The combination of these two factors has meant there was sustained improved viral suppression among the group.

The beneficial effects of SEEK-GSP may be attributed to the ongoing emotional and social support that is developed within the groups, the positive coping techniques and the income-generation skills that are learnt, all of which are buffers against depression.

The long-term positive outcome that SEEK-GSP is having in Uganda cannot be overstated. The intervention is effective in terms of reducing the burden of disease, alleviating poverty, and it is highly cost effective, due to its group format and its use of lay workers.

The potential for this approach is immense, and in addition to it being rolled out across Uganda as part of the government’s non-communicable diseases programme, Ethel and her team continue to work towards extending its reach, tailoring it to children and young people, with the initial pilot producing highly encouraging results.

Ethel also continues to work with MQ to seek further funding for scale up across Africa, with local partnerships with public health departments already in place in Nigeria and Cameroon.

You can read more about Ethel here.


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