Mental health services for HIV/AIDS patients versus ARV services for mentally ill HIV/AIDS patients.

摘要

To the Editor: I fully support the call made by Andersen and Seedat, and would like to add another dimension to the challenges posed by HIV/psychiatric co-morbidity. Apart from the psychiatric complications caused by the infection, an increasing number of - especially - the young adult psychiatric population, with chronic disorders such as schizophrenia and bipolar disorder, present with co-morbid HIV infection. Owing to the adverse socio-economic backgrounds of most public sector patients, combined with the increased socio-economic vulnerability of chronic psychiatric patients, the HIV-positive chronic mental health care user (MHCU) is the most disadvantaged of the disadvantaged! The understandably rigorous prerequisites for ARV therapy hinder access by MHCUs to ARV treatment: they may be homeless, rejected by their families, or lead nomadic lives owing to their mental condition. These factors make identification of a 'buddy' a major challenge. Their mental condition may pose limitations on their ability to engage in the mandatory educational programme preceding commencement of treatment, or cognitive impairment from the mental illness and/or the HIV infection may diminish their capacity to give informed consent.