HIV/AIDS and the human psyche

Do men and women react differently when they are diagnosed with HIV/ AIDS? The answers to these questions raise important implications for health care workers.

While much research focuses on the psychological implications of being diagnosed with HIV/ AIDS, very little research has been done on the role of gender. Do men and women differ in their response to the diagnosis? And if they differ, what does that tell us?

The body maps were painted by HIV-positive women from Khayelitsha as part of an outreach programme run by the AIDS and Society Research Unit at the University of Cape Town. - Photographed by Alwyne Todd.

This question was investigated by Dr Ben Olley, who was the recipient of last year's prestigious Africa Research Fellowship. He performed his work in Prof. Dan Stein's Anxiety and Stress Disorders Research Unit at the Medical School of the University of Stellenbosch and has since then returned to his home country, Nigeria..

Dr Soraya Seedat, a co-investigator on the project, says HIV/ AIDS is usually associated with high rates of psychiatric and emotional problems, in addition to its negative social impact. Research has found that these problems contribute to people not sticking to their drug regimens. It can even speed up the progression of the disease and hasten the death of a patient.

"Most of the existing research has been conducted in the developed world and very little or no gender differences have been reported. However, women in the developing world generally face more stigmatization and suffer more negative life events than men, leading us to suspect that being diagnosed HIV-positive could lead to more psychological problems among women," she explains.

Gender divide
The study team assessed 149 newly diagnosed HIV/ AIDS patients (44 male and 105 female) attending an infectious diseases clinic at the Tygerberg Hospital. The team used well-known psychiatric questionnaires to assess the patients. The most frequent diagnosis was depression (34,9%) followed by dysthymic disorder (21,5%) (see box for an explanation of this disorder). Interestingly, there was no difference between the rates of depression in the two genders. "This differs from our studies done in HIVnegative populations, where women are at least twice more likely to develop depression," says Dr Seedat. This is where the similarity between the men and women ended. The researchers found that the women were more likely to suffer from post-traumatic stress disorder (PTSD), while the male patients were significantly more likely to abuse alcohol and have risky sex. "We're not sure why women more frequently develop PTSD. Hormonal and neurodevelopmental factors may play a role but there isn't enough evidence to allow us to draw any conclusions," she explains.

Why are men more likely to abuse alcohol and have risky sex? "In our experience, men are more likely to 'externalise' their distress. An interesting possibility is that they could have been infected with HIV as a result of their alcohol abuse.

Another possibility is that they could use alcohol as a coping mechanism after becoming HIV-positive - almost 'self-medicating', says Dr Seedat.

Implications for health
Dr Seedat says HIV-positive women are a high-risk population for developing depression. Studies by other researchers concluded that HIV-positive women are four times as likely as HIV-negative women to develop depression.

"So much focus is given to the physical aspects of the disease, but I really believe that a mental health evaluation should form part of the general health assessment of the HIV-positive patient.

"Although more careful evaluation is needed, our results suggest that maybe our approach to treatment needs to be different for men than for women.

"Women have a hormonal cycle that may influence their response to medication - this includes medication for physical and mental health problems," Dr Seedat says.