The aim of the Umeed II study was to design and test a contextually relevant intervention to address depression and anxiety among people living with HIV, which now, thanks to advances in treatment, can be considered as a chronic disease. 

 

The study is relevant to people living with affective disorders, particularly when these are experienced in the context of chronic physical illness. I carried out the research in Goa, India, in partnership with colleagues at Sangath, a non-governmental organisation specialising in world-leading health-related community-based research. India has the third largest population of people living with HIV globally but the number of people per head of the population is low. In my previous work, conducted 10 years earlier in Goa, I found that living with depression and anxiety was associated with poor engagement with HIV-related care. In this study, I wanted to understand how people living with HIV perceived connections between their mental health and HIV and to use this new knowledge to design an intervention to improve people’s mental health, supporting them to access HIV care so that they could reap the benefits of treatment. 

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My intervention was based on “Problem-Solving Therapy” (PST), which helps people to develop strategies to address the problems that are causing them most stress with the support of a counsellor. PST has previously been used by Sangath in the local community and been found to be successful in treating depressive symptoms among older people. We adapted PST to address the needs of people living with HIV by adding information about HIV treatment, support for adherence, as well as information about local sources of support for people living with HIV. We trained six peer counsellors (other people living with HIV). Our recruitment of participants was affected by COVID-19 but counsellors successfully delivered the intervention to a small number of people, all of whom completed six sessions and benefitted from the intervention. The counsellors themselves also reported that taking part in the study was good for their wellbeing. Findings from open-ended interviews with people living with HIV suggested that in Goa, where HIV remains highly stigmatised, depression, narrowly defined, may not be the priority problem for many people living with the disease. Whilst people living with HIV are now able to access life-saving treatment, they still face a social death- a HIV diagnosis was experienced as a shocking and disruptive life event, leading many to feel suicidal. Participants in open-ended interviews described a distinctive arc in depressive symptoms (around the time of diagnosis) which suggested the importance of the timing (and specificity) of interventions. Over time and with the support of local non-governmental organisations, friends and family members, people living with HIV drew strength from the parts of their lives that endured their diagnosis- faith in God, parental roles, and were ultimately able to restore their sense of self and purpose.

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My work indicated the power of peer interactions and peer support in improving the lives of people living with HIV, which deserve further exploration, particularly in relation to delivery of mental health. This suggests that health services may not be the most appropriate location for mental health interventions and health professionals may not be the best people to deliver interventions. My findings demonstrate that people living with HIV can and do find a way of piecing together their lives into a new whole, including reconstituting their mental health, despite pervasive stigma and discrimination. They require holistic support to do so. 

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