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Exploring Mental Impairment Caused by HIV/AIDS with Dr. Mukiibi, a Clinical Psychologist

HIV/AIDS has been associated with many stereotypes, prejudices and myths. However, according experts in psychology, the virus can have devastating impacts on one’s mental health irrespective of whether a person is receiving treatment or not.

Dr. Cabrine Mukiibi, a Clinical Psychologist at Exulansis Uganda notes that from the point of diagnosis to the step of disclosure, patients undergo five grieving stages of Denial, Anger, Bargaining, Depression and Acceptance (DABDA).

“This becomes the initial point of a patients’ psychological stability or instability. HIV affects both the physical and psychological aspects of a human being. Basing on the prejudices and myths underlying its spread and prevalence rates, HIV-infected patients are at an increased risk of developing mental health symptoms, which negatively affect the patients and the public health,” he notes.

Dr Mukiibi said that depression with suicidal attempts and ideation (resulting from the loss of meaning and interest in life) are very common after disclosure.

“Depression progresses on with other co-morbidities like insomnia (lack of sleep), Anorexia nervosa (lack of appetite and interest in food) with dissociative disorders.”

He notes that people living with HIV can easily develop Paraphilias (abnormal sexual behaviour), which can lead to personal, social, and career problems, and serious legal consequences which may require Psychiatry and Forensics evaluation (DSMV).

“Among the many behavioural disorders are pedophilia (sexual focus on children), zoophilia (sexual activity with animals and pets), Fetishism (use of inanimate objects like dildos and vibrators), sexual masochism (being humiliated or forced to suffer), sexual sadism (inflicting humiliation or suffering) and transvestism disorder (sexually arousing cross-dressing; men dressing in female clothes and vice versa), frotteurism (touching or rubbing against a non consenting person) and Necrophilia (Sexual activity with dead bodies),” the doctor explained.

He further noted that patients develop Philophobia (fear of falling in love and fear of engagement in relationships) since many fear to spread HIV to others. In this essence, People Living with HIV (PLHIV) suffer discrimination which increases stigma within themselves.

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As such, Dr. Mukibi noted, when stigma reaches a high peak, PLHIV also suffer Agoraphobia (fear of being in crowded and public places) which creates a feeling of loneliness and lowliness among them hence the development of dissociative disorders.

“PLHIV also express more symptoms like fear, anger and guilt. As a result, they develop copying mechanisms to accommodate their fears, anger and guilt. This is mainly through substance and drug abuse which results into alcohol and drug addiction,” he said.

HIV/AIDS creates anxiety and according to the Diagnostic and Statistical Manual of Mental Disorders IV, it creates Hypochondriasis, a feeling and thinking that a patient will contract other illnesses. It also creates separation anxiety to patients from both the care takers and the health practitioners.

“The contraction of HIV further comes with Opportunistic Infections (IOs) which can be caused by viruses, bacteria, fungus, and parasites. Among the many include; Candidiasis (thrush), HIV-related neurocognitive disorders, HIV wasting syndrome, PCP, Salmonella, and TB. HIV affected personnel are also prone to HIV related cancers like Cervical cancer, anal cancer, Kaposi sarcoma and Lymphomas,” Dr. Mukiibi said.

He pointed out that HIV also causes HIV induced Psychosis which results from denial and poor adherence and this is characterized by mental confusion of visual and auditory hallucinations, uncoordinated speech and ideas, total confusion with partial consciousness, derealisation, depersonalization, delusions, poor attachment to reality and poor cognition.

“HIV does not directly invade nerve cells (neurons) but puts their function at risk by infecting cells called glia that support and protect neurons. HIV also triggers inflammation that may damage the brain and spinal cord (CNS) and cause symptoms such as; confusion and forgetfulness, inability to concentrate, behavioural changes, headaches, mood disorders, movement problems (loss of movement control) including a lack of coordination and difficulty walking,” Dr. Mukiibi explained.

HIV/AIDS, he noted, brings damage to the peripheral nerves which cause progressive weakness and loss of sensation in the arms and legs. Research also shows that HIV infection causes shrinking of brain structures involved in learning and information processing.

It should be noted that other nervous system complications that can occur as a result of HIV include; pain, seizures, stroke, shingles, difficulty swallowing, fever, vision loss, coma, and problems with bladder control or sexual function.

HIV in children

Dr Mukiibi said that in children, HIV/AIDS causes among others; developmental delays, brain lesions, nerve pain, smaller than normal skull size, slow growth, eye problems, and recurring infections.

He argued that even when HIV is well controlled with ART, many infected individuals still develop HIV-associated neurological and cognitive difficulties.

“This is because many drugs used to combat HIV cannot cross the protective layer called the blood-brain barrier and enter the brain, and even those that can, may not completely control the virus in the brain. Antiretroviral drugs can also become toxic after long-term use and cause neurological side effects.”

AIDS-related disorders of the nervous system, the doctor stated, may be caused directly by the HIV virus, by certain cancers and opportunistic infections (illnesses caused by bacteria, fungi, and other viruses that would not otherwise affect people with healthy immune systems), or by toxic effects of the drugs used to treat symptoms.

“There are also other disorders like AIDS Dementia Complex (ADC), or HIV-associated dementia (HAD), Central nervous system (CNS) lymphomas, Cryptococcal meningitis, Cytomegalovirus (CMV) infections, and Herpes virus infections,” Dr. Mukiibi highlighted.

He revealed that people with AIDS also suffer from several different forms of neuropathy, or nerve pain like Peripheral neuropathy and Distal sensory polyneuropathy, Neurosyphilis, Progressive multifocal leukoencephalopathy (PML), Psychological and neuropsychiatric disorders, Toxoplasma encephalitis, (cerebral toxoplasmosis) and Vacuolar myelopathy.

He recommended diagnosis of HIVAIDS infections to the brain through; Brain imaging, CT scan, MRI, Functional magnetic resonance imaging (fMRI), Magnetic resonance spectroscopy (MRS), Electromyography (EMG), Biopsy and Cerebrospinal fluid analysis.

He emphasized that it is important to develop an optimal treatment plan for PLHIV to avoid the development of mental health problems. This encompasses spiritual, physical psychosocial and psychological based treatments.

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