University of Toronto faculty and students are breaking through the stigma of mental health and HIV by enhancing services for HIV-positive people in Namibia.
Members of 11 faculties at the University of Toronto together with colleagues at the University of Namibia (UNAM), have developed HIV-focused courses on HIV and gender, care and management and HIV and mental health. It is not known when they will be offered.
A recent workshop in Namibia was led by UNAM's HIV/AIDS task force and the Centre for International Health's HIV/AIDS Initiative-Africa at the University of Toronto. This program, initiated in 2003 and led by the Faculty of Medicine, partners with African universities to meet the challenges of HIV/AIDS through developing curricula, scaling up cutting-edge antiretroviral therapy and establishing a knowledge network.
Members of the UNAM task force visiting Casey House Hospice in Toronto were struck by the “multidisciplinary approach and the integration of mental health care as a key component of comprehensive HIV care,” says Dr. Mark Halman, Casey House's consulting psychiatrist and an assistant professor at the University of Toronto.
“In Namibia, mental health and physical health are very separate in the health care structure,” he says. But people with HIV contend with “lots of mental health issues.” Nurses recognize this but have very little resources or time to address mental health concerns.
“There's a tremendous stigma around mental health and HIV in most places,” says Halman, who is also the director of the HIV Psychiatry Program and a scientist in the Inner City Health Research Unit at St. Michael's Hospital.
In Namibia, 21.3% of adults are HIV-positive — the sixth highest rate in the world — but there is no medical school, few physicians (only 3 psychiatrists in the whole country), so nurses “take on a huge responsibility,” says Halman. “Addressing mental health issues is seen as almost a luxury, but if they don't get addressed it takes a terrible toll.”
“We struggled with what it means when 21% of your population has HIV,” says Halman. “It touches every aspect of people's lives.” As a result the demands placed on government are “huge.”
Halman and HIV-specialist nurses are developing courses in mental health and HIV for nurses, and curricula for diploma students in psychology, social work and nursing. Some of the courses are train-the-trainers, others are aimed at care providers.
The HIV/AIDS Initiative-Africa is also active in Kenya, and at the University of Zambia, where Toronto physical education faculty are developing activities and traditional games as teaching tools to prevent HIV/AIDS.