COVID-19: Increased Risk to the Mental Health and Safety of Women Living with HIV in South Africa

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COVID‑19: Increased Risk to the Mental Health and Safety of Women Living with HIV in South Africa John A. Joska1 · Lena Andersen1 · Stephan Rabie1 · Adele Marais2 · Esona‑Sethu Ndwandwa1 · Patrick Wilson3 · Aisha King3 · Kathleen J. Sikkema2,3

© Springer Science+Business Media, LLC, part of Springer Nature 2020

COVID-19 is a global health crisis. While involvement of the respiratory system is the primary cause of transmission and morbidity, there is increasing interest in the individuallevel mental health consequences of this pandemic. Even as many countries are struggling to treat an overwhelming number of patients acutely infected with COVID-19, the epidemic in South Africa raises unique challenges. A lockdown implemented by the government at the initial stages of the outbreak stemmed the spread of infection, preventing the healthcare system from being inundated with cases. While the effect of the lockdown on “flattening the curve” remains to be seen, the mental health and wellbeing of the South African population is at increased risk. Our clinical experience working with women with HIV infection (WLHIV) and a history of psychological trauma suggests that they may have several anxieties linked to the impact of a life-threatening infection on their well-being and that of their children. We propose that the early stages of the COVID-19 epidemic in South Africa may exert the following deleterious mental health effects on WLHIV: (1) re-kindling of trauma related to restrictions applied to specific communities under Apartheid, (2) increased anxieties related to potential infection with a fatal virus, (3) associated behavioural avoidance leading to further reduced access to care and medication adherence, and (4) increased rates of domestic violence resulting from lockdown.

* John A. Joska [email protected] 1



Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa

2

Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

3

Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA



Trauma Rooted in Apartheid Older WLHIV would recall the restrictions placed on persons of colour before our first democratic election, including severely curtailed movement enforced by the police and the military. While COVID-19 restrictions apply to all South Africans, those traumatised before 1994 may report increased anxiety and fear as a result of re-living past experiences. In order to avoid negative associations of lockdown, WLHIV may avoid travelling. One consequence may involve missing clinic visits and not obtaining necessary medication.

Another Infection to Fear Another likely consequence of COVID-19 for WLHIV is anticipatory anxiety. The novel coronavirus adds a superlayer of infection to the lives of these individuals. Co-morbid and opportunistic infection is no stranger to HIV-affected communities. Tuberculosis rates