“It’s When the Trees Blossom”: Explanatory Beliefs, Stigma, and Mental Illness in the Context of HIV in Botswana

Abstract

Mental illness is a common comorbidity of HIV and complicates treatment. In Botswana, stigma impedes treatment of mental illness. We examined explanatory beliefs about mental illness, stigma, and interactions between HIV and mental illness among 42 adults, from HIV clinic and community settings, via thematic analysis of interviews. Respondents endorse witchcraft as a predominant causal belief, in addition to drug abuse and effects of HIV. Respondents describe mental illness as occurring “when the trees blossom,” underscoring a conceptualization of it as seasonal, chronic, and often incurable and as worse than HIV. Consequently, people experiencing mental illness (PEMI) are stereotyped as dangerous, untrustworthy, and cognitively impaired and discriminated against in the workplace, relationships, and sexually, increasing vulnerability to HIV. Clinical services that address local beliefs and unique vulnerabilities of PEMI to HIV, integration with peer support and traditional healers, and rehabilitation may best address the syndemic by facilitating culturally consistent recovery-oriented care.

The validity and reliability of the Patient Health Questionnaire-9 for screening depression in primary health care patients in Botswana

“…The study utilised a cross sectional design. The study was conducted at two primary care facilities in Gaborone, the capital and largest city in Botswana (population~200,000) [16]. The two facilities were purposively selected to make the sample heterogeneous.…”

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

“…There is also considerable use of traditional medicines and faith healers in a number of LMICs which may also have a negative impact on patient outcomes; however, this may not always be the case [50][51][52]. With respect to stigma, in Botswana patients with mental disorders can often be seen as untrustworthy and cognitively impaired; consequently, they can be discriminated against in their working environment [53]. Domestic violence and issues of stigma are also reported among patients with mental disorders in Pakistan [54] and in Tunisia, there is also still a considerable social stigma associated with severe mental illness; however, less for patients with bipolar disorders than schizophrenia [12].…”

“…Co-morbidities are a particular issue in patients with BD as adherence to therapies is already a concern [125,139]. This will be a particular issue in patients with both mental disorders and HIV necessitating additional psychosocial support [9,53,154,155], with high rates of HIV seen in sub-Saharan Africa [154]. There are also concerns that some treatments for HIV may also result in mental disorders warranting greater care [155] with these patients again needing to be carefully managed.…”

Not Enough Money and Too Many Thoughts: Exploring Perceptions of Mental Health in Two Ugandan Districts Through the Mental Health Literacy Framework

“…Evidence suggests that the relationship between HIV and MHDs is bidirectional. Some MHDs are associated with increased risk of HIV infection (Machado Neto et al, 2015) and people living with HIV are at higher risk of experiencing stigmatization and poor mental health (Becker et al, 2019;Bernard et al, 2017;Nedelcovych et al, 2017). HIV directly impacts the brain by crossing the blood brain barrier, triggering a chronic inflammatory response and chemical changes (such as reduced tryptophan and serotinin) that increase risk of depression and suicide (Remien et al, 2019).…”