The mental health of people living with HIV/AIDS in Africa: a systematic review.

This paper reviews published quantitative research on the mental health of HIV-infected adults in Africa. Twentyseven articles published between 1994 and 2008 reported the results of 23 studies. Most studies found that about half of HIV-infected adults sampled had some form of psychiatric disorder, with depression the most common individual problem. People living with HIV or AIDS (PLHIV) tended to have more mental health problems than non-HIV-infected individuals, with those experiencing less problems less likely to be poor and more likely to be employed, educated and receiving antiretroviral treatment (ART). Being female, experiencing poor health, receiving poor-quality health services, and a lack of material and emotional support from family and friends were associated with greater psychiatric morbidity. While some key findings emerged from the studies, the knowledge base was diverse and the methodological quality uneven, thus studies lacked comparability and findings were not equally robust. Furthermore, more rigorous research is needed to put mental health services for PLHIV in Africa on the healthcare agenda. Priorities for future research should include replicating findings regarding common mental health problems among PLHIV, important issues among HIV-infected women, and the longer-term mental health needs of those on ART. Research is also needed into predictors of mental health outcomes and factors associated with adherence to ART, which can be targeted in interventions.