Chapter 20: Substance use among mentally ill out-patients of Ndera psychiatric HIV unit and Kigali psychosocial consultation center. Rwanda by Alfred Ngirababyeyi, Vvonne Kayiteshonga, Beata Mukarusanga, Chantal Nyirarnugisha & Daniel Uwimana


Mental disorders can be a risk factor as well as a consequence of HIV infection. Multiple studies have shown that certain mental illnesses (including substance dependence) increase vulnerability to HIV infection (Bogart et al., 2006; Stoff1 et ai., 2004). HIV infection can also lead to psychological reactions that range from emotional distress to frank mental disorders.’The stress of living with a chronic, stigmatized life-threatening disease; caring for others who are ill; witnessing the death of individuals in one’s social network; and managing the loss of income when breadwinners succumb to the illness often bring feelings of fear and sadness that may be mild and transient or severe and enduring- (McKinnon,Cournos, & Herman, 2002; Meade, & Sikkema, 2005). The patients identified as HIV infected therefore need special care that takes into account the impact of HIV and AIDS on their mental health (Collins et al., 2009). The triple diagnoses of HIV/AIDS, substance use disorder and psychiatric disorder have long been recognized by those who Work with this population. In the general population, approximately 50% of people with psychiatric disorders will meet criteria for substance use disorder in their lifetime (George & Krystal, 2000). Rates of mental disorders and substance use disorders tend to be higher in HIV population than in the general population (Mckinnon et al., 2002).
Further, HIV-infected patients with mental illness and substance abuse disorders face special challenges related to adherence to care and medications (Mugavero et al., 2006). Klinkenberg and Sacks found in 2004 that among opiates users, a current and lifetime history of any mental disorder has been associated with a higher frequency of sharing injection equipments and less condom use. They are also less likely to receive medical treatment or to accept to undergo highly active antiretroviral therapy in the first instance.