HIV, mental illness and substance abuse; the experiences of persons diagnosed with triple diagnosis at Chris Hani Baragwanath Academic Hospital outpatient clinic

Abstract

INTRODUCTION: The term triple diagnos is is used to refer to patients with mental illness, substance use disorder as well as HIV infection. Not only is this group clinically complex to manage optimally, but it is also faced with unique challenges that have both predisposed them to having this condition as well as those that are the sequalae of living with multiple co-morbidities. The purpose of this study is to look at the subjective experiences of those individuals who are living with and being managed for a triple diagnosis. METHODS: This is a descriptive qualitative study using the convenience sampling method. Semi-structured in-depth interviews with 12 open ended questions were conducted with 10 participants from the ‘3D’ Triple Diagnosis clinic at Chris Hani Baragwanath Hospital in Soweto, South Africa. This was done between July and December 2018. The participants were questioned about awareness of their condition, the experience of the clinic where they receive health care, the experience of disclosing their diagnoses, their general life challenges and their perception of the level of difficulty that the triple diagnosis may or may not pose in their lives. RESULTS: It was found that the triply diagnosed individuals are most knowledgeable about their HIV diagnosis and seek health care primarily for it. Many are aware of their psychiatric diagnoses and most are aware of their substance use disorders but are less forthcoming due to feelings of guilt and shame on a background of minimal support from those in their lives. This is compared to more support felt for HIV and mental illness diagnoses, with a few exceptions. The areas of greatest difficulty in general included financial difficulties with unemployment, the burden of being stigmatised for having HIV and poor social support with poor interpersonal relations, as well as having to cope with past childhood stressors that preceded the triple diagnosis. Many participants noted that the burden of living with three chronic conditions, as opposed to one like other people, was difficult. They experienced the clinic as a supportive base to help with the challenges the three diagnoses pose. However, the overriding stance was that whilst being triply diagnosed poses a unique set of difficulties, there are conditions that are more difficult to have. CONCLUSIONS: Attending a specialised multidisciplinary clinic that is specifically geared at managing triple diagnosis is beneficial for the physical and mental health of this population. Providing a space where they are seen and heard helps these persons cope with their multiple hardships. This also helps with the reduction of some of the harmful coping strategies previously used by this group