title: 'I was thinking too much': experiences of HIV-positive adults with common mental disorders and poor adherence to antiretroviral therapy in Zimbabwe.
abstract: OBJECTIVE
  To document the lived experiences of people with both poor mental health and suboptimal adherence to antiretroviral therapy in high HIV prevalence settings.
  
  
  METHODS
  In-depth qualitative interviews were conducted with 47 (female = 31) HIV-positive adults who scored above the cut-point on a locally validated scale for common mental disorders (CMDs). Purposive sampling was used to recruit participants with evidence of poor adherence. Six additional key informant interviews (female = 6) were conducted with healthcare workers. Data were collected and analysed inductively by an interdisciplinary coding team.
  
  
  RESULTS
  The major challenges faced by participants were stressors (poverty, stigma, marital problems) and symptoms of CMDs ('thinking too much', changes to appetite and sleep, 'burdened heart' and low energy levels). Thinking too much, which appears closely related to rumination, was the symptom with the greatest negative impact on adherence to antiretroviral therapy among HIV-positive adults with CMDs. In turn, thinking too much was commonly triggered by the stressors faced by people living with HIV/AIDS, especially poverty. Finally, participants desired private counselling, access to income-generating activities and family engagement in mental health care.
  
  
  CONCLUSIONS
  Better understanding of the local expression of mental disorders and of underlying stressors can inform the development of culturally sensitive interventions to reduce CMDs and poor adherence to antiretroviral therapy.
authors.affiliation: Arnhold Global Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
authors.forename: Khameer
authors.initials: K
authors.lastname: Kidia
authors.affiliation: University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.|Women's University in Africa, Harare, Zimbabwe.
authors.forename: Debra
authors.initials: D
authors.lastname: Machando
authors.affiliation: University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
authors.forename: Tarisai
authors.initials: T
authors.lastname: Bere
authors.affiliation: Institute of Psychiatry, King's College London, London, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Macpherson
authors.affiliation: University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
authors.forename: Primrose
authors.initials: P
authors.lastname: Nyamayaro
authors.affiliation: Institute of Psychiatry, King's College London, London, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Potter
authors.affiliation: University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.|Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA.
authors.forename: Tariro
authors.initials: T
authors.lastname: Makadzange
authors.affiliation: University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
authors.forename: Ronald
authors.initials: R
authors.lastname: Munjoma
authors.affiliation: University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
authors.forename: Marshall
authors.initials: M
authors.lastname: Marufu
authors.affiliation: Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Araya
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Safren
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Conall
authors.initials: C
authors.lastname: O'Cleirigh
authors.affiliation: University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
authors.forename: Dixon
authors.initials: D
authors.lastname: Chibanda
authors.affiliation: University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.|Institute of Psychiatry, King's College London, London, UK.
authors.forename: Melanie
authors.initials: M
authors.lastname: Abas
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003469:Culture; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D011203:Poverty; D015995:Prevalence; D057545:Social Stigma; D012944:Social Support; D018454:Spouses; D013315:Stress, Psychological / Q000209:etiology; D013850:Thinking; D015030:Zimbabwe
chemical_list: D019380:Anti-HIV Agents
keywords: HIV/AIDS; VIH/SIDA; adherence; adherencia; adhésion; antiretroviral therapy; barreras; barriers; barrières; compliance; depresión; depression; dépression; mental health; salud mental; santé mentale; terapia antirretroviral; thérapie antirétrovirale