Data Analysis and Results

Introduction The aim of this study was to establish among potential users their understanding of depression, their perceptions of what the potential influences of depression in HIV-positive women are and how they think they can be helped with this mental health problem. Accordingly, the aim of the study was to answer the following questions: How do HIV positive women understand the phenomenon of depression, particularly in terms of its manifestations and course? What influences do women living with HIV identify as a source of their depression? What interventions do they perceive as helpful? And, lastly, how would these interventions meet the needs of HIV positive women? Using data elicited from interviews with four participants, four main themes have been identified, namely, symptoms of depression; causal and contributory factors of depression; ways of coping; and perceptions of possible interventions. In order to clearly illustrate what these main themes and their constituent subthemes entail, and to explore the phenomenon under study, these themes will be discussed further. Each of the four participants in this study will be referred to as Participant 1-4. 1. Symptoms of Depression The symptoms of depression can be divided into five subthemes, namely, physical, medical, behavioural, psychological and emotional. 1.1. Physical Physical symptoms were a common complaint among three out of the four participants. Symptoms such as a loss of weight, physical pain, a lack of strength, tiredness and lethargy were among the physical symptoms identified. A visible manifestation of a physical symptom that was identified was a change in the normal facial expression of a person. Participant 1: I lost weight from 60 to 5. Participant 2: I cant sleep , eat and become tired Participant 3: ...if you have pains you feel it in your body. Participant 3: You see that her face is not in normal condition, there are some changes that show that she facing some problems.

1.2. Medical There were two symptoms mentioned that were medically related and these were a decrease in CDS count and the ceasing of menstruation. Participant 1: ... Her CD$ count decreases Participant 3: Im no longer menstruating. 1.3.Behavioural Behavioural symptoms identified include a loss of appetite, loss of sleep, social withdrawal and unusual quietness. Further symptoms include an inability to express oneself or express physical affection, a poor sense of humour, an inability to perform household chores or activities previously considered enjoyable and a displacement of anger. Participant 1: ...you know that this person is always open and you see that person so quiet and even when you meet in the street still the same and you start asking her about the problem and she will tell you. Participant 1: ...you will see that there is something that she want to tell but dont know how. Participant 1: ...if you work together we always greet and hug each other and let say I come the following day try to hug you and you not want to and I will see that you are not alright Participant 1: I just lost appetite when I see food in front of me Participant 2: You dont feel like talking to people Participant 2: And you want to be alone. Participant 2: ...unable to do house chores. Participant 4: ...unable to do things that you like as before and you feel like some other things are not worth like doing Participant 4: It was so bad because I had to take it out on my boyfriend like everything he said I just twisted everything that he said. 1.4.Emotional Feelings of anger were common across the responses of two participants and feelings of unhappiness were common across two participants as well. Other emotional symptoms of

depression mentioned include apathy, jealousy, irritation, poor humour, crying and hurt feelings. Participant 1: ... you will see her being angry everytime not wanting to talk Participant 1: ... if someone is not well like me when Im not felling well it very easy to see that ,because I cry very fast and when Im not well I keep quite, even if you talk to me laughing the tears would be running down on my face very fast showing you that Im not well Participant 2: I dont know what to say Participant 3: ... finding that people are laughing but I dont feel like it Participant 4: You see so I just get so jealous sometimes that they are..like I just look at them being happy and everything I think that they dont have to go through what Im going through
1.5. Psychological

Forgetfulness, anxiety, fear of mockery, hopelessness, low self-esteem and low self-worth, confusion, preoccupation, guilt, alienation and distrust are just some of the psychological symptoms associated with depression. The fear of being pitied and of exposing others to infection was also mentioned among these symptoms. Participant 1: ...they usually forget to take treatment. Participant 1: ...I have a problem of forgetting things you must excuse me Participant 3: You are thinking of something only find that what you thinking does not make sense. Participant 4: ... what if my boyfriend like get infected because of me Participant 4: ...my self esteem have dropped big time and I just feel like, There are things that like Im not worth 2. Causal and Contributory Factors of Depression 2.1. Hopelessness

Hopelessness was common across three participants, one of whom viewed the disease as a death sentence, while the other saw no hope beyond medical treatment to keep her alive and the third felt like her depression would never end. Participant 2: ...since Im sick Im nothing because I can die at anytime Participant 3: I dont see myself getting better 2.2. Poor Health All four participants complained of declines in their general health, with one claiming to get the flu very often and another complaining of tiredness and a loss of strength. Participant 1: It because Im HIV positive and I always have flue and the month wont end not being sick Participant 4: ...my health is not the same as before ever since I found out that I was HIV positive 2.3. Lack of Social Support Three participants experienced a lack of social support, with two having been abandoned by their boyfriends, one experiencing rejection from family, another choosing not to talk to anyone and the third losing a father. Participant 1: It when your partner dump you and when you family doesnt give you support Participant 2: I tell no one Participant 3: ...the child was born and I raise the child all by myself 2.4. Stigma and Discrimination All four participants feared, witnessed or experienced discrimination- within their families, from friends or in the workplace. Participant 1: ... if at home now they are putting your things aside like having your own plate, spoon and your own cup and that hurt. Participant 4: ... when people are talkig about it they always say negative things about people who are HIV positive and it does affect me but I try to hide it

2.5. Fear of Disclosure Two participants did not disclose their statuses for fear of being mocked, being discriminated against and treated differently by those they love. Participant 2: Its when I think about this problem that I stay with my children and they dont know that Im sick and how am I going to tell them Participant 4: I try to hide it because I dont want them finding out because you know how people are 2.6. Stressful Life Circumstances Two participants experienced stress in the workplace through feared job loss or being forced to get tested for TB. Another participant faced issues of hunger and poverty.

Participant 3: ...it was very hard because at home no one was working and child was sick having malnutrition and I took her to hospital but now it better because she grown. Participant 4: So like I was scared all the time when I wake up in the morning that what if she phones me and ask me to stop coming to work you see Ive been having those thoughts
3. Ways of Coping 3.1. Problem- Focused

Three participants actively sought to cope with the disease by taking medical treatment while one of them engaged counselling services.

Participant 1: I took my treatment very well Participant 3: I can say I did get help because of medication Im still alive because if you dont take treatment you die 3.2. Emotion- Focused Emotion-focused strategies identified include self-acceptance, seeking support, convincing oneself that the disease will pass, distracting oneself, trying to forget and focusing on the positive aspects of ones life.

Participant 1: It will be for a short time it will pass I must accept my situations and not to concentrate on unnecessary things Participant 4: Im still better because I still got a job Ive got a family and Ive got everything you know and then I just say okay at least nobody can see that Im HIV positive so why should I worry about something that some people know nothing about 4. Perceptions of Possible Interventions 4.1. Social Support Three participants stated the importance of social support (family, friends or a counsellor) and the need to talk to someone and seek advice. Participant 1: ...by being able to communicate with people by going to church and not to be alone because that will cause a stress Participant 3: Is to talk with other people about your problem, and if your problem is not easy you need to talk to someone you trust and you will be relieve you dont have to keep it inside of you and that person will give you advise and you will feel good.

4.2. Treatment Plan The importance of sticking to a good treatment plan which includes medication and a healthy diet was emphasised. Participant 1: ... to make sure that you take your pills not in an empty stomach and taking care of you to make sure that you always free and happy. Participant 3: If you did not eat you wont be able to concentrate because you are hungry.

4.3. Professional Counselling and Education One participant stated that it is important to seek the help of a counsellor to keep one motivated to continue treatment. Participant 1: It will help because after talking with the councilor Ill be happy and make sure not allow anything that will hurt me and continue taking my pills and as long my family love me.

4.4. Religion and Spirituality It was suggested by a participant that an individual visits their local church and seeks advice and prayers from a pastor. Potential benefits include a reduction in the infection rate among youth due to increased education. Participant 1: ...is to go to church so that you will receive different kind of advises, like when someone is preaching it seems as if he or she know about your problem and that help you to receive that advise, unlike when you always lock yourself at home you find yourself losing weight only because you always alone Participant 1: It need other people because we dont have the same gift in praying 4.5. Acceptance One participant tries to accept her situation and forget that she has the disease so that she can move forward. Participant 1: ...be free and just accept the way you are Participant 2: I can tell her to let it go 4.6. Helping Others One participant claims that she would be able to regain a small measure of self-worth if she had more money and was able to spend it helping others. Participant 4: ...maybe sometimes I just wish I had a lot of money you see and then just have money and then support other people you see that are in need maybe that will make me like feel like Im worth something Conclusion As noted above, there were certain factors that were common across all four participants. The most common concern of these participants was a fear of disclosure due to stigma and discrimination. All participants noted a general decline in their health and placed great emphasis on the need to strictly adhere to a proper treatment plan and to seek social support.