Building Community Support for Mental Health and HIV in Botswana

By Jillian Rose Lim

Editor’s Note: Where Discovery Leads is a multimedia storytelling project that delves into key research themes at CHOP Research Institute. This is part two of a two-part series that focuses on the suite of scientific studies aimed at better understanding the neuropathogenesis of HIV infection on cognitive and intellectual development and to improve support services for affected children and adolescents. See part one of this series.

Youth living with HIV in limited-resource settings face unique challenges when it comes to mental health. In Botswana, a country with one of the highest HIV prevalence rates in the world, few accessible places exist for children and adolescents to receive mental healthcare.

“We see a lot of depression and a lot of anxiety, and many of our patients unfortunately experience multiple traumas in their life,” said Elizabeth Lowenthal, MD, MSCE, research director for Children’s Hospital of Philadelphia’s Global Health Center, who lived full-time in Botswana for four years serving in a large clinic dedicated to the care and treatment of children with HIV infection. “For many, there’s a post-traumatic stress component as well: They’ve experienced the death of loved ones from HIV, and after losing mom or dad, learning about your own diagnosis can be similarly traumatic.” 

Addressing the mental health of children living with HIV in limited-resource settings is essential, Dr. Lowenthal explained, because depression or anxiety can impact how actively an adolescent adheres to their daily HIV medications. Depression and anxiety also decrease the quality of life for these young people already managing more than most youth.

“It’s common that children become good at [taking the medicine] at elementary school age and always remember, but as soon as they get older and start struggling in other areas of their life, medication-taking often becomes hard,” Dr. Lowenthal said. “You have to be able to be there for them and be non-judgmental.” 

In neighboring countries, mental health initiatives are inspiring researchers at CHOP to adopt creative, culturally adapted approaches to safeguard the mental health of Botswana’s youth. In Zimbabwe, psychiatrist Dixon Chibanda, PhD, conceptualized the Friendship Bench intervention, where grandmothers or other highly respected community members learn problem-solving therapy and help youth think and talk about some of their life struggles.

Inspired by Dr. Chibanda’s approach, Merrian Brooks, DO, MS, a pediatrician and adolescent specialist completing a David Pincus Global Health Fellow at CHOP, piloted a “Near Peer” young adult lay counselor program in Botswana, in which young people who show leadership potential receive problem-solving therapy training. As part of the program, the Botswana-Baylor Children’s Clinical Center of Excellence, where Dr. Lowenthal formerly worked, conducts basic mental health screening as part of their standard of care to pick up if a teen has depression or anxiety symptoms or reports substance use. 

If they score as having severe problems, the teens are referred to the clinical psychologist. But since the clinical psychologist doesn’t have the capacity to care for those with mild and moderate symptoms, those who score as having mild or moderate symptoms become eligible for a match with the near peer youth lay counselors. The intervention provides support to youth before their mild symptoms lead to serious mental health concerns. Drs. Lowenthal and Brooks are currently observing the intervention’s efficacy.

Read more about Dr. Lowenthal’s work in Botswana on Cornerstone.