Aim. The aim of the study was to determine knowledge, attitudes and personal beliefs regarding HIV and AIDS in a group of mentally ill patients attending outpatient clinics in Soweto, Johannesburg. Method. All patients attending four randomly chosen clinics in Soweto were invited to complete a self-administered questionnaire after obtaining informed written consent. The 63-item questionnaire, developed from others specifically for this study, included questions on socio-demographic and clinical characteristics; knowledge on how HIV is acquired and spread; attitudes and beliefs regarding HIV and AIDS; and condom usage. The statements in the knowledge sections were used to calculate a composite score, which if greater than or equal to 75% was defined as ‘adequate knowledge’. Results. A total of 1 151 patients with mental illness participated in the study. The mean age was 41.9 years (standard deviation 11.6) and the majority were males (50%); single (55%), and had achieved only a secondary level of education (53.3%). Overall, most of the study population did not believe in the myths surrounding the spread and acquisition of HIV and AIDS. There were however, significant associations between a low level of education and the belief that HIV is acquired from mosquito bites (odds ratio (OR) 1.61; 95% CI 1.19 - 2.18; p=0.002) and through masturbation or body rubbing (OR 1.76; 95% CI 1.34 - 2.33; p=0.000). Although more than 90% of the patients were aware of the facts regarding the spread of HIV, approximately 40% did not believe that one could acquire HIV through a single sexual encounter. The composite scoring for knowledge showed that less than half the patients had adequate knowledge of HIV/AIDS. This was significantly associated with gender and level of education: females were 1.6 times (p

Toxic epidermal necrolysis (TEN) is a distinct clinical entity within a spectrum of adverse cutaneous drug reactions. It is characterized by >30% of the body surface area of skin detachment with an average reported mortality of 25-35%. Drug induced TEN is associated with various antibiotics, anticonvulsants and other drugs. While adverse cutaneous drug reactions are common with antidepressants, the majority eruptions are benign and easily treated. TEN is rarely reported in association with selective serotonin reuptake inhibitors (SSRI's). We describe TEN in a 34-year-old patient from Mozambique associated with the addition of fluoxetine for a major depressive episode with psychotic features.

Background: Persons with HIV and severe mental illness face numerous barriers in antiretroviral treatment adherence. More information is needed on reasons for loss of follow-up in this population. Methods: A retrospective analysis was conducted on adult HIV patients with a history of mental illness enrolled at an urban HIV clinic in Johannesburg, South Africa who discontinued care. Results: 24.8% of adult patients in the clinic discontinued follow-up during the study period. Of those discontinuing follow-up, 48 were successfully traced by home visits. Among this group, 21 (43.8%) were not engaged in care, 12 (25.0%) had transferred care, 9 (18.8%) were deceased, 3 (6.2%) had relocated, and 3 (6.2%) were missing. Transportation costs and distance, conflicts with work/school schedule, and confusion regarding when to return were the most frequently cited reasons for discontinuing follow-up. Conclusions: Although almost 25% of patients were lost to follow up, overall rates of retention in care for these patients were similar to those seen in other HIV-infected populations and higher than those seen among patients with psychiatric disease. Tracing patients through home visits proved to be an effective means to confirm the magnitude of patients lost to follow up, ascertain their outcomes, and elucidate the reasons for discontinuing care.

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These guidelines are intended as a reference document to assist HIV nurse and doctor clinicians in managing mental health disorders. It is intended to improve awareness, knowledge and capacity to support patients living with HIV and mental health disorders.