WATCH | Bhekisisa: Should nurses be allowed to hand out psychiatric drugs?

There is a high likelihood that people with HIV are battling mental health problems. However, only doctors can prescribe psychiatric medicines. Could getting nurses to do this help people with HIV to stay on their treatment, and reduce infection rates?

Mia Malan finds out from a doctor who has lived through HIV with his patients for the past 20 years. 

By 2028, trained nurses in South Africa should be able to prescribe psychiatric medicines — if lawmakers move fast enough. This will make antidepressants and drugs to deal with anxiety easier to obtain , especially for people with HIV, who are about five times more likely than those without the virus to have depression, and eight times more likely to experience anxiety.

Only doctors can prescribe mental health medication, but the national five-year HIV plan, which ends in 2028, aims to change this, as treating mental health challenges results in people with chronic conditions such as HIV finding it easier to stay on treatment.

Once the health minister publishes draft regulations to say who may dispense what kind of drugs, it “could be a matter of months” for the new rules to come into effect, said Andy Gray, a senior lecturer in pharmacology at the University of KwaZulu-Natal and a member of the committee which advises government which medicines to buy. 

The health department has not yet announced when it will start the process for changing the law, but the matter is urgent and relatively high on the department’s agenda, experts said, because adjusted legislation will help to slow the spread of HIV. 

Research has shown  there’s a high likelihood for someone with HIV to struggle with a psychological problem such as depression or anxiety, or to think about suicide. 

Mental health challenges such as depression and anxiety are associated with people with HIV taking their medicine less regularly, which means they could stay infectious. Taking HIV drugs every day stops the virus from multiplying in your body and lets the level of the virus drop so much that it’s virtually impossible to transmit the infection through sex. 

However, government's health system, which most HIV-positive people in the country use to get their treatment,doesn’t have nearly enough doctors to staff clinics full-time. There are about eight doctors for every 10,000 people in South Africa, while the number sits at about 21 per 10,000 people in other upper middle-income countries. Instead, nurses run such clinics, with doctors doing shifts once or twice a week.

Getting nurses to diagnose mental health conditions and prescribe treatment will mean patients won’t have to return for a doctor's appointments to be treated.   

This will not be the first time such task shifting is written into the country’s laws to help get the spread of HIV under control.

When free antiretrovirals (ARVs) were introduced to the public health system in 2004, only doctors were allowed to prescribe the HIV pills. Since 2010, however, nurses have been able to do this too, which is part of the reason why about 6.1-million people with HIV are on treatment today (this is about 77% of people who know they have HIV). 

ARVs become more accessible in August when trained pharmacists were given permission to prescribe them. 

Most mental health medicines are schedule 5 drugs, which is why only doctors can prescribe them. Nurses can hand out drugs only up to schedule 4, said Gray, so changing this rule will be the first step in getting the process for better access to mental health treatment started. 

A change in law won’t be enough, though. Nurses will have to get special training for dispensing psychiatric medicines, similar to what nurses who are allowed to hand out HIV drugs have to do. Moreover, said Gray, these health workers will have to be guided by psychiatrists.

“Mentoring is going to be really important, not only during the training but as an ongoing referral mechanism for those nurses who will be asked to take care of patients with mental conditions.” 

What are the dangers of shifting some of the psychological care for people with HIV to nurses, and will it be as effective as when ARVs were put in nurses’ hands? 

Malan spoke to Francois Venter, a doctor who has lived through HIV for the past two decades with his patients and the director of Ezintsha at Wits University, to find out in the latest episode of Health Beat, Bhekisisa’s monthly TV show.

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.