5 December 2019 (PAHO) - Due to advances in treatment and care, advocacy, health promotion and public education, people with the human immunodeficiency virus (HIV) are living longer than ever. However, this longevity also makes them susceptible to other illnesses including non-communicable diseases and mental health disorders. The need for other services such as mental and psychosocial support is therefore vital for this population.

Anguilla jetty

Gary Gumbs is a 50-Year-old Anguillan who has been living with HIV for many years. Gary came from an abusive family situation which escalated after his HIV diagnosis. Additionally, he has battled mental illness, depression and social issues. This resulted in him needing psychiatric care for some time in 2017. Since his release, Gary receives his HIV medication through the mental health programme at the Princess Alexandria Hospital which also provides him with a daily meal. 

gary gump

Anguilla has a low prevalence of HIV infection: Between 2010 and 2015, there were eight confirmed cases. Gary currently receives community-level mental health support, which ensures him consistent access to HIV and mental health services. This maximizes the provision of support service in Anguilla, a Caribbean island with less than 15,000 inhabitants. 

“I struggled with alcoholism for many years which eventually led to being HIV positive. Being HIV+ today is a new challenge, taking meds, trying to stay positive and eating healthy” Gary Gumbs

In March 2018, the Pan American Health Organization (PAHO) provided training to Non-Specialist health care workers, school counsellors and social workers to strengthen the ‘team-based care approach’. This provided an opportunity to build skills and competencies on detecting, managing and referring persons for mental health disorders. The ultimate purpose being to decrease stigma and discrimination and increase the comfort level of the support services in identifying, referring and following up people like Gary.

The Mental Health Gap Action Program (mhGAP) aims to scale up services for mental, neurological and substance use disorders and is adaptable within the country’s context. Emphasis was placed on the following modules during the implementation process in Anguilla:

Essential Care and Practice,
Self-harm/Suicide and Disorders due to substance use

This programme is expected to strengthen the support that patients would receive. 

Positive changes

For Gary, there have been positive changes in the support provided to him, and a more holistic approach is used to integrate his care.

The government provides Gary with HIV medication, he is currently on 4th line drugs which is the last level of treatment for patients. Healthy meals and positive support are also provided. Gary credits Ms. Monique Rey, Coordinator Mental Health Services at the Health Authority of Anguilla for being a great support to him. Monique Rey was responsible for counseling Gary Gumbs during his period of alcoholism and subsequent HIV+ status. 

Monique Rey

Monique recalls that Gary’s journey was tough but that she stood by and encouraged him, reminding him that he also had a big role to play in what he was going through. “I stuck with him, tried to show him that all was not lost. If you make the change then things will get better, it is not all about the medication, it is all about you and the change in lifestyle,” she said.

The Health Authority of Anguilla is a statutory body responsible for providing health services to the people of Anguilla. The Princess Alexandra Hospital is the only hospital on island with a psychiatric ward, which has ten beds. Anguilla currently has five trained mental health nurses who also offer community outreach services. Many clients are treated in the community, Gary Gumbs is one of them.

Mental health care in the community

Mrs Maeza Demis-Adams is the Chief Executive Officer (CEO) at the Health Authority of Anguilla. She highlighted the need for early identification of persons at risk and treatment of patients in the community. The main challenge she said is the resources required to provide community services as most personnel are also assigned to the 24-hour acute care facility.

demis adams anguilla

Mrs Demis-Adams noted that Gary is not only one of the many clients being treated in the community but that he is also employed on the Chronic Disease Unit at the Ministry of Health in the area of Health Promotion. Despite the challenges he is still facing, she explained that Gary inspires many. Mrs Demis-Adams said that after she created the Facebook page for the Health Authority, the management of the page was passed on to Gary, who in her opinion did an excellent job of using that medium to touch and improve lives.

mhGAP training focuses on social services. The aim is to treat professionals that are not specialized in mental health, including nurses and doctors in the community. Demis-Adams said that staff have been asking for the training as a priority, especially because of the importance of treating clients in the community as opposed to the acute center because of the stigma still attached to mental illness. As a result, continued training for health professionals, District Medical Officers and nurses is being planned for 2020 by the Ministry of Health.

Gary is very thankful for the support he receives from the Government of Anguilla and by extension the staff and colleagues with whom he interacts at the community and hospital level. He looks forward to a long and successful life. His love for photography and the encouragement received from his colleagues will be fundamental to him pursuing this dream.