Group Therapy Helps Ease Burden of AIDS in Uganda
By Marc Lacey
The New York Times
January 15, 2004
YOTERA, Uganda, Jan. 11 - There is no word for depression in
Luganda, the local language, but until about a year ago Jose-
phine Namaganda was most certainly suffering from just that.
She shunned her grandchildren, preferring to cry alone in her
hut. She lacked the energy to work, which meant that her fertile
farmland became overrun with weeds. She wished she were dead.
Mrs. Namaganda was not alone. Researchers who visited 30 vil-
lages in southwestern Uganda three years ago found 21 percent of
the people surveyed showed depression. They traced the problem
In villages along Lake Victoria, some of Africa's earliest AIDS
cases were discovered 20 years ago. The disease has devastated
the area, dotting the fertile landscape with graves. Uganda's
government has made strides in reducing its overall infection
rate, but the lakefront remains a trouble spot.
One aggravating factor is the havoc that depression can wreak on
those infected or those who have seen family members die one af-
ter another. Researchers have responded with a new group-therapy
program. And they have found that in the African bush, as else-
where, treating people's minds can help their bodies rebound.
"You see people who in the beginning don't want to live anymore
who start becoming productive," said Cephas Hamba, a group fa-
cilitator with World Vision, a relief organization that con-
ducted the research with experts from Johns Hopkins and Columbia
Mrs. Namaganda lost her husband to AIDS, and 6 of her 12 chil-
dren have died, some from related ailments. She now cares for
nine grandchildren, tiny ones with big eyes who have had no
choice but to suffer through her low moments with her.
She says she reached rock bottom in 2002, when she discovered
that she, too, was infected with H.I.V., the virus that causes
AIDS. "I locked myself in the bedroom and I chased all the chil-
dren outside," she recalled. "I beat them whenever they came
around. They would say, `Grandma, where's the food?' I'd say,
`Let's all die.' "
Then one day last year, a World Vision counselor invited her to
share her woes with her neighbors. At first she sent the coun-
selor away, but eventually she agreed to listen. A session was
convened, and after many long silences, people began opening up.
They shared their suffering. They recalled the funerals. Once
they came to trust one another, each revealed his or her H.I.V.
And their depression lifted.
The therapy study was conducted with 15 groups of up to a dozen
people each - segregated by sex to encourage confidences. Each
group met 90 minutes a week for four months.
Results indicate that 6.5 percent of those who underwent therapy
still suffered from major depression. In a control group without
therapy, 54.7 percent remained depressed.
"Group interpersonal psychotherapy was highly efficacious in re-
ducing depression," read an article on the research in the June
2003 issue of the Journal of the American Medical Association.
"A clinical trial proved feasible in the local setting. Both
findings should encourage similar trials in similar settings in
Africa and beyond."
Mrs. Namaganda began sleeping through the night. She picked up
her hoe and started working her fields, growing corn, bananas
Before the researchers came along, locals described their suf-
fering using two terms. In Luganda, "yo'kwekyawa" means hating
oneself. "Okwekubagiza" means pitying oneself. Nobody had any
idea that talking could make one feel good enough to get out of
The researchers had had similar doubts. They ruled out antide-
pressants because of the cost and a lack of health services.
They worried that psychotherapy might not translate well in the
"So much attention is being paid to AIDS but so little is being
done about the mental health aspects of the disease," said Paul
Bolton of the Boston University School of Public Health, who led
the project while he was at Johns Hopkins. "Depression devas-
tates people's ability to function."
By using local facilitators, the researchers found that talking
through one's woes works just as well on a straw mat as on a
One of the study participants, Maria Prisca Namugerwa, said she
had been so afraid before the therapy that AIDS would kill her
that she had thought about taking her life before the disease
The researchers said that for ethical reasons, nobody who enter-
tained active thoughts of suicide had been included in the
study. But many of those who took part said they had thought
At a recent group therapy session, Mrs. Namugerwa smiled broadly
as she described how she used to toss and turn at night. She now
sleeps peacefully, she said, adding, "The group told me my life
was worth something."
In a group session for men, Livingstone Ntale got the strength
to visit a clinic to determine if he was H.I.V.-positive. Though
the results confirmed his fears, he said the group discussions
changed his attitude so much that he took his wife for testing,
too. Her test was negative, and they now live with the hope that
she, at least, will be around to rear their 10 children, some of
whom were borne by Mr. Ntale's first wife, who died of AIDS.
"My philosophy now is, `I could die tomorrow but I could live
another 50 years,' " Mr. Ntale said. "I used to pick up the hoe
and start working, but then I'd stop. I'd think, `Why should I
Others who have benefited include Justine Nalweyiso, who learned
to control her urges to abandon her three children, and Gormet
Nayiga, who no longer thinks she is going to die every time she
does not feel well.
The therapy sessions drew participants together so effectively
that many have continued meeting. Some have also used their
counseling groups to start business ventures together. Women
weave multicolored mats. Men pool their money to buy chickens
Lwanga Lawuli, 65, who has lost all his relatives to the dis-
ease, said he considered the half dozen men in his group to be
his brothers. The best thing about the discussions, he said, is
the comfort of knowing that he will have people around to take
care of him if he falls ill.
Like so many others, Abdul Hakim Ssempijja thought he had AIDS
but was too terrified to find out for sure. He, too, got tested,
and he, too, found the virus was in his blood.
But talking about his woes, he said, has given him strength.
"This group didn't take the virus out of my body," he said. "I
still fall sick. I am still weak. But at least now I'm living."
At one recent session, Mr. Lawuli chastised a fellow member,
George Lubulwa, for failing to get tested.
Mr. Lubulwa said he was fairly sure that he is H.I.V.-positive
but would rather live without the certainty. He feared falling
into depression again if the test is positive. His wife, he
said, definitely could not handle the news.
"He keeps telling us he'll go get tested," countered Mr. Lawuli.
"But he doesn't do it."
Mr. Lubulwa's big smile faded and he looked down solemnly. "I
respect your advice," he said. "I'm still looking for the right
There was an awkward silence.
Then Mr. Lubulwa spoke again. "Let me tell you a secret close to
my heart," he said. "I want a child. If I'm positive or my wife
is positive, and we know it, maybe we won't get one."
The men sitting around him had no mercy. They told him sternly
that the child might be born infected, spreading the disease
into a new generation. And they told him that his wife might not
have the virus yet and that he might infect her.
"I think I should go get tested," Mr. Lubulwa said finally.