I lome-based caregivers arc in the frontline of SA's HIV/AIDS response,especially in rural areas like llcilbron, where the shortage of healthcare professionals is most acute. Their training, however, is limited to identifying and dealing with the physical symptoms of HIV, and counselling patients on how to live positively with the virus. They tire less well equipped to deal with the emotional and psychological consequences of an I [IV-posilive diagnosis. "We do deal with patients who find out they're | HI V j positive and they lose it." Gladys Scabi. a care worker who attended the workshop, told /RIN/PlusNcws. "They end up with depression that's untreated, and 1 don't know how to help them because [ haven't been trained in it." SADAG's volunteer trainers, usually students in their third or fourth year of a psychology degree, conduct one-day workshops for home-based care workers all over the country. A day is only enough to teach basics such as the causes, symptoms and effects of depression and stress; the warning signs of suicide; how to help a child cope with death; and how to start a support group, but there is a toll-free line the care workers can call il'lhey need more information after the workshop. The organisation has also developed a 'speaking book' on 11IV and depression, but caregivers are encouraged to refer clients with suspected depression to their local clinic or hospital. "If they have a swilehed-on nursing sister they'll identify it as depression," said Zane Wilson, SADAG's founder and director. "But if that doesn't happen, which is in about 50% of cases, we get the carcgivcr to go back [to the clinic or hospital] with the patient and one of our brochures, and try to actually educate the nurse." A double stigma After years of struggling with her own undiagnosed depression, Wilson abandoned her career as a successful businesswoman and founded SADACi in 1997. At the time, she said, there was a perception that mental illness only affected white people. "There's more awareness now that it can affect anyone, and that anyone with a severe illness, whether it's cancer or f 11V. is more vulnerable," she said. But the stigma attached to mental illness persists, and when combined with 1 [IV-related stigma it can be devastating. Gugu Nyathika/i, a trainer, recal led that alter her father died when she was a child, none of her relatives thought to take her for counselling. "You're just supposed to be strong and get over it or they'll say you're bewitched and take you to a traditional healer," she said. Recognising that traditional healers arc often a patient's lirst port of call, SADAG recently started running training workshops for them. "We teach [the traditional healers] the basics of depression and say to them, 'If you can't gel patients well then send them to a clinic,"' said Wilson. Care workers also vulnerable A second goal of SADAG's workshops is to help home-based care workers recognise their own potential for depression. A study by SADAG, in conjunction with the University of Witwatcrsrand, in Johannesburg, found that 89% of home-based 1 M V/A1DS care workers in two South African provinces were depressed or showed signs of depression. "They may not even recognise it, but they get stressed and burnt out and then leave, and that's a disaster," said Wilson. Anje Manfroni, the director of Hkuphoteni Mental Health Centre, a non-profit facility in the township of Katorus, east of Johannesburg, pointed out that the lives of care workers often differed little from those of their clients. The small government stipends they earned were usually not enough to lift them out of poverty and. in most cases, their families have also been affected by HiV. "It's really overwhelming." agreed Gloria Ndwandwe, a care worker and counsellor at Kkupholeni. "We're always listening to other people's problems, and at home we're busy with [those of] our families." The problems Scabi encounters in the homes of her clients sometimes keep her awake at night. "I'm passionate about the work but there are those who bunt out, who can't cope anymore." The SADAG workshop suggests ways for care workers to manage their stress and get support when they need it. Scabi said she deals with stress by talking to her mother and attending regular debriefing sessions with her col leagues, but Nyathikazi, the SADACi trainer, said not all care workers looked alter their mental health. "i think they don't talk [about themselves] sometimes because they think they have to be-strong for their patients," she said.