A new study in South Africa aims to examine the effect of psilocybin on treating depression in HIV-positive women with the goal of increasing treatment compliance.

No matter how effective HIV and AIDS treatment have become in the so-called “first world,” the disease is still devastating in places like South Africa. Indeed, HIV infection represents one of the most serious public health challenges in the country. South Africa has the tragic distinction of being the country with the highest number of people infected with the disease globally and the fourth highest adult HIV prevalence rate according to UN statistics. A whopping 13% of the population is infected.

Further the demographics are different than they have been in Western countries. It is not a disease mostly of gay and bisexual men, but straight, Black women. In fact, women are twice as likely to contract HIV in sub-Saharan Africa. Tragically, women between 15-19 years old account for 6 out of 7 new infections and represent 63% of the newly infected. In 2020, 4,200 women between 15 and 24 became infected weekly.

AIDS contributes to about a quarter of all deaths in the country.

Beyond the complications of AIDS, however, are two other large and looming problems.

About one third of all South African HIV patients are also comorbid with tuberculosis. Beyond this, mental illness, specifically major depressive disorder is a widespread and unaddressed problem. According to available data, 40% of South Africans living with HIV also suffer from depression and 60% suffer from PTSD.

Both of these conditions also appear to affect compliance with the retroviral treatments necessary to live rather than die with HIV.

Psilocybin as a compliance tool in South Africa?

A new study helmed by Cannsun, Africa’s largest existing commercial medicinal cannabis facility located in the Western Cape and TASK, a research organization focusing on communicable diseases, aims to understand if psilocybin, administered to this population, will treat comorbid mental illness—and as a byproduct also create better drug compliance with retroviral therapy. 

The study will build upon academic work published this year by Roland Griffiths, a pioneer in such research, which examined the efficacy of psilocybin over the course of a year on patients suffering from just MDD. The Griffiths study showed that psilocybin had substantial antidepressant effects which lasted about 12 months.

The South African study is innovative—and for several reasons beyond the treatment. This starts with its focus: Women are routinely underrepresented in mental health studies everywhere.

Each patient will be enlisted for a minimum of three months. The trial will last about eight. Researchers hope to publish the results in spring 2023.

Cannabis and psilocybin—psychedelics on the new frontier in medicine?

The trial is also interesting for another reason. Not surprisingly, the cannabis industry has become increasingly interested in other psychedelic drugs, psilocybin being one of them.

The first commonality beyond the modern move towards medical utilization, however, is also the disease at issue. For the last forty years, cannabis has been used by people suffering from the symptoms of AIDS and HIV—starting with nausea. More recent research has determined that there is a link between cannabis use and reduced inflammation caused by HIV.

The second is the new interest in treating major depressive disorder with psilocybin.

Using them together is also increasingly on the cards in modern medical inquiry about the effectiveness of both cannabis and psilocybin.

The reality is that people have combined the two compounds for centuries. In the modern context, a 2006 study found that nearly 60% of the 149 students surveyed used both substances.

Most of what is known about combining these drugs comes from anecdotal reports as there have been no formal trials. It is unclear how these drugs could be taken together to augment therapeutic effects of either.

The good news is that as cannabis reform progresses globally, expect to see more studies on both—individually, and of course, in combination.

MDD associated with major incurable medical conditions, as well as compliance, is an issue that exists far beyond South Africa.