Adaptation of Inuka coaching problem-solving therapy to support mental health and HIV medication adherence among status-neutral men who have sex with men in South Africa

Depression and other mental health challenges are common among men who have sex with men (MSM) in South Africa and can make it harder to take HIV prevention (PrEP) or treatment (ART) medication consistently. This study explored whether an adapted coaching programme called WeCare, based on the Inuka/Friendship Bench problem-solving therapy approach, could help address both mental health and medication-related challenges.

Twenty MSM with mild to moderate symptoms of depression based on the PHQ-9 took part in the pilot programme. Trained peer lay mental health workers provided four individual coaching sessions and optional group sessions focused on identifying problems, finding practical solutions, and building coping skills. We measured changes in mental well-being before and after the programme and collected participants’ and coaches’ experiences through interviews and discussions.

Participants’ mental health scores improved after the intervention, and many described the coaching as helpful because it offered a safe, supportive space to talk about personal challenges with peers who understood their experiences. Stigma related to sexuality and HIV status emerged as an important factor affecting both well-being and medication use. Lay mental health workers valued the training and reported increased confidence in supporting others, though they highlighted the need for more knowledge about HIV medications to better assist participants.

Overall, the findings suggest that the adapted coaching approach is acceptable and feasible, with potential to improve mental well-being and support HIV care engagement among MSM in South Africa. The study also identified areas for refinement, including cultural tailoring and enhanced medication literacy training, to strengthen future implementation and evaluation.