By Avit Ndayiziga
In this twirling world, almost every person is likely to face mental health challenges at some point in life. This is due to major stressors like the death of a loved one, striking poverty, divorce, loss of a job, forced displacement, and others. However, according to the Office of Infectious Disease and HIV/AIDS Policy (HIV.gov), acquiring a serious virus like HIV adds salt to the wound, fueling depression and anxiety, two major mental health challenges for people living with HIV.
During the International AIDS Conference 2024, various sessions tackled the interconnectedness between HIV and mental health while highlighting the importance of integrating mental health services into HIV response programs such as prevention, treatment and care.
Over 970 million people worldwide are dealing with mental health challenges.
According to Rivet Amico, a counselling psychologist and associate professor at the University of Michigan’s School of Public Health, in the Department of Health Behavior and Health Education, working in the areas of HIV prevention and treatment for over two decades, “people living with or vulnerable to HIV struggle with mental health problems silently due to the stigma surrounding mental health, poor monitoring of mental health indicators worldwide, and lack of access to affordable and competent mental health services.” She added that “currently, over 970 million people worldwide are dealing with mental health challenges. Among people living with HIV, one in three faces serious mental health issues, while among young people living with HIV, one in four also suffers from the same problems.” She highlighted this during a symposium session entitled “Bridging mind and body: The interconnectedness of HIV and mental health.”
Stigma, discrimination and criminalization fuel mental health problems
During the same session, Annette Sohn, Vice President and Director, of TREAT Asia, a paediatrician and researcher with extensive experience in the Asia region, backed her, emphasising that multiple factors contributing to the mental health of people living with HIV include internal and external stigma and discrimination, mental health conditions that are not specific to HIV and Past-Partum depression.
In her presentation, Sohn shared the emotional toll of Veronica Betani, who lives with HIV in South Africa. “Being HIV is a challenge that is very hard in someone’s life, that makes you to break trust from everyone. It develops anger, pain and thinking that it’s only you in that situation and you don’t think straight, developing anxiety that needs help and care from people around you.
On the other hand, when speaking in the Satelite session entitled “From commitments to action: A thoughtful dialogue on integrating mental health into HIV prevention, treatment, and care,” Tung Doan, Executive Director of Lighthouse, a social enterprise based in Vietnam, mentioned that mental health issues mainly affect young people living with HIV for various reasons. ”Young people, once they acquire HIV, fear disclosing its status to their friends and loved ones. This, in turn, causes emotional stress and impacts their mental health and well-being developing severe depression and anxiety of loneliness, resulting in severe mental health illnesses.” Noted Doan.
Mental health therapy: Listening is the key
According to him, to provide effective mental health therapy for young people living with HIV, one key is listening to them. “As I mentioned earlier, young people living with HIV feel isolated. Therefore, they need someone to talk to. Someone who walks in their shoes and understands the root cause of their emotional tolls. To this end, we have implemented digital platforms where they can access mental health care easily and hotlines to call whenever they need any advice or help,” he concluded.
For Sohn, delivering mental health care for people living with HIV requires both clinical and technical resources. “In order to deliver mental care to people living with HIV in the public health context, clinical and technical resources need to be multiplied without substantial increases in staff and cost.” She underscored.
Integration is cheaper than treatment costs
As per United for Global Mental Health, an organization advocating for the right to enjoy the highest attainable level of mental health for everyone, by integrating mental health into HIV programs, nearly 1 million individuals could be spared from contracting the illness by 2026. The organization stresses that the advantages of this integration surpass the necessary investment, adding that integrating mental health services into existing HIV programs could accelerate the decline in infections by 10-17% without increasing treatment costs.
In working towards this objective, the organization uses its expertise in advocacy, funding, and activism to pursue a world where mental health assistance is available to everyone without stigma or constraints. Ultimately, their endeavours seek to cultivate a more empathetic, healthier, and efficient global society.
Ayibatari Burutolu Pepfar Program Manager at the U.S. Department of State, acknowledges that integrating mental health into HIV response is not a new concept or approach. Still, she emphasises the need to increase funds allocated to it in various countries that the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) collaborates with worldwide. So far, PEPFAR has saved more than 25 million lives by allowing them access to HIV response such as prevention, diagnosis, treatment and others.
Stigma, discrimination and criminalization hinder HIV response
However, even though, the world is working to meet the 95-95-95 targets by 2030, the International AIDS Conference 2024, has revealed that Stigma, discrimination and criminalization still stand as major obstacles hindering the HIV response.
Data do not lie
The data analysis of 842,169 people, including 70,109 people living with HIV, across 33 African countries links stigma with reduced engagement at every stage of HIV care.
Researchers analysed three stigma measures, all associated with lower past-year HIV testing: discriminatory attitudes towards people living with HIV (reported by 36% of people); the shame of associating with people living with HIV (18%); and perceived HIV stigma (79%).
As community-level discriminatory attitudes increased by 50%, people living with HIV were 17% less likely to be on ART and had 15% lower viral load suppression.
More than half of 18,430 healthcare workers across Europe are worried when providing care to people living with HIV. Almost half of 8,128 respondents in a study on HIV criminalization and enacted stigma in Eastern Europe and Central Asia had experienced stigma in healthcare settings.
Criminalization LBGTQ adds fuel to the fire
Laws that criminalize LBGTQ relationships in some African countries have worsened the challenges of key populations in accessing HIV services.
In Uganda, the Anti-Homosexuality Act threatens to set back progress that includes HIV prevalence among adults reducing from 18% in 1992 to 5.2% in 2020. Communities have seen a surge in discrimination, violence, arrests, “mob justice”, and service providers fearing to treat LGBTQ people.
A response team (formed by the government and other agencies) coordinated efforts to address the effects of the law on LGBTQ people; service providers were trained in maintaining LGBTQ-friendly services; and key population peers were supported to conduct client follow-up, refills and linkages.
In Ghana, where its Parliament approved anti-gay legislation, health workers are using integrated, community-based strategies to maintain access to HIV services for men who have sex with men. This includes peer educators pivoting from group outreach to engaging one-on-one to reduce visibility; shifting testing and treatment to homes and safe locations; and promoting multi-month dispensing of ART and PrEP to eliminate clinic visits. As the researchers say, the influence of the legislation on HIV programming is enormous, and they call for high-level stakeholder advocacy.