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Mental health and HIV/AIDS
the need for an integrated response
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Integration of mental health screening and care into all HIV testing and treatment settings would not only strengthen HIV prevention and care outcomes, but it would additionally improve global access to mental healthcare.
AIDS 2019
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ABSTRACT
Tremendous biomedical advancements in HIV prevention and treatment have led to aspirational efforts to end the HIV epidemic. However, this goal will not be achieved without addressing the significant mental health and substance use problems among people living with HIV (PLWH) and people vulnerable to acquiring HIV. These problems exacerbate the many social and economic barriers to accessing adequate and sustained healthcare, and are among the most challenging barriers to achieving the end of the HIV epidemic. Rates of mental health problems are higher among both people vulnerable to acquiring HIV and PLWH, compared with the general population. Mental health impairments increase risk for HIV acquisition and for negative health outcomes among PLWH at each step in the HIV care continuum. We have the necessary screening tools and efficacious treatments to treat mental health problems among people living with and at risk for HIV. However, we need to prioritize mental health treatment with appropriate resources to address the current mental health screening and treatment gaps. Integration of mental health screening and care into all HIV testing and treatment settings would not only strengthen HIV prevention and care outcomes, but it would additionally improve global access to mental healthcare.
Prevalence of mental health disorders among people living with HIV
In a US multisite study with over 2800 PLWH, 36% had major depression and 15.8% had generalized anxiety disorder , compared with only 6.7 and 2.1%, respectively, in the general population . Other studies from North America have shown similarly higher rates of mental health disorders among PLWH. PLWH presenting at an academic medical center in the Southeastern US showed high levels of mood disorder in the past year (32%) and past month (21%), as well as anxiety disorder in the past year (21%) and the past month (17%). Although major depression is one of the most commonly seen mental health disorders in PLWH, rates of posttraumatic stress disorder (PTSD) are also much higher among PLWH than in the general population, ranging from 10 to 74% compared with only 8% in the US general population .
Conclusion
Our review has identified the following understandings about the intersection of mental health and HIV/AIDS:
Mental health problems (ranging from distress to SMI) are elevated among people at-risk for HIV and those living with HIV. This risk is true across populations most affected by the epidemic in different regions of the world.
Mental health problems contribute to HIV acquisition and poor outcomes along the HIV treatment continuum.
HIV and the resulting chronic immune activation increase the risk to develop mental health problems.
We have the necessary assessment (screening) tools and efficacious treatments to treat mental health problems among people living with and at risk for HIV. However, we need to prioritize mental health treatment, especially mental health treatment integrated into HIV care, with appropriate resources to address the current screening and treatment gap.
Promising advances have been made integrating mental healthcare into HIV primary care (via task-shifting, stepped-care interventions, and other strategies).
Some community and public health driven campaigns regarding HIV treatment and prevention may help reduce stigma and psychological distress.
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