Addressing Mental Health: A Crucial Component to Ending the HIV Epidemic

The mind and body are one! Overall good health must include mental health. If we do not address the mental health of HIV infected individuals, we will not achieve our goal of diagnosing 90% of all patients who are HIV infected, making sure 90% of HIV patients are having their antiretroviral medication, and 90% having viral suppression. It is known that mental health conditions contribute up to ten-fold increase in the risk of acquiring HIV infection. This is due to the fact that people suffering with a mental illness are more likely to have high risk behaviour, less likely to get a sexual health screen, more likely to have poor adherence to treatment, thus leading to a poor health outcome.

Presented by Robert H. Remien: New York State Psychiatric Institute and Colombia University, New York, USA

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People living with HIV have higher rates of alcohol use, drug use, post traumatic stress disorder and depression with the prevalence rates steady all over the world. Why is mental health illness so high in those who have HIV infection? This is influenced by social disparity, biological, community, environment, and psychosocial factors. Depression is associated with 2-3 times increased risk of mortality. HIV crosses the blood brain barrier contributing to oxidative stress and neuronal injury, leading to a state of chronic inflammation.

Dr Remien mentioned that most western countries are failing to diagnose mental health conditions optimally. Out of 100% of possible depression diagnoses, 47% were clinically diagnosed to have depression, 24% received treatment, 9% received adequate treatment, and only 6% achieved remission. Why are we doing so badly? For starters, mental health funding only accounts for only a minuscule percentage of the total health budget in most countries worldwide!

When is the best time to integrate mental health screening? One should be opportunistic, we should integrate screening during STI testing, during PrEP consultation, when diagnosing HIV, and when accessing HIV care. The only way we are going to succeed in reaching our goal of 90-90-90 is by integrating mental health into primary care because there is no health without mental health!

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