Are more mental health services for people affected by HIV around the corner?

What is this story about?

Making sure mental health support is a central part of HIV programmes.

Why is this important?

The relationship between HIV and mental health goes both ways. People with HIV are more likely to experience mental health conditions. This is for many reasons, including trauma, stigma and discrimination. For example, around 25% of adolescents with HIV have a mental health condition.

At the same time, people with mental health conditions may be less able to look after their health than other people. They may be more likely to take HIV-related risks, such as having condomless sex or injecting drugs and sharing needles. People with mental health conditions are also less likely to test for HIV and access and stay on treatment.

Despite these strong links, mental health support is often lacking in HIV programmes.

What are the main issues?

Funding is one of the main reasons mental health support is missing from HIV programmes. But efforts are being made to change this.

At AIDS 2022, The Global Fund released new guidance for countries applying for Global Fund funding for the next three years. This encourages countries to provide mental health screening, diagnosis and management as part of HIV and tuberculosis programmes.

Until recently, there has been uncertainty about what kind of mental health support is most effective in HIV programmes. But a new research series on mental health and HIV is helping to close the evidence gap. Successful interventions include:

• one-on-one peer support
• peer support groups
• family counselling
• whole-family mental health support, such as dealing with conflict
• problem-solving therapy
• motivational coaching
• cognitive behavioural therapy
• economic empowerment, such as cash transfers.

But the things that can cause people mental distress must also be dealt with. This is especially true for people with HIV and people from marginalised communities who often face criminalisation, inequality, a lack of resources, social isolation and violence.

What does this mean for HIV services?

To be more effective, HIV services need to include or increase support for people’s mental health and well-being. But doing this with limited resources is challenging. There is a need to gather and provide evidence to show decision-makers the importance of including mental health support within HIV programmes.

The World Health Organization and UNICEF has issued guidance on simple, low-cost ways to integrate HIV and mental health, which is useful for anyone working in this area.

When mental health specialists are scarce, training peers, lay health workers and treatment adherence counsellors to provide mental health support can be an effective strategy.

Providing mental health screening through community-based HIV prevention and testing services can help to identify mental health conditions early on. But working with community representatives to develop these screening tools is important, otherwise people might not engage with the process.

It is very important to provide counselling for people who test positive for HIV, as this can be a time of distress. Providing one-to-one or group support around this time can also encourage people to start treatment. And it can help people cope if they experience any stigma and discrimination.