Fighting HIV: No Health Without Mental Health
By:Joshua A. Gordon, M.D., Ph.D., Director, National Institute of Mental Health andJimmy Kolker, HHS Assistant Secretary for Global Affairs December 1, 2016
Mental and substance use disorders can increase vulnerability to acquiring HIV infection and they can pose serious barriers to successful management of HIV.
In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched aFast Track strategy to eliminate HIV by 2030. Fast Track encompasses efforts to increase testing, and more rapid initiation of treatment, and simplifies and maintains long-term adherence to effective therapy. The goal is to suppress HIV in people living with the virus so that it becomes virtually undetectable, extending the lifespan of people living with HIV and preventing further transmission.
Over the past 30 years, the HIV epidemic has shown doctors, patients, advocates, and researchers that one of the major obstacles in reaching that goal has to do with mental health. There is a powerful two-way relationship between HIV infection and mental disorders. Mental and substance use disorders can increase vulnerability to acquiring HIV infection and they can pose serious barriers to successful management of HIV.
Conversely, HIV infection itself affects the brain; in some cases, infection can result in symptoms of dementia and psychosis. Moreover, living with a chronic disease, like HIV, is often accompanied by anxiety and depression. These common mental disorders occur more frequently in people with HIV than in the general population; they can occur following a positive test result or as the HIV disease progresses.
HIV infection is frequently accompanied by depression
Major depression globally affects an estimated 350 million people. It is the second leading cause of disability worldwide, with potentially severe and long-lasting effects on people’s ability to work productively, parent effectively, and care for themselves.
Depression is twice as common among people living with HIV as those free of the infection. Left untreated, depression can worsen the course and outcome of HIV; it affects a person’s ability to adhere to a medication schedule and otherwise engage in treatment and take care of him- or herself. Evidence suggests that effective, holistic care for people with HIV must integrate care for depression and other mental disorders.
This integration is consistent with the recommendations of the World Health Organization (WHO).WHO has stated that attention to the psychosocial needs of people with AIDS must be an integral part of HIV care, including assistance with employment, income, and housing, coping with illness and discrimination, and prevention and treatment of mild and serious mental health problems.
Integration of depression care can improve outcomes of HIV care and treatment
Efforts are underway to include treatment for depression as part of routine HIV care, and preliminary studies show good evidence that improving depression results in better suppression of the virus.
For example, the National Institute of Mental Health (NIMH) is supporting researchers at the University of California, San Francisco (UCSF) to study the use of interpersonal psychotherapy (IPT)—an evidence-based psychotherapeutic approach—in Kenya to treat depression that occurs in women after experiencing gender-based violence, in order to improve health outcomes in women living with HIV. This activity is one of many examples undertaken within the U.S. Department of Health and Human Services (HHS) and its agencies.
Any person, whether living with HIV or not, cannot live a fully healthy life without addressing mental health concerns, and HHS entities, including NIMH and the Substance Abuse and Mental Health Services Administration (SAMHSA), are working with partners to research and implement the best treatment options for those living with HIV.