16 June 2020

Mental Health: the key to living well with HIV

Mental health: the key to living well with HIV

Efforts to enhance the quality of life of people living with HIV must include a strong focus on mental health and wellbeing 

Mental health is essential to quality of life. Low mood and cognitive impairment can affect the ability to manage daily tasks, to build relationships, to be productive – to be content.

People living with HIV face significant mental health challenges. They are more likely than the general population to develop depression and problems with memory, concentration and cognition. Add to that the burden of facing stigma and discrimination in society, the workplace and the health system, and the impact on wellbeing is clear.

Mental health problems – particularly when untreated or poorly managed – can degrade physical health and the ability to take antiretroviral therapies which reduce their viral load. It is also a barrier to engaging with services: people avoid clinics if the experience is likely to cause them stress or to experience discrimination. Along with taking a profound toll on individuals, this has implications for public health and the future trajectory of HIV epidemics.

As highlighted during European Mental Health Week in May, new stresses can exacerbate existing mental health challenges. The COVID-19 pandemic has been a strain on people and communities everywhere. For those living with HIV, robust mental health is now more important than ever.

Our goal is to help people with HIV to live longer, healthier and happier lives. This demands clear policies to integrate mental health care into health services for people with HIV

Policy response

HIV policy should move beyond viral suppression to focus on quality of life. However, no conversation on quality of life is complete without addressing mental health and wellbeing.

The HIV Outcomes Recommendations call for mental health and neurocognitive impairment services to be integrated into long-term, patient-centred care for people with HIV. In practice, this means enhancing access to psychosocial supports and relevant specialists. Joined up thinking is essential: mental health services should be closely coordinated with other health services for people with HIV.

This vision of multidisciplinary, people-centred and outcome-focused care is reflected in the Call to Action to European policymakers published in November 2019. Some countries are already embracing integrated care.

A large Swedish clinic, for example, has brought together a psychiatrist, a conversational therapist, an infectious disease expert and a GP to meet patients’ needs. Other countries – including Romania – have made special provisions for people with HIV in mental health strategies.

By redesigning services and updating policies, ‘living well with HIV’ can become the lived reality for people with HIV everywhere.

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