BOSTON – In 25 years of a conference providing a forum for research on HIV and the conditions that can accompany life with the virus, this morning’s plenary talk was, apparently, the first to examine the interaction between mental health and risks of infection, treatment challenges and death.
Still, Dr. Robert Remien of New York State Psychiatric Institute said in his talk, those planning and providing HIV services would be leading the way and could set an example for other medical providers by demonstrating that mental health services can be integrated into routine and ongoing services to prevent and treat HIV and that the human right to health includes mental health.
That opportunity for leadership, his talk indicated, is a measure of both the scarcity of mental health services in routine primary and preventive care services, and of the breadth of the need for mental health services in HIV programs.
The topic was propelled into plenary prominence by Canadian findings noted at last year’s CROI showing suicide to be the leading cause of death among people living with HIV accessing effective antiretroviral treatment.
Relationships between HIV and conditions that include depression, addictions, anxiety and post traumatic stress syndrome, are destructive and common, with mental health challenges contributing to infection risks and often accompanying other liabilities that contribute to infection risks, while reducing chances of diagnosis and successful treatment. In turn, continuing stigmas, shame, and hardships associated with living with HIV can contribute to and exacerbate mental health challenges. And, while mental illnesses that include depression can directly affect the immune system, HIV and some antiretroviral medicines can directly affect neurological functions.
Still, Dr. Remian said, screening, medicines, treatments for addictions, and counseling interventions have been demonstrated to be effective in addressing all of these challenges. Studies have shown that they can work even where resources are stretched. Task shifting, to nurses and lay workers can extend the reach of services in countries that include South Africa and Zimbabwe with one psychiatrist for every million to 1.5 million people, he said. Still investment will be crucial — longer interventions are more effective than short ones, and screening for mental health needs should continue throughout the HIV care continuum from diagnosis, to care, to ongoing treatment. Investment in mental health services also will be essential to reaching UNAIDS 90-90-90 goals to control HIV by 2030 by ensuring that 90 percent of all people living with HIV are aware of their infection, 90 percent of those are accessing treatment, and that treatment be effective and consistent for 90 percent of those to keep the virus suppressed, Dr. Remian said. The people who need those services, he noted, “may be part of our 10-10-10, or our current 30-30-30 who are not being reached.”
“Let’s not forget the individual,” he added, “in our global response to the epidemic.”