MONTREAL – People with mental health conditions are more likely to get HIV, while people with HIV often struggle with depression and other mental health issues – but few countries offer psychosocial support as part of their HIV services.
“As a result of systemic inequalities, mental health issues keep coming up and you have to deal with them head-on,” said Lucy Njenga from Positive Young Women Voices, who works with women and girls with HIV in some of the poorest communities in Kenya.
“Violence against women and girls and poor socio-economic conditions are the key challenges,” Njenga told International AIDS Conference delegates.
Her organization has a counselor available but addressing poverty through cash transfers that enabled girls to remain in school and food parcels “that made them feel that they are loved” have also proved important.
“Mental health is a necessary, essential part of any HIV programme,” Dr Don Operario from Brown University’s School of Public Health in the US, told delegates.
“Mental health and HIV aren’t two co-occurring, siloed epidemics, but operate interactively, exacerbating each other’s negative effects in the most marginalized populations,” he added.
“We’re seeing a consistently high prevalence of depression, anxiety, suicidality, post-traumatic stress disorder and substance abuse in men who have sex with men (MSM), and substantially higher relative to heterosexual peers,” said Operario, who is one of the authors of a Lancet-published series on mental health and HIV.
South Africa’s mission to broaden HIV services
Aside from mental health, few HIV programs include screening and treatment for a host of other non-communicable diseases (NCDs) that prey on people with HIV – including diabetes, hypertension and cervical cancer.
In South Africa, which has the biggest population of people living with HIV in the world, more people are now dying of diabetes than AIDS. People with HIV are living longer thanks to antiretroviral treatment, and having to confront a range of NCDs.
South Africa’s health minister, Dr Joe Phaahla, told Health Policy Watch that his mission in Montreal is to persuade donors to allow his country the flexibility to build screening for diabetes and hypertension into HIV programs as a start.
“Of course, HIV and TB are still important because they are still killing people, but we want donors to accept that the HIV resources we get for training health workers, for laboratories and so on, will be expanded to include diabetes and hypertension screening and diagnosis,” said Phaahla.
“The cancers are more complicated, but diabetes and hypertension are our priorities.”
Phaahla’s targets for persuasion are the Global Fund to Fight AIDS, TB and Malaria and the US President’s Emergency Plan for AIDS Relief (PEPFAR).
Earlier, a presentation at the conference that involved spatial mapping data of people’s health needs in rural KwaZulu-Natal, a province in South Africa, found that people living with HIV also had a high burden of diabetes and hypertension.
— NCD Alliance (@ncdalliance) July 29, 2022
The Global Fund’s replenishment conference is being held in September and much of the focus of the conference involves discussion about how money raised should be spent.
Marijke Wijnroks from the Global Fund’s secretariat conceded that the fund had only made “small scale” investments in mental health so far, citing Zimbabwe as one example of a country that is trying to address this in its HIV services – but that there is a global growing impetus for integrated services.
Last year, the United Nations Political Declaration on HIV/AIDS pledged to ensure that 90% of people living with, or at risk of, HIV should be able to get essential health services, including mental health and other NCD care by 2025.
Wijnroks said that the fund had not been “explicit enough” about the importance of integrated care in the past although the evidence of its impact was “clear”.
However, the fund’s new 2023-2028 funding strategy adopted in December includes integrated people-centred primary health care with “explicit language” about including NCD diagnosis and treatment in HIV services, she said.
“It’s really about looking at a person and trying to provide support to that person in a comprehensive way because people don’t live in siloes. They have a whole range of issues that they need support with,” said Wijnroks.
Integration makes financial sense too. Modeling by the non-profit United for Global Mental Health estimates that reducing new HIV infections could be at least 10% faster if mental health services and psychosocial support are included as a core part of HIV services – and up to 20% faster if included in tuberculosis care.
NCD Alliance appeals to Global Fund
Despite the growing realization that NCDs have to be factored into HIV services, the AIDS conference offered few successful models – and only two sessions focused on NCDs and HIV.
In an open letter to the Global Fund issued shortly before the AIDS conference, the NCD Alliance (NCDA) called on the fund to “prioritize the inclusion of NCD interventions” in its 2023-2028 strategy.
This should include financial and technical support for HIV and NCD prevention and care at the primary healthcare level, said the NCDA.
It also called for people living with the fund’s target diseases – HIV, TB and malaria – and NCDs to be properly consulted about their “full health care needs to improve quality of life and physical and financial barriers to access”, and for proper data to be collected about needs and gaps in health coverage.
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