The Enduring Impact of HIV/AIDS on Mental Health

December 10, 2023

Writer/ Researcher: Kevin Miko Buac
Graphics: Jia Moral, Ian Stephen Velez, Krystle Mae Labio
Moderator: Marc John Paul Agbuya
The Silent Epidemic Continues

Imagine being told by a doctor that you have a severe condition; reactions of shock and surprise are valid. This scenario is a glimpse into the experience of being told about an HIV/AIDS diagnosis, which reflects the emotional toll and the subsequent impact on an individual. Compared to the general population, people living with HIV/AIDS (PLHIV) face elevated risks of mental health issues, including emotional stress, anxiety, stigma, and discrimination (1). Global research shows a higher incidence of conditions like depression, anxiety, suicidal ideation, and substance use among PLHIV (2). Despite efforts in HIV/AIDS advocacy, more work for an optimal public health response is needed, including preventive measures and accessible healthcare services (3). The COVID-19 pandemic has exacerbated issues among PLHIV, giving rise to the term “silent epidemic” (3,4). The problems mentioned above thus reinforce the need for comprehensive HIV management that integrates medical and mental health services.

The Mental Health Challenges among PLHIV

An HIV/AIDS diagnosis triggers a significant psychological impact, evoking emotions like shock and anxiety. Stigma and discrimination, often tied to social identities and behaviors, which typically include being LGBTI, drug use, sex work, gender expression, immigration status, and history of incarceration, compound mental health challenges for PLHIV (2). These issues act as barriers to testing, diagnosis, and treatment, hindering timely medical care and potentially leading to poor health outcomes (1,3,5). Persistent throughout the lives of PLHIV, stigma, and discrimination contribute to chronic stress and anxiety, alongside lifestyle adjustments and managing comorbidities. If unmanaged, these stressors can lead to additional mental health conditions, impacting the overall quality of life for PLHIV (6,7).

The dual challenges of managing chronic illness and potential HIV/AIDS stigma may lead to social withdrawal, loneliness, and isolation among PLHIV, increasing the risk of mental health concerns like stress, depression, and anxiety. The threat alone for PLHIV can significantly influence self-care and management of their condition (7). Depression is prevalent among women and adolescents with HIV/AIDS and is associated with poorer antiretroviral (ART) therapy adherence and disease progression (6,7). The complications of HIV/AIDS can fuel anxiety, impacting health outcomes (7). Unhealthy coping mechanisms, such as substance use, emerge as a response to stressors, posing additional challenges to treatment adherence (2). Support networks, including friends and family, are vital in mitigating these challenges. Family involvement and community-based interventions centered on healthy communication contribute to building resilience, serving as protective factors in coping with an HIV/AIDS diagnosis (6,8).

Bridging Physical and Mental Health in HIV/AIDS Management

Given the interconnected physical and mental health dynamics for PLHIV, a holistic approach to patient care is essential. Integrating comprehensive healthcare that accounts for the medical and psychological aspects of HIV/AIDS ensures dynamic management and a patient-centered approach to HIV/AIDS care (2). Mental health professionals can do their part as well as their role is paramount in addressing the psychological dimension of HIV/AIDS. Approaches include facilitating service delivery of psychosocial interventions (social support, counseling, psychoeducation, and therapy) for PLHIV and training mental health professionals and social workers in the medical aspects of HIV/AIDS (2,9,10). These strategies are stepping stones towards multidisciplinary collaboration among healthcare professionals and other professions participating in HIV/AIDS management. The above discussion of education brings us to advocacy for building safe spaces to improve the well-being of PLHIV. Fostering safe spaces in the community and in healthcare settings promotes those who are at risk of developing HIV/AIDS, thus potentially improving health outcomes through early screening and management (2). Involving PLHIV in community programs targeted to them also helps by improving adherence to the interventions for them, promoting meaningful engagement (8), thus empowering them in building a more compassionate and inclusive society for those with HIV/AIDS.

Addressing HIV/AIDS requires a multifaceted approach that involves advocacy, engaging PLHIV, building support networks, and integrating mental health into medical management. Mental health professionals, along with healthcare stakeholders, play vital roles. Goals encompass raising awareness, reducing stigma, and integrating psychosocial support into healthcare systems. Ultimately, a holistic, multidisciplinary approach recognizing the interdependence of physical and mental health enhances the quality of life for those with HIV/AIDS.

Session Questions:

1. In what ways does the chronic nature of HIV/AIDS influence the mental health among affected individuals?
2. What are effective strategies for reducing stigma and fostering safe spaces to promote mental health in the context of HIV/AIDS?
3. How can advocacy efforts address the intersection of mental health, medical management, and HIV/AIDS?

References:

1. Remien, R. H., Stirratt, M. J., Nguyen, N., Robbins, R. N., Pala, A. N., & Mellins, C. A. (2019). Mental health and HIV/AIDS: the need for an integrated response. AIDS (London, England), 33(9), 1411–1420. https://doi.org/10.1097/QAD.0000000000002227
2. World Health Organization. (2022). Integration of mental health and HIV interventions. https://www.who.int/publications/i/item/9789240043176
3. Ines, J. (2023). The state of HIV epidemic in the Philippines. Rappler. https://www.rappler.com/newsbreak/in-depth/things-to-know-hiv-epidemic-philippines/?utm_source=Facebook&utm_medium=Social&utm_campaign=SocialFlow&fbclid=IwAR346yrfyX4ZbBu3qGNvmHOHPlIX-jy7B6H9GYUiFMjXmdM4msyxOEYe224_aem_AWYMGwhaaMPXClia1ASCjGnkmDAaZ1BLqx6kgTCR_YD6GipJOxd_mud7F1Kl0MYZ-2o
4. Hong, C., Queiroz, A., & Hoskin, J. (2023). The impact of the COVID-19 pandemic on mental health, associated factors and coping strategies in people living with HIV: a scoping review. Journal of the International AIDS Society, 26(3), e26060. https://doi.org/10.1002/jia2.26060
5. Kane, J. C., Elafros, M. A., Murray, S. M., Mitchell, E. M. H., Augustinavicius, J. L., Causevic, S., & Baral, S. D. (2019). A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries. BMC medicine, 17(1), 17. https://doi.org/10.1186/s12916-019-1250-8
6. Ayano, G., Demelash, S., Abraha, M., & Tsegay, L. (2021). The prevalence of depression among adolescent with HIV/AIDS: a systematic review and meta-analysis. AIDS research and therapy, 18(1), 23. https://doi.org/10.1186/s12981-021-00351-1
7. Waldron, E. M., Burnett-Zeigler, I., Wee, V., Ng, Y. W., Koenig, L. J., Pederson, A. B., Tomaszewski, E., & Miller, E. S. (2021). Mental Health in Women Living With HIV: The Unique and Unmet Needs. Journal of the International Association of Providers of AIDS Care, 20, 2325958220985665. https://doi.org/10.1177/2325958220985665
8. Bhana, A., Abas, M. A., Kelly, J., van Pinxteren, M., Mudekunye, L. A., & Pantelic, M. (2020). Mental health interventions for adolescents living with HIV or affected by HIV in low- and middle-income countries: systematic review. BJPsych open, 6(5), e104. https://doi.org/10.1192/bjo.2020.67
9. Du Zeying, M., Ashcroft, T., Kulkarni, D., Sawrikar, V., & Jackson, C. A. (2022). Psychosocial interventions for depression delivered by non-mental health specialists to people living with HIV/AIDS in low- and middle-income countries: A systematic review. Journal of global health, 12, 04049. https://doi.org/10.7189/jogh.12.04049
10. van Luenen, S., Garnefski, N., Spinhoven, P., Spaan, P., Dusseldorp, E., & Kraaij, V. (2018). The Benefits of Psychosocial Interventions for Mental Health in People Living with HIV: A Systematic Review and Meta-analysis. AIDS and behavior, 22(1), 9–42. https://doi.org/10.1007/s10461-017-1757-y