“People don’t live in silos”: call for HIV services to include mental health and other chronic diseases

A delegate to the 24th International AIDS Conference.

MONTREAL – People with mental health problems are more likely to get HIV, while people with HIV often struggle with depression and other mental health problems, but few countries offer psychosocial support as part of their HIV services .

“As a result of systemic inequalities, mental health problems continue to emerge and you have to address them head-on,” said Lucy Njenga of Positive Young Women Voices, who works with HIV-infected women and girls in some of Kenya’s poorest communities.

“Violence against women and girls and poor socio-economic conditions are the key challenges,” Njenga told delegates from the International AIDS Conference.

His organization has a consultant available but addressing poverty through money transfers that allowed girls to stay in school and food packages “that made them feel loved” proved important.

“Mental health is a necessary and essential part of any HIV program,” Dr. Don Operario of Brown University’s School of Public Health in the United States told delegates.

“Mental health and HIV are not two epidemics that occur concurrently, but they operate interactively, exacerbating each other’s negative effects in the most marginalized populations,” he added.

“We are seeing a consistently high prevalence of depression, anxiety, suicidal tendencies, post-traumatic stress disorder and substance abuse in men who have sex with men (MSM) and substantially higher than in heterosexual peers,” said Operario , who is one of the authors of a Lancet series on mental health and HIV.

South Africa’s mission to expand HIV services

Aside from mental health, few HIV programs include screening and treatment for a number of other noncommunicable diseases (NCDs) that prey on people with HIV, including diabetes, hypertension, and cervical cancer.

In South Africa, which has the largest population of people living with HIV in the world, more people die from diabetes than from AIDS. People with HIV live longer thanks to antiretroviral treatment and face a range of noncommunicable diseases.

This was stated by the South African Minister of Health, Dr. Joe Phaahla Health policy supervision that his mission in Montreal is to persuade donors to give his country the flexibility to include diabetes and hypertension screening in HIV programs as a start.

“Of course, HIV and TB are still important because they continue to kill people, but we want donors to accept that the HIV resources we receive for healthcare worker training, for laboratories and so on, will be expanded to include it. diabetes and hypertension screening and diagnosis, “Phaahla said.

“Cancers are more complicated, but diabetes and hypertension are our top priorities.”

Phaahla’s persuasion targets are the Global Fund to Fight AIDS, Tuberculosis, and Malaria and the United States President’s Emergency Plan for AIDS Aid (PEPFAR).

Previously, a conference presentation involving spatial mapping data of people’s health needs in rural areas of KwaZulu-Natal, a South African province, found that people living with HIV also had a high fraught with diabetes and hypertension.

The Global Fund replenishment conference will be held in September, and much of the conference’s focus is on discussing how to spend the money raised.

Marijke Wijnroks of the Global Fund Secretariat admitted that the fund has so far made only “small scale” investments in mental health, citing Zimbabwe as an example of a country trying to address this in its HIV services. but that there is a global growing impulse to integrated services.

Last year, the United Nations Political Declaration on HIV / AIDS pledged to ensure that by 2025, 90% of people living or at risk of HIV should be able to obtain essential health services, including mental health and other treatments for noncommunicable diseases.

Wijnroks said 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 is new 2023-2028 financing strategy adopted in December includes person-centered integrated primary health care with “explicit language” about including NCD diagnosis and treatment in HIV services, he said.

โ€œIt’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 silos. They have a whole host of problems that they need support with, “Wijnroks said.

Integration also makes financial sense. Modeling by the non-profit United for global mental health estimates that the reduction of new HIV infections could be at least 10% faster if mental health services and psychosocial support were included as a core part of HIV services and up to 20% faster if included in HIV care. tuberculosis.

24th International AIDS Conference (AIDS 2022), Montreal, Canada.

NCD Alliance appeals to the Global Fund

Despite the growing awareness that noncommunicable diseases must be considered in HIV services, the AIDS conference offered few successful models and only two sessions focused on noncommunicable diseases and HIV.

In a open letter to the Global Fund issued shortly before the AIDS conference, the NCD Alliance (NCDA) invited the fund to โ€œprearrange the inclusion of NCD interventions โ€in its 2023-2028 strategy.

This should include financial and technical support for HIV and noncommunicable disease prevention and treatment at the primary health care level, the NCDA said.

It also called for people living with the fund’s target diseases – HIV, tuberculosis and malaria – and noncommunicable diseases to be properly consulted about their “comprehensive health care needs to improve quality of life and physical barriers and financial access “and for adequate data to be collected on needs and gaps in health coverage.

Image credits: Marcus Rose / IAS, Jordi Ruiz Cirera / IAS.

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