Penelitian

Do We Need A Specific Mental Health Services for People Living with HIV?

  • By Theresia Puspoarum
  • 19 October 2022
Mental Health for People Living with HIV

People living with HIV are more vulnerable to mental health problems than the population in general. The prevalence of mental health problems among people living with HIV is always higher compared to the general population

Some studies found a definite connection between physical and mental health conditions [1]. More specifically, people who suffer from chronic illness (e.g., diabetes, heart disease, HIV) have a higher risk of mental health problems as they have to face this condition for a long time. Therefore, people living with HIV are more vulnerable to mental health problems than the population in general [2]. The prevalence of mental health problems among people living with HIV is always higher compared to the general population [3] [4]. The current HIV program only focuses on physical treatment – which is ARV therapy – and tends to dismiss the mental health services for people living with HIV. Conversely, people living with HIV faced a specific crucial issue related to stigma and discrimination, lack of social support, and lifetime medication that could lead to mental health problems. 

Stigma and Discrimination

HIV issue is closely related to stigma and discrimination. There are many false assumptions in society related to HIV or people living with HIV. The most common misperception is that HIV could infect easily, as likely as flu or cough. In practice, some criteria and conditions must be met for HIV transmission. Another perception is that most people perceive that HIV only infects some groups (LGBT (lesbian, gay, bisexual, transgender), people who use drugs, sex workers, etc.). In fact, AIDS cases mainly were among housewives other than non-professional employees [5]. These false perceptions were developed not only in society, but people living with HIV would also ‘agree’ with these labels, which led to internalized stigma [6]. This labelling then develops into discriminative behaviour. People avoid having physical contact with people living with HIV because they fear being infected. This kind of discriminative behaviour could affect the self-perception of people living with HIV because they feel rejected by the neighbourhood.

A discouraging environment related to stigma and discrimination conceived by people living with HIV could be a trigger to mental health problems [7]. There is evidence that perceived discrimination and depression positively correlate [8]. people living with HIV who perceived discrimination would also experience depressive symptoms. In addition, another research result is that people living with HIV who experience internalized stigma and discriminative behaviour has a higher possibility of depression [9]. This evidence showed that perceived stigma and discrimination could result in mental health problems on people living with HIV. 

Lack of Social Support

It is another struggle for people living with HIV to have social support because of the stigma. Most people living with HIV prefer hiding their HIV status from their relatives, even their spouses. The fear of rejection is why people living with HIV were reluctant to open their status. When people living with HIVs knew their HIV status, they started to 'self-isolate’ themselves from others [10], people living with HIV tended to avoid social contact and kept away from the community. Since almost half of the people living with HIV (43%) reported having unsupportive and hostile families [11], it became ‘understandable’ why people living with HIVs prefer to isolate themselves.

Moreover, this ‘self-isolated’ worsen the HIV treatment process. people living with HIV who self-isolate themselves is less likely to seek health service or show up in an HIV support group [12], which leads them to a minimal social support resource. On the contrary, social support is essential to provide mental stability for people who live with chronic illness. Social support became substantial for people living with HIV to help them cope with the stressful long period time of HIV treatment [12]. Higher social support is associated with better mental health status; people living with HIVs with lower social support tend to face depression8. Overall, having more friends or family that support people living with HIV means they have more alternative support to reduce stress related to HIV treatment.

Lifetime HIV Treatment

As well as other chronic illnesses, people living with HIV has a lifetime treatment process; the medication is called antiretroviral (ARV) therapy. people living with HIV needs to consume ARV at an exact time in daily routine for a lifetime to suppress the HIV rate and lessen the possibility of infecting others. Adherence to ARV therapy is the most important thing to make sure people living with HIV is virally suppressed. Nevertheless, adherence to ARV therapy depends on the mental health condition of people living with HIV. 

ARV therapy could also become stressful for people living with HIV, other than the never-ending repetitive activities; it is also confirmed that side effects of ARV could lead to psychiatric problems, such as depression [13]. people living with HIV experiences emotional and psychological problems, such as depressive symptoms, as a side effect of consuming ARV, then it becomes crucial to address this issue. Otherwise, studies have demonstrated that mental illness lowers the quality of ARV therapy adherence [14]. This unfavourable condition meets the urgency to integrate mental health services into the HIV treatment process. 

Effects of Mental Health Problems on HIV Treatment Outcomes

There is a global target for 2030 to end the HIV AIDS epidemic as public health threat [15]; to achieve this ambitious target, it is impractical to only focus on physical health services and ignore mental health. The impact of each mental health problem on people living with HIV may be varied. The effect is not only on the individual level, but also could impact the achievement of this global target. 

Several mental health problems on people living with HIV are depression, social phobia, mood disorder, and anxiety disorder [12]  [16] [17], which are caused by the interaction of several conditions mentioned above (stigma and discrimination, lack of social support, and lifetime HIV treatment). For example, major depressive disorder is a predictive factor to ARV therapy non-adherence, which led to higher rates of HIV virus in people living with HIV’s body. This also supports by Ingersoll’s16 conclusion that mental health and adherence to ARV therapy are intertwined effects that also impact viral suppression. This viral suppression is a substantial issue in achieving the HIV global target, but only 68% of total people living with HIV were virally suppressed [18], which is far from the target. This means that major depressive disorder could contribute to the HIV epidemic if it is not maintained well. There is an urgency for a breakthrough program that not only focuses on ARV therapy but also targets mental health conditions. 

Moreover, some studies showed higher mortality rates for people living with HIV with mental problems. Depression or depressive symptoms have been correlated to the progression of a disease and worsened the physical condition of people living with HIV, which could lead to death [19]. Another study also showed that people living with HIV with chronic depressive symptoms is twice likely to die related to worsen HIV symptoms. Then it is settled that mental health problems in people living with HIV could contribute to a more significant mortality rate related to HIV. 

 

Several specific issues faced by people living with HIV related to their mental health would lead to severe problems of their HIV treatment. Some studies have confirmed that mental illness in people living with HIV could impact HIV treatment outcomes and even increase mortality in people living with HIV. This situation proves that the severity of mental health problems has been associated with HIV symptoms and vice versa. Then it is impossible to only address the physical condition of people living with HIV without taking care of their mental health condition. 

Researchers believe focusing on people living with HIV and their mental health condition is essential to improve HIV treatment outcomes. For instance, psychological screening or assessment at the beginning of the diagnosis could be the first step to address people living with HIV's mental health condition before starting HIV treatment. HIV programs should pay more attention to people living with HIV mental health conditions; integrating mental health services into HIV treatment could be a breakthrough strategy for HIV programs. After all, future studies are required to have more comprehensive knowledge of mental health and its effect on HIV treatment outcomes, to develop a better HIV program. 


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[5] Laporan Eksekutif Perkembangan HIV AIDS dan Penyakit Infeksi Menular Seksual (PIMS) Triwulan IV Tahun 2021

[6] Shrestha, S., Poudel, K. C., Poudel-Tandukar, K., Kobayashi, J., Pandey, B. D., Yasuoka, J., ... & Jimba, M. (2014). Perceived family support and depression among people living with HIV/AIDS in the Kathmandu Valley, Nepal. Journal of the International Association of Providers of AIDS Care (JIAPAC)13(3), 214-222.

[7] Meyer, I. H. (2013). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence.

[8] Liu, H., Zhao, M., Ren, J., Qi, X., Sun, H., Qu, L., ... & Cui, Y. (2018). Identifying factors associated with depression among men living with HIV/AIDS and undergoing antiretroviral therapy: a cross-sectional study in Heilongjiang, China. Health and quality of life outcomes16(1), 1-10.

[9] Lee, R. S., Kochman, A., & Sikkema, K. J. (2002). Internalized stigma among people living with HIV-AIDS. AIDS and Behavior6(4), 309-319.

[10] Saki, M., Kermanshahi, S. M. K., Mohammadi, E., & Mohraz, M. (2015). Perception of patients with HIV/AIDS from stigma and discrimination. Iranian Red Crescent Medical Journal17(6).

[11] Chandra, P. S., Ravi, V., Desai, A., & Subbakrishna, D. K. (1998). Anxiety and depression among HIV-infected heterosexuals—a report from India. Journal of psychosomatic research, 45(5), 401-409.

[12] Bhatia, M. S., & Munjal, S. (2014). Prevalence of depression in people living with HIV/AIDS undergoing ART and factors associated with it. Journal of clinical and diagnostic research: JCDR, 8(10), WC01.

[13] Su, X., Lau, J. T., Mak, W. W., Choi, K. C., Chen, L., Song, J., ... & Cheng, J. (2013). Prevalence and associated factors of depression among people living with HIV in two cities in China. Journal of Affective Disorders, 149(1-3), 108-115.

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[15] UNAIDS. 2025 AIDS Target.

[16] Ingersoll, K. (2004). The impact of psychiatric symptoms, drug use, and medication regimen on non-adherence to HIV treatment. AIDS care, 16(2), 199-211.

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[18] UNAIDS. Fact Sheet 2022.

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