MONTREAL – People with mental health problems are more likely to contract HIV, while people with HIV often struggle with depression and other mental health problems, but few countries offer psychosocial support as part of their mental health services. HIV.
“As a result of systemic inequalities, mental health issues continue to emerge and need to be tackled head-on,” said Lucy Njenga of Positive Young Women Voices, who works with women and girls with HIV in some of America’s poorest communities. . Kenya.
“Violence against women and girls and poor socioeconomic conditions are the key challenges,” said Njenga. International AIDS Conference delegates
Your organization has a counselor available but addressing poverty through cash transfers that enabled girls to stay in school and food packages “that made them feel loved” have also proven important.
“Mental health is a necessary and essential part of any HIV program,” Dr. Don Operario of the Brown University School of Public Health in the US told delegates.
“Mental health and HIV are not two simultaneous epidemics in silos, but instead operate interactively, exacerbating each other’s negative effects on 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 their heterosexual peers,” said Operario, who is one of the authors of a series published by The Lancet on mental health and HIV.
South Africa’s mission to scale up HIV services
Aside from mental health, few HIV programs include screening and treatment for a host of other noncommunicable diseases (NCDs) that prey on people with HIV, such as 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 are living longer thanks to antiretroviral treatment and have to deal with a number of NCDs.
South African Health Minister Dr. Joe Phaahla said Surveillance of health policies that his mission in Montreal is to persuade donors to give his country the flexibility to incorporate diabetes and hypertension screening 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 that we get to train health workers, for labs, etc. will be expanded to include diabetes and hypertension screening and diagnosis,” Phaahla said.
“Cancers are more complicated, but diabetes and hypertension are our priorities.”
Phaahla’s lobbying targets are the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US President’s Emergency Plan for AIDS Relief (PEPFAR).
Earlier, a conference presentation involving spatial mapping data of the health needs of people in rural KwaZulu-Natal, a province of South Africa, found that people living with HIV also had a high burden of diabetes and hypertension.
People living with HIV with the greatest unmet health needs (undiagnosed or uncontrolled disease) also have a high burden of #diabetes & #hypertension using spatial analysis data from a rural community of KZN.
👉 #AIDS2022 data that help us build the case for #HIV–#NCD integration. pic.twitter.com/Xh9X7Qrlyl
— NCD Alliance (@ncdalliance) July 29, 2022
The Global Fund replenishment conference will take place in September and much of the focus of the conference involves discussion of how the money raised should be spent.
Marijke Wijnroks of the Global Fund secretariat admitted that the fund had only made “small-scale” investments in mental health so far, citing Zimbabwe as an example of a country that is trying to address this in its health services. HIV, but that there is a global problem. growing momentum of integrated services.
Last year, the United Nations Political Declaration on HIV/AIDS committed to ensuring that 90% of people living with or at risk of HIV can obtain essential health services, including health care. mental health and other NCDs by 2025.
Wijnroks said the fund had not been “explicit enough” about the importance of integrated care in the past, although evidence of its impact was “clear”.
However, the new background 2023-2028 financing strategy adopted in December includes integrated and people-centered primary health care with “explicit language” about including NCD diagnosis and treatment in HIV services, he said.
“It’s really about looking at a person and trying to support them holistically because people don’t live in silos. They have a wide range of issues that they need support with,” Wijnroks said.
The integration also makes financial sense. Modeled by the non-profit organization United for Global Mental Health estimates that the reduction in new HIV infections could be at least 10% faster if mental health and psychosocial support services are included as a core part of HIV services, and up to 20% faster if they are included in tuberculosis care.
NCD Alliance appeals to the Global Fund
Despite the growing understanding that NCDs need to be considered in HIV services, the AIDS conference offered few successful models, with only two sessions focusing on NCDs and HIV.
in a open letter to the Global Fund issued shortly before the AIDS conference, the NCD Alliance (NCDA) called on the fund to “pprioritize 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 health care level, the NCDA said.
It also called for people living with the fund’s target diseases (HIV, tuberculosis and malaria) and NCDs to be properly consulted on their “comprehensive health care needs to improve quality of life and physical and financial barriers to access.” , and to obtain adequate data to gather information on needs and gaps in health coverage.
Image credits: Marcus Rose/IAS, Jordi Ruiz Cirera/IAS.
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