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| CONCEPT ARTICLE |
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| Year : 2017 | Volume
: 14
| Issue : 1 | Page : 32-34 |
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Mental health issues in HIV/AIDS
Jyothi S Sunandha
Assistant Professor, PSG College of Nursing, Peelamedu, Coimbatore – 641 004, India
| Date of Web Publication | 9-Jul-2019 |
Correspondence Address:
Jyothi S Sunandha
Assistant Professor, PSG College of Nursing, Peelamedu, Coimbatore – 641 004
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2231-1505.262420
Mental health and behavioral disorders such as depression, cognitive disorders, personality disorders, and co-occurring conditions such as substance-related disorders are often overlooked in HIV/AIDS. These disorders can have a profound effect on adherence, clinic attendance, and quality of life, which can influence the progression of HIV/AIDS. Given the potential impact of mental health problems on the overall care and support of PLHIV, it is important for a mental health nurse to be aware of the different mental health needs at varying points in the continuum of care, and to design interventions and support services to address those needs. A mental health issue that may impact initiation and management of HIV in the continuum of care is discussed in this article.
Keywords: HIV, AIDs, Menati health issues
How to cite this article:
Sunandha JS. Mental health issues in HIV/AIDS. Indian J Psy Nsg 2017;14:32-4 |
| The Beginning of the Epidemic | |  |
In 1981, five homosexual individuals were found to have Pneumocystis carinii Pneumonia. Kaposi sarcoma was detected in 26 others. Both conditions were later found to be the result of an immune deficiency. The underlying cause of the immune deficiency was identified in 1983-84 as the human immune deficiency virus (HIV), the causative agent of the Acquired Immuno Deficiency Syndrome (AIDS)[1].
| The Demographic Impact | | |
WHO reports that, 36.7 million people were living with HIV when 2015 ended of which, 1.8 million were children under the age of 15. 46% of people living with HIV were receiving antiretroviral treatment in 2015. That same year, approximately 2.1 million people were newly infected with HIV and 1.1 million deaths from AIDS occurred[2].
| Mental Health issues in the continuum of HIV care and support | | |
Mental health issues, including depression are common among people living with HIV, with depression rates as high as 60% in some settings. Without good mental health care, people with HIV may fail their treatment, which could jeopardize the outcomes of vital investments made by countries[3]. Mental health and behavioral disorders such as depression, cognitive disorders, personality disorders, and co-occurring conditions such as substance-related disorders are often overlooked in HIV/AIDS. These disorders can have a profound effect on adherence, clinic attendance, and quality of life, which can influence the progression of HIV/AIDS[4].
Given the potential impact of mental health problems on the overall care and support of People Living with HIV (PLHIV), it is important for a mental health nurse to be aware of the different mental health needs at varying points in the continuum of care, and to design interventions and support services to address those needs. The continuum of care is divided into pre-ART, ART, and advanced disease/end-of-life phases.
- Pre-ART Phase: The initial entry point into the continuum of care is through counseling and testing services. Described below are a number of mental health issues that may impact initiation and management of HIV care and support in persons with mental health problems.
- Early identification and diagnosis of mental health problems: This is an essential part of the care and support of PLHIV, and can contribute to better treatment outcomes. Further it can reduce the risk of further transmission of the virus due to risky behavior.
- Access to care: The presence of mental health problems are potential risk factors for HIV infection. In resource-limited settings undiagnosed HIV infections are common among mentally ill and are less likely to receive ART if diagnosed[5]. The reasons for this lack of access are complex and require specific strategies for increasing access to routine HIV screening, referral to care and support for people with mental illness[6].
Response to HIV diagnosis : For most people, finding out that they are HIV-positive raises personal concerns about death and dying, disclosure and stigma, changes in personal relationships, and uncertainties about the future. These stresses can precipitate anxiety and depression, which may contribute to delayed entry into or drop-out of HIV treatment[7].
Stigma and discrimination:Social isolation, marginalization, and discrimination resulting from HIV stigma can have profound effects on the mental health of PLHIV and those caring for them. Stigma also has a direct effect on care- seeking behavior and outcome and must be addressed to optimize care for those infected and affected by HIV[8],[9].
Need for psychosocial support: Because HIV infection can be chronic, PLHIV have an ongoing need for social and psychological support to deal with the stresses associated with the disease and its treatment. Events during the course of treatment can also trigger depression and anxiety, including the appearance of new symptoms, co-infections, diagnosis of AIDS, or the death of friends and family with HIV. Psychosocial support can be crucial in reducing psychological distress and improving treatment adherence and outcome[10].
ART Phase: Issues related to HIV treatment access, adherence to complex drug regimens, management of mental health and substance use co-morbidity, assessment of side effects, and neuropsychiatric concomitants of HIV or its treatment become even more critical during the ART phase of care and support.
Co-occurring mental health problems: Mental health problems associated with HIV can have a major impact on willingness of providers to initiate ART and on subsequent treatment adherence and outcome. Common mental health disorders commonly associated with HIV are listed below.
 Adjustment disorders
Mood disorders, including major depression and dysthymia
Anxiety disorders, including generalized anxiety disorder
Substance-related disorders (substance dependence, substance abuse, intoxication, and withdrawal)
HIV-associated dementia[7].
Co-occurring substance abuse Disorders: Both mental health and substance use disorders are commonly associated with HIV infection. Medical treatment of the substance use disorder may be necessary to create sufficient patient stability to begin the treatment of other conditions. Early identification and treatment of drug or alcohol use disorders are essential in both the care and treatment of PLHIV and for the prevention of HIV trans-mission due to risky drug and sexual behavior.
Side effects and cognitive impairment: Proper management of the side effects of HIV treatment is crucial to enhancing treatment adherence and the mental well-being of patients on ART. HIV infection can act directly on the brain and create a clinical picture that resembles certain mental disorders. Estimates are that 30 to 60 percent of PLHIV experience mild forms of cognitive impairment, with 10 to 15 percent progressing to HIV-related dementia. Even mild forms of impairment can affect learning and memory, attention, language, psychomotor abilities, and executive functions (e.g., planning, evaluating, problem solving), all of which are vital to the person’s ability to manage ART and consequently their survival and well-being. The challenge is to assess and manage side effects and neurocognitive changes while maintaining effective levels of ART[11].
Advanced Disease/End-of-Life Phase: With HIV progression, PLHIV and their caregivers have an increasing need for physical, emotional, and spiritual support, which can overwhelm the resources available to them. A coordinated approach between formal and informal support systems is needed to support PLHIV and their caregivers through the death and dying process and the grief and loss afterwards.
Palliative care: Palliative care includes not only the management of physical symptoms associated with advanced disease but also depression, suicidal thoughts, and other psychological problems. It also includes spiritual support and bereavement counseling and includes the client and his or her support environment[12].
Care For The Caregiver: A high burden of care is often associated with depression and poor health among the caregivers themselves. Discrimination and stigma affect caregivers as well as PLHIV, leading to greater social isolation and lack of social support. In addition to practical assistance with the physical demands of caring for a terminally ill person, caregivers need the same kind of psychosocial and mental health support, since they themselves may be at risk for depression and other mental health problems. Informal social networks and other family and community members are the primary sources of support for family caregivers[13].
Promising Practices In Mental Health Care and Support of
PLHIV: In spite of the challenges, there are a number of innovative programmatic approaches that show promise in addressing the mental health needs of PLHIV. The program elements reviewed below has to be integrated with HIV care across different levels of the health care system.
Extending access to care: Two programmatic approaches can be useful in increasing access to HIV care for persons with mental health and co-occurring substance use disorders. One approach is targeted screening for HIV in mentally ill populations to increase detection and recruitment into treatment[14]. The second approach is the use of HIV stigma reduction strategies to increase HIV knowledge, change attitudes about PLHIV, and minimize barriers to seeking HIV care[15]
Post-HIV test clubs: One promising approach to addressing the emotional response to HIV test results is the use of “posttest clubs” after counseling and testing which can be a significant form of peer support for individuals with mental health disorders. Initial findings suggest that participation in post-test clubs increases perceived social support and enhances treatment adherence[16].
Psychosocial support: A variety of approaches for providing psychosocial support have shown promise in addressing the psychosocial needs of PLHIV. These interventions include individual, family, or group counseling; stress management and coping sessions; educational sessions; home visits; and respite care[17],[18].
| Conclusion | | |
A mental disorder nearly always complicates illness management. However there is strong evidence that appropriate and assessment of co morbid mental conditions can optimize the overall health outcomes. More attention and research is clearly needed to better inform future interventions for this most vulnerable group of individuals.
| References | | |
| 1. | Sana Loue. Mental Health Practitioner’s Guide to HIV/AIDS. New York. Springer-Verlag; 2012.  |
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| 6. | Parry CD et al. Responding to the threat of HIV among persons with mental illness and substance abuse. Current Opinion in Psychiatry. 2007; 20(3): 235-41. |
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| 13. | Orner P. Psychosocial impacts on caregivers of people living with AIDS. AIDS Care. 2006; 18(3): 236-40. |
| 14. | Joska JA, Kaliski S, Benatar SR. Patients with severe mental illness: A new approach to testing for HIV. South African Medical Journal. 2005; 95(3): 630-34. |
| 15. | Brown L. et al. Interventions to reduce HIV/AIDS stigma: what have we learned? AIDS Education and Prevention. 2003; 15(1): 49-69. |
| 16. | Rwekikomo F et al. AIDS Information Centre: The Post Test Club. Paper presented at the VIIIth International Conference on AIDS, July 1992, Amsterdam. Abstract no. PoC 4492. |
| 17. | Berg CJ et al. Behavioral aspects of HIV care: Adherence, depression, substance use, and HIV-transmission behaviors. Infectious Disease Clinics of North America. 2007; 21(1): 181. |
| 18. | Catalan, J. et al. Mental Health and HIV/AIDS Psychotherapeutic Intervention in Anti-retroviral (ARV) Therapy (for Second Level Care). Mental Health and HIV Series. Geneva: WHO. 2005 |
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