Op-ed: Let's Talk About HIV and Mental Health

Treating HIV is about more than just taking pills — it’s about treating the whole person. This includes addressing any underlying mental health challenges, which in turn will help people stay adherent to medication and live a healthier life.

Approximately 1 in 5 adults in the U.S. are affected by mental illness. Mental health and physical health go hand-in-hand, with chronic conditions inextricably linked to mental health conditions. Individuals living with serious behavioral health issues face an increased risk of chronic medical conditions, and mental health challenges can make managing chronic conditions more difficult. HIV is one of many chronic conditions that is deeply affected by mental health.

People receiving care for mental health issues are four times more likely to be living with HIV than the general population – we must both identify HIV risk factors among people with mental health issues and provide better mental health screenings for those already infected with HIV. The first step to improving mental health care as it relates to HIV is understanding the connection between HIV infection and early life trauma resulting from issues such as racism, gender and gender identity discrimination, poverty, and violence. By understanding a person’s background and risk factors, we can help prevent the transmission of HIV to high-risk individuals and provide more comprehensive mental health services to those who are already infected.

Similar to physical health, mental health can have ramifications in all aspects of a person’s life. This is why behavioral health services are an essential component of treating HIV, because mental illness and substance use can interfere with the overall wellbeing of a patient. Day-to-day management of HIV can become overwhelming when coupled with mental illness. Failure to follow a treatment regimen and attend regular doctor’s appointments can lead to a more rapid and harder-to-treat progression of HIV.

For example, a recent study found that HIV-positive individuals with comorbid bipolar disorder have significantly worse adherence to their antiretroviral medication than a comparable group without bipolar disorder. These issues can also hamper a person’s ability to maintain a healthy lifestyle, leading to outcomes such as not getting enough sleep and exercise or having unprotected sex.

Substance use and addiction are closely linked with HIV. Because intravenous drugs are a common source of HIV infections, many drug users are also living with HIV. A better understanding of addiction and its relationship with HIV has resulted in needle-exchange programs as well as changes to how both conditions are treated. Through mental health services, we can uncover the sources of addiction and help patients work towards a healthier lifestyle.

Instead of following the traditional abstinence model, a growing number of practitioners are using the harm reduction model of assisting their patients in progressively reducing their drug usage and working towards the ultimate goal of overcoming addiction. More providers must be equipped to tailor treatment plans for the individual needs of each patient. For example, a regular meth user has mastered the ability to follow a regimented drug schedule.  A practitioner can apply that behavior to taking HIV meds regularly while working to lower his or her meth usage.

At Amida Care, we know from firsthand experience that in order to fully treat people living with HIV, it is imperative to provide comprehensive health coverage and coordinated, holistic care. Many of our members are connected with mental health and substance abuse coverage and services that were previously inaccessible to them. This approach has paid dividends in both better health outcomes and dramatic cost-savings for taxpayers.

We also go the extra mile to ensure that our members stay in care by reaching out to anyone who has been missing doctor’s appointments or failing to pick up prescriptions. We physically go and knock on the doors of these individuals to talk through what may be impeding their adherence to treatment.

A treatment regimen for HIV is incomplete without mental health services. From understanding and overcoming addiction to tackling challenges that came about following an HIV diagnosis, mental health practitioners are uniquely equipped to help patients find their personal path to wellness. To end the AIDS epidemic, mental health and substance abuse services must be more accessible. Increasing awareness of the connection between mental health and HIV is a critical first step.

Lee Garr, director of Integrated Care at Amida Care