Easing the Mental Toll of HIV-AIDS

HIV-AIDS has become a modern-day 40-year epidemic. Since the summer of 1981, when the first cases of what would later be called Acquired Immune Deficiency Syndrome (AIDS) were identified in the United States, the global toll has been jarring:

In 2020, nearly 700,000 people died from AIDS-related illnesses and 38 million were living with HIV worldwide.

Since the global epidemic began, an estimated 79.3 million people have been infected with the HIV virus and 36.3 million people have died of HIV-related illnesses.

In the early 1990s, HIV was the number one cause of death among Americans ages 25 to 44.

Some 1.2 million people in the U.S. are currently infected with HIV, 13 percent of them unaware that they have the virus.

The devastation caused by HIV infection and AIDS is not only physical; those living with HIV are at a higher risk for developing mental health conditions. In fact, they are twice as likely to experience depression than people who do not have the virus. Persecution, isolation, and exclusion still occur. Discrimination and stigma also can negatively affect their mental wellness. Then there is the chronic stress and inflammation that can drive chemical changes related to anxiety and suicidal ideation. Add to that the mental health fall-out of the COVID-19 pandemic, which for some has become a PTSD-like experience. While an HIV diagnosis is now much more survivable, it still can disrupt mental health for patients, their partners, and families.

Much Has Improved

Dr. Anthony Fauci recently wrote that AIDS-related deaths are down by 64 percent since they peaked worldwide in 2004. He pointed to the research and HIV activism triumphs of understanding that “undetectable equals untransmittable,” along with the pre-exposure prophylaxis now available to people before they are exposed to HIV. Have you noticed the many ads for HIV prevention and treatment medications? Providing mainstream advertising space to these remedies was virtually unheard of prior to this century; however, thanks to the gradual lifting of taboos, messages of hope and normalcy are being more broadly communicated.

Additionally, there are mental health advantages to treating HIV-AIDS. When HIV-positive people begin antiretroviral therapy (ART), they may become less anxious because they are taking care of themselves and their illness. Experts have found that patients also benefit from mental health or HIV-AIDS support groups, as well as talk therapy, regular exercise, and meditation.

Private and public agencies are working hard to keep the focus on HIV identification and elimination. UNAIDS (the Joint United Nations Programme on HIV-AIDS), which began in 1996, has three goals for 2025: that 95 percent of those living with HIV know their status, 95 percent of those who know their status be on treatment, and 95 percent of those on treatment be virally suppressed. The U.S. government recently announced a new HIV-AIDS strategy aimed at ending the HIV epidemic by 2030. The proposal focuses on "priority populations" in the battle such as Black women, trans women, people ages 13 to 24, people who inject drugs, and Black, Latino, and American Indian-Alaska Native men. In addition, the U.S. President’s Emergency Plan for AIDS Relief, led by the U.S. Department of State, has provided people-centered HIV services to millions in 55 countries during the past 18 years.

Still Much to Do

As experienced with all other diseases and conditions, healthcare inequity remains a major roadblock to controlling and eradicating HIV and AIDS. The CDC notes a higher proportion of new infections today among racial and ethnic minorities, young men who have sex with men (MSM), and women, unlike the epidemic’s early days when White, urban MSM, or male injection drug users (IDUs) were primarily infected. African-Americans account for a higher proportion of HIV infections than any other population at all stages of the disease from initial infection to death. Risky sexual behavior linked to substance abuse is exacerbating this trend, along with complacency and a youthful lack of historical awareness about the danger of infection.

Programs to prevent and treat the physical and mental health effects of HIV-AIDS continue in all parts of the world. In 2019, South Africa had more than 7.9 million people living with HIV. The people at greatest risk there, young men, remain hesitant to get tested because they have multiple sexual partners and fear that they will test positive. Imagine the stress, guilt, and other emotions resulting from that approach. While the government, non-government organizations (NGOs), and healthcare workers continue to encourage testing, some feel that the focus on treatment has overshadowed the importance of each person knowing their HIV status.

Speaking of treatment, it has been found that some ART medications enhance symptoms of depression, anxiety, and sleep disturbance, or worsen existing mental health. Plus, some medicines used to treat mental health conditions can interact negatively with ART. It is a daunting clinical challenge to find the right chemical combination to treat the physical and mental aspects of HIV and AIDS.

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And what about an HIV vaccine? When you think about how quickly vaccines were developed to fight COVID-19, it is discouraging that the same global effort has not been applied to the HIV-AIDS epidemic. Fauci noted that while an HIV vaccine remains elusive, he believes a safe and effective one is possible, perhaps building on some of the tools and platforms, such as messengers RNA, used for COVID vaccines. While it is exciting that our country has a new HIV-AIDS strategy (only our third such plan since 1981) it cannot negate a sad truth: despite setting a goal in 1997 to find an HIV vaccine within 10 years, there is still no vaccine or cure four decades after this infection emerged.

Commitments Remain Strong and Hopeful

It has been a privilege to participate in the massive undertaking to offer quality research, education, training, and technical assistance to address this worldwide public health crisis. We are partnering to set global standards for HIV prevention; the care and treatment of pregnant women; the prevention of mother-to-child HIV transmission; and the development of evidence-based strategies and global health initiatives. From Africa and Europe to Asia, the Pacific Islands, and the Caribbean, we continue to create and support programs to reduce the impact of HIV-AIDS.

Collectively, our work is far from over, but we are not giving up. The U.S. government’s theme for this month’s World AIDS Day 2021 was Ending the HIV Epidemic: Equitable Access, Everyone’s Voice. Similarly, the World Health Organization marked this year’s AIDS Day with the rallying cry, “End inequalities. End AIDS.” As we continue to ease the physical toll of HIV and AIDS, we also improve the mental wellness of those living with or caring for infected individuals. Together, let us make the dream of ending the HIV epidemic during this decade a reality.