An opportunity this World AIDS Day

By Elisha London, co-founder and former CEO of United for Global Mental Health

This World AIDS Day falls at the end of the most extraordinary year. The COVID-19 pandemic has brought unprecedented difficulties for all of us, not least the wave of mental health challenges, which are now putting pressure on already overburdened mental health services.

But the pandemic has also taken a toll on the fight to tackle HIV. It’s estimated that in high burden settings, over the next five years HIV-related deaths may increase by up to 10% compared to if there were no COVID-19 epidemic. Access to treatments and drugs has been disrupted, HIV prevention measures have been limited, and many people have found themselves in unsafe lockdown situations. The latest research from UNICEF highlights that the pandemic may already be aggravating feelings of loneliness, depression and anxiety in key populations and young people living with HIV.

It’s long been established that HIV and mental and substance-use disorders are inextricably linked. Poor mental health is a risk factor for HIV infection and, once infected, having HIV is a huge risk factor for developing mental disorders. We know that people with HIV experience higher rates of depression, which has previously been linked to higher rates of HIV mortality. We also know that the risk for depression is twice as high for people with HIV. Those with mental health illness, such as depression, anxiety, and substance use disorders are less likely to seek testing for HIV, and less likely to follow advice given in response to their test result. As Abhina Aher, a trans* activist working in India with the HIV/AIDS Alliance says, when talking about her work with some of the most vulnerable populations:

“We all face different challenges but the one thing that unites us all is the need for better mental health support.”

The global pandemic has, for many, increased the importance of prioritising mental health, although this is not yet translating to proper financial investment from governments and global leaders. However, with the increased attention we are seeing on the impact COVID-19 on mental health, there are growing calls to integrate mental health not only into all global recovery plans. This would not only help ensure more robust pandemic preparedness, including the protection and scaling up of mental health support and services, but also deliver greater progress on HIV.

As the second largest funder of the HIV response, the Global Fund for AIDS, TB and Malaria has a unique opportunity to take the reins here. In the five year strategy currently being developed, the Global Fund must take a holistic approach that does not see mental health as a sub-sector of the health system. This should include the promotion and protection of the right to good mental health in the key populations that are most vulnerable to ill mental health and HIV, and the establishment of a mental health Task Force within the Global Fund structure, all of which would help to set the global HIV response back on track to ending the epidemic.

We are at a pivotal moment in the history of mental health and the global HIV response. As a key leader in the HIV response, the Global Fund must continue to demonstrate this leadership role by the integration of, and investment, in mental health and HIV, as it has the chance to do things differently and transform both the response to the co-epidemics of HIV and mental ill health, and the futures of those affected.

This leadership also has the potential to inspire others too to ask the question; where else should mental health be integrated, both during the current pandemic and looking forward to the future and the world we want to rebuild?