HIV, TB and the Global Fund

The COVID-19 pandemic has highlighted to governments, and to key figures in the private and non-profit sectors alike, that mental health outcomes are intertwined with physical and disease healthcare.

Overview

The COVID-19 pandemic has highlighted to governments, and to key figures in the private and non-profit sectors alike, that mental health outcomes are intertwined with physical and disease healthcare. We have taken the fight to HIV and TB worldwide, two of the most perennially debilitating diseases that overwhelmingly affect low and lower-middle income countries.

Mental health is now a key facet of the 2023-2028 strategy for the Global Fund to Fight HIV, TB and Malaria – an international financing partnership helping lead the fight against HIV, TB and Malaria with an eye to achieving the Sustainable Development Goals laid out by the United Nations. This paves the way for further investment in mental health and psychosocial support as part of the worldwide response to HIV and TB.

By investing in this way, we can expect both mental and physical health outcomes for key population groups vulnerable to HIV infection, TB cases, and mental ill-health, to be improved substantially.

The Challenge

There will be no end to HIV or to TB without addressing mental health. The relationship between HIV/TB and mental illness is bi-directional. Poor mental health is a risk factor for HIV and TB exposure which complicates the disease course and treatment. Furthermore, living with HIV and/or TB is a significant risk factor for a decline in the individual’s mental health, and developing psychiatric illness. This is compounded by the psychological distress associated with stigma and discrimination which may also trigger or aggravate the symptoms of mental health conditions (e.g. depression) in affected individuals.

Depression, one of the most common mental health conditions, is also the most common mental disorder affecting people living with HIV and/or TB. It is estimated that 24% of people with HIV in sub-Saharan Africa also have depression. The prevalence of depression is estimated to be as high as 50% among individuals with tuberculosis, with other reviews suggesting even higher levels of co-morbidity between TB and all forms of mental disorder.

Individuals with unsupported mental health conditions, such as depression, anxiety, and substance use disorders are less likely to seek testing for HIV and/or TB, and to follow advice given in response to their test result. Significant risk factors for both HIV and TB, include harmful substance use, poor mental health outcomes and traumatic life experiences. These are associated with poor medication adherence and treatment outcomes.

Our Approach

We work with global organisations, from the WHO to several private and non-profit organisations, to draw attention to a growing body of evidence of the effectiveness of an integrated approach to healthcare, and to provide real-world solutions to questions of investment and how that investment can be spent.

Our goal is for mental health and psychosocial support to be integrated into all approaches to treating HIV and TB and into all investments relating to HIV/AIDS and TB, now and in the future. This will deliver better physical and mental health for all those at risk of, and impacted by, HIV/AIDS and TB.

Our Impact

Our advocacy over the last 2-3 years has helped bring mental health into the forefront of strategic planning at the Global Fund for the first time. Together working with national partners on the ground, we have helped bring the case for global mental health to the heart of future international messaging as the pandemic recedes.

We have already made huge progress in drawing attention from key stakeholders, particularly in conjunction with the WHO, HSBC and The Lancet. We have supported partners in engaging with the issue, on the governmental, private and non-profit level. With this in mind, we have organised a presence at AIDS 2022 in Montreal this year with an eye to encouraging further advocacy at the Replenishment Conference in September.

What’s Next

With an eye to the future replenishment conference for the Global Fund, we are continuing to push the case with our partners to stand by commitments, and make meaningful change tangible.

Download Our Report: Bending the curve: The impact of integrating mental health services on HIV & TB outcomes

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