Putting mental health at the heart of the HIV and TB global response

It’s time.

Two weeks ahead of critically important discussions on the new strategy of the Global Fund to Fights AIDS, TB and Malaria, it is increasingly clear that unless mental health moves from being seen as a “bolt on” to the HIV and TB response, reaching the global targets to end these epidemics will remain elusive.

Why? Because it has long been established that HIV, TB and mental and substance-use disorders are inextricably linked – poor mental health is a risk factor for HIV and TB infection and, once infected, having HIV and/or TB is a huge risk factor for developing mental disorders. We know that people with HIV and TB experience higher rates of depression, which has been linked to higher rates of mortality.

As the Global Fund crafts its new strategy that will take us through the next five years, putting mental health at the heart of it will demonstrate bold leadership and help get the world back on track to ending HIV and TB, and improve mental health globally.

Why does investing in mental health matter and what are the returns?

Given the intrinsic links between mental health, HIV and TB, there are many reasons – and returns to be gained – by integrating mental health in the global response from the impact on testing, to prioritising the quality of life of individuals.

Testing: 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 less likely to follow advice given in response to their test result. 

Adherence: Mental health conditions often impact on medication adherence for HIV, TB, and TB/HIV coinfection, increasing the risk of developing drug-resistance, loss to follow up and increased deaths.

Overlapping risk factors: Significant risk factors for HIV, TB and many mental health conditions include harmful substance and alcohol use, and traumatic life experiences. These are associated with poor medication adherence and treatment outcomes.

Overlapping key and vulnerable populations: The groups most at risk for mental health conditions, HIV and TB  overlap considerably. This not only reinforces the two way nature of poor mental health, HIV and TB but also provides considerable return on investment of mental health services and significant impact and efficiency of interventions.

Quality of life: As so much of the community – and the Global Fund itself –  acknowledges, viral suppression should not be seen as the ‘end goal’ of the response to HIV and TB. Instead, individuals should have the support to be empowered to live a good quality of life,  in which for many mental health is front and centre, especially given the stigma and discrimination faced, and the impact this can have on mental health.

Economic returns: There are compelling economic reasons to integrate mental health into the Global Fund’s new strategy too. Every US$ 1 invested in mental health, HIV, and TB programmes, can reap an economic return of US$ 4, US$ 6.40 and US$ 43 respectively.

So what does the Global Fund need to do? 

In order to achieve and sustain long term gains, the Global Fund must fully embed mental health into its new strategy, increasing resources and capacity for providing psychosocial services at every stage of the care continuum. By focussing psychosocial support that addresses both the psychological and social needs of individuals, families and carers – on vulnerable populations as part of holistic HIV and TB planning, the Global Fund will also be promoting a person-centred communities-based approach whilst fighting inequity. The allocation of sufficient resources to quality of life initiatives – specifically person-centred, community-led programmes that incorporate mental health as part of essential support and services for people living with HIV and/or TB – is also critically important and would be a game-changer.

As the growing evidence shows, without integrating mental health and psychosocial support into work and funding, the aims and aspirations of the Global Fund and of all us who support it are not going to be achievable. Placing mental health at the core of its new strategy would help transform the global response to the co-epidemics of HIV, TB and mental ill health, and the futures of those affected.The full set of recommendations from United for Global Mental Health to the Global Fund Strategy Committee can be found in our latest briefing.