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Why putting mental health at the heart of the HIV and TB response will pay off

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Putting mental health at the heart of the HIV & TB response

By James Sale and Anna Watkins

When the Global Fund to Fight AIDS, TB and Malaria asks what are the most pressing challenges and opportunities in the fight against HIV and TB (as part of an open consultation to steer the development of their next strategy), our recommendation is clear. Put mental health - through psychosocial support - at the heart of their response. Why? Because without addressing mental health there will be no end to HIV or to TB. 

One of the most significant barriers to ending HIV and TB is the lack of psychosocial support for people at risk of, or living with, HIV and/or TB. 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 both the course of the disease and treatment. In addition, 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 often compounded by the psychological impacts that stigma and discrimination bring which may also trigger or aggravate the symptoms of mental health conditions. Individuals with unsupported mental health conditions, such as depression, anxiety, and substance use disorders are known to be less likely to seek testing for HIV and/or TB, or follow advice given in response to their test result. Mental health conditions can also have a negative impact on medication adherence and as a result are significant risk factors for developing drug-resistance, less follow up with patients  and ultimately an increased chance of transmitting the disease.

The consultation on the Global Fund’s next strategy comes on the heels of COVID-19 which brings with it new challenges for HIV and TB. Estimates indicate that in high burden settings, HIV and TB-related deaths over the next five years may increase by up to 10% and 20%, respectively, compared to if there was no COVID-19 epidemic. There is also increased attention on the mental health impact COVID-19 is having across societie. Over 1000 experts and activists have joined the UN Secretary General and the leadership of WHO, UNICEF and other agencies in calling for the integration of mental health not only into COVID-19 response plans, but also in building back better health systems. This includes the protection and scaling up of mental health support and services, which would also help deliver greater progress on HIV and TB. 

So the bottom line is that the Global Fund needs to increase both resources and capacity for providing psychosocial services at every stage of the HIV and TB care continuums. But how can the Global Fund do this? Firstly by taking a holistic approach that does not treat mental health as a sub-sector of the health system. A holistic approach means thinking about the big picture, knowing that each change made to one can affect the whole, so fully integrating psychosocial services throughout their approach. Through HIV and TB programmes psychosocial support can be embedded in primary and community level care, reaching the most susceptible to HIV and TB to prevent transmission and help those who may be at their most vulnerable.

Secondly, promote and protect the right to good mental health in the key populations that are most vulnerable to ill mental health, and HIV and TB. In focussing psychosocial support efforts on these vulnerable populations as part of the holistic HIV and TB planning, the Global Fund will also be fighting inequity. Win. Win. 

Finally, the Global Fund has a range of task forces and working groups that focus on specific elements and issues, but it doesn’t yet have one on mental health - something we think should be rectified. Comprised of expert agencies, academia, civil society, and people with lived experience of ill mental health and HIV and/or TB, this task force could provide a laser focus on just how impactful integration of psychosocial support in HIV and TB programming can be provided, which in turn will help end these epidemics. Something we are all united in working towards. 

We are delighted that key Global Fund donors have written in support of the integration of mental health into the Global Fund strategy, and we continue to receive support from partners also working on this issue. 

This is United for Global Mental Health’s full response to the Global Fund’s Strategy Open Consultation. Do feel free to plagiarise us!  The consultation closes on 1st September, to submit your response go to https://www.theglobalfund.org/strategy-consultation/