Healthcare
Mental health must be integrated into global initiatives for HIV/AIDS
By British Journal of Psychiatry
Jul 5, 2005, 22:23

A more prominent role is needed for mental health interventions in global HIV/AIDS initiatives, such as the World Health Organisation 'Treat 3 Million by 2005' ('3 by 5') Initiative.

This is the conclusion of an editorial in the July issue of the British Journal of Psychiatry, which reviews the reasons why mental health matters to HIV/AIDS treatment programmes in developing countries.

In July 2004 a group of 18 mental health professionals from developed and developing countries met under the auspices of the WHO to consider how mental health should be integrated into the '3 by 5'. This editorial presents the key themes arising from the meeting.

There are at least five distinct mental health-related issues that are relevant to HIV/AIDS:

* cognitive impairment due to viral infection of the brain
* depression and anxiety due to the impact of the infection on the person's life
* alcohol and drug use, which contribute to risk behaviours
* the psychiatric side-effects of some antiretroviral therapy
* the social difficulties faced as a result of stigma and discrimination.

Anecdotal evidence suggests that only a small number of treatment programmes in developing countries provide mental health services, and only a fraction of those people with HIV/AIDS receive mental health care.

Would mental health interventions improve the medical and treatment outcomes of the disease? It is known that depressive symptoms in women with HIV/AIDS are associated with disease progression.

Further, the success of HIV treatment programmes requires that patients adhere to long-term therapy with multiple drugs, some of which may produce unpleasant side-effects. Mental disorders have been shown to be a significant impediment to adherence to antiretroviral therapy.

In addition to the treatment of specific mental disorders, behavioural interventions such as cognitive-behavioural and group supportive therapy may also contribute to adherence.

Three broad recommendations were made for the integration of mental health in the '3 by 5' and other HIV/AIDS programmes in developing countries:

* including assessment of mental disorders and their management in normal service provision
* supporting research on mental health and HIV/AIDS
* advocacy from a range of stakeholders to highlight the role of mental health in HIV/AIDS treatment programmes

WHO's '3 by 5' initiative is a massive response to an enormous global health crisis. Its implementation must include effective alleviation of psychiatric symptoms, and the promotion of the emotional well-being of people living with HIV/AIDS.

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