October 12, 2015 – Mental Health Care for People Living with HIV HIV Care Updates for the Indianapolis-Carmel Metropolitan Statistical Area

Marion County Public Health Department, Epidemiology Request DR2370
Prepared by: Sara J. Hallyburton and Tammie L. Nelson, MPH, CPH

The Marion County Public Health Department’s Ryan White Services Program oversees Ryan White Part A, C, and Minority AIDS Initiative grants in the Indianapolis-Carmel Metropolitan Statistical Area (MSA). These programs serve the needs of persons newly infected or living with HIV and out of care and/or uninsured or medically underserved.

About Mental Health: Mental health refers to an individual’s psychological, emotional, and social well-being.1 A person’s mental health affects how he or she relates to others, handles stress, and makes decisions. It affects behavior, thoughts, and feelings and is an important aspect of every person’s life.1 This year, the World Health Organization is celebrating World Mental Health Day on October 10. The theme is “Dignity in mental health”.2

Just as those who live with HIV/AIDS often face discrimination and stigma, people suffering from mental health problems may face them too. The similarity doesn’t stop there. Both groups want to be treated with respect and maintain their dignity throughout their illness.

Mental Health in People with HIV/AIDS: Many people living with HIV also have a mental illness. There is evidence that at least 50% of individuals living with HIV have a comorbid mental illness.3 The mental illness can be independent of HIV, can come before the diagnosis and is a risk factor for HIV, or can occur as a result of diagnosis.3 When someone is diagnosed as HIV-positive they might feel a wide range of emotions from anger to hopelessness.4 HIV diagnosis may instigate the development of a mental illness or exacerbate one that previously existed.

Major Depression is the most prevalent psychiatric comorbidity among those with HIV.5 Those with untreated depression are likely to have decreased quality and length of life, higher treatment costs and longer hospital stays, and decreased treatment adherence.5 They are more likely to engage in behaviors that increase the risk for secondary HIV transmission.5 Some may become self-destructive or suicidal.5 Suicidal thoughts are common following HIV diagnosis, and issues that can increase these thoughts are stigma, concerns over quality of life, and a fear of disclosing their illness to others.5

Anxiety is relatively common for those living with HIV.5 Patients might have anxiety about their disease and treatment, or their anxieties could be unrelated to their diagnosis.5 Patients with panic disorders may suffer from a debilitating interference with their daily life and are more likely to commit suicide.5 Those with HIV are more likely than the general population to develop PTSD, also known as Posttraumatic Stress Disorder.5 Receiving a diagnosis of HIV is a traumatic event that can be a triggering event, especially in those who have experienced past trauma. Left untreated, PTSD can lead to behaviors that increase the risk of HIV transmission and decrease treatment adherence.5

Importance of Positive Mental Health: Improving the mental health of those living with HIV is a crucial benefit by reducing risk behavior and increasing linkage and adherence to care.6 Positive mental health can help people function better at work or school and in their day-to-day lives, as well as more effectively coping with difficult situations and taking better physical and emotional care of themselves and others.7 The ability to do these things is especially important for those living with HIV.

In order to effectively provide comprehensive mental health care and support, HIV/AIDS educators and care givers should be well equipped with the tools to handle any mental health problems that may coincide with someone’s HIV/AIDS diagnosis. The American Psychiatric Association has some great resources from experts in HIV/AIDS psychiatry. The HIV/AIDS Bureau of the U.S. Department of Health & Human Services offers an extensive Guide for HIV/AIDS Clinical Care that provides detailed information on how to diagnose, treat, or care for any number of diseases, disorders or ailments faced by those living with HIV, including a gamut of mental health problems. With so many people living with HIV today, it is vital that there be more comprehensive mental health care and support available.

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Sources:

1 U.S. Department of Health & Human Services. (n.d.). What is Mental Health?

2 World Health Organization. (2015). World Mental Health Day 2015.

3 The National Academies Press. (2005). Appendix C Mental Illness & Health Comorbidity: A Large and Vulnerable HIV Subpopulation

4 National Institute of Mental Health. (n.d). HIV/AIDS and Mental Health.

5 U.S. Department of Health & Human Services. (2014). Guide for HIV/AIDS clinical Care.

6 U.S. Department of Health & Human Services. (2015). Impact of Mental Illness on People Living with HIV.

7 AIDS.gov. (2014). Mental Health.

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