Dr Melanie Abas presents at International AIDS Conference 2018

07 Aug 2018

There have been considerable advances in HIV treatment over the past 20 years.  People living with HIV and taking antiretroviral therapy (ART) now have near normal life expectancy and are unable to transmit the virus to sexual partners. In 2015 the World Health Organisation adopted a ‘treat all’ strategy, recognising that early initiation of ART is beneficial at both an individual and population level. The UNAIDS goals for 2020 are for 90% of people living with HIV worldwide to know their status, 90% of these to be initiated on ART, and 90% of all people receiving ART to be virally suppressed. These 90–90–90 targets have become central to global strategy to end the AIDS epidemic. Whilst many countries are reporting real progress towards achieving these goals, recent data confirm a bleak picture globally.

Poor mental health is contributing to the global lack of control of the epidemic. The link between HIV and mental health is multifaceted. Depression is associated with higher HIV risk behaviours, particularly when it occurs alongside other health and social conditions. For those living with HIV, good adherence to ART is central to continued viral suppression. Depression has been shown to be significantly associated with nonadherence to HIV treatment and poor engagement in care. Mental disorders are common in people living with HIV. This is particularly true for adolescents and young people, with available evidence suggesting that at least a fifth of young adults living with HIV in high-burden countries have a mental disorder, recent thoughts of self-harm, and/or an alcohol or substance use disorder.

A recent Lancet commission has highlighted the global epidemic is not on track to end partly due to poor capacity to address multiple health problems simultaneously. Because of the centrality of mental health to the management of HIV, services should either be integrated or at a minimum co-located. However, countries with high prevalence of HIV, also have sparse mental health treatment services. The lancet commission reveal that in low and middle-income countries, most health systems are not equipped to provide an integrated and scaled-up access to mental health services.

Research is needed in countries with high HIV-burden on approaches to blend interventions for both non-adherence and common mental disorders, and on diverse approaches to improving mental health in people living with HIV where the availability of mental health care is extremely low.

Dr Melanie Abas, co-Deputy Director of the CGMH presented at the 22nd International AIDS Conference on June 25th in Amsterdam. Dr Abas presented on her program of work on mental health and HIV, including clinical trials to improve viral suppression in people with depression and poor adherence to antiretroviral therapy. The symposium was entitled “The intersection of mental disorder screening and treatment and HIV/AIDS in LMICs: State of the science and priority directions”. The purpose of the workshop was to provide an overview of state-of-the-science approaches for screening and intervention for mental disorders among persons living with HIV in low and middle-income settings.  Other speakers include Prof Kathy Sikkema, Duke University; Associate Professor Susan Meffert, UCSF; Assistant Professor Conall O’Cleirigh, Harvard Medical School and Professor Claude Mellins, Columbia University. The session was chaired by Dr Christopher Gordon, National Institute of Mental Health.  On the previous day, Elton John and Prince Harry attended AIDS2018 and announced a new one billion-pound Global Partners Pledge to launch the MenStar Coalition to engage men especially in sub-Saharan Africa to break the cycle of HIV transmission.