The Key Role of Mental Health Services in Ending the HIV Epidemic

May is Mental Health Awareness Month, a time to raise awareness about the importance of mental health for everyone and at every stage of life, from childhood and adolescence through older adulthood. I want to spotlight the importance of mental health for people with risk for and living with HIV.

The National HIV/AIDS Strategy makes it clear that mental health services are a key component of a comprehensive approach to ending the HIV epidemic in the United States. That’s because HIV and mental health are a syndemic or a set of linked health conditions that adversely interact with one another and contribute to an excess burden of disease in a population.

We know that mental health issues can contribute to someone’s risk for acquiring HIV or negatively impact treatment for those diagnosed with HIV. Conversely, good mental health can support HIV prevention or care and treatment, and foster resilience. Living with HIV can also exacerbate mental health issues. So, we need to take a more integrated, holistic approach to delivering HIV and mental health services, informed by insights from research and evaluation and supported by the necessary modifications to policies, funding, and regulations.

The Biden-Harris Administration is committed to addressing the nation’s behavioral health crises and strengthening mental health of all Americans. A whole-of-government strategy to transform mental health services for all Americans is a key part of President Joe Biden’s Unity Agenda. It calls for strengthening system capacity, connecting more Americans to care, and creating a continuum of support – transforming our health and social services infrastructure to address mental health holistically and equitably.

Agencies across the government are working to address the mental health challenges that have been exacerbated by the COVID-19 pandemic, including substance use, youth mental health, and suicide. (Read about HHS Secretary Xavier Becerra’s National Tour to Strengthen Mental Health and about HHS mental health efforts over the past year.) These efforts will certainly support and bolster implementation of the National HIV/AIDS Strategy.

We know that the prevalence of mental health disorders among people with HIV is higher than among the general population. One of the most common mental health conditions that people living with HIV experience is depression. Depression can range from mild to severe, and the symptoms of depression can affect your day-to-day life. Both HIV-related medical conditions and HIV medications can contribute to depression. Other common mental health conditions among people with HIV include anxiety disorders, mood disorders, and personality disorders. In fact, 26% of people with HIV reported recent symptoms of depression and/or anxiety according to the latest data from CDC’s Medical Monitoring Project.

Fortunately, many mental health conditions are treatable and many people with mental health conditions recover completely. While mental health treatment is often available where someone with HIV receives care – either from their health care provider or a social worker, psychiatrist, and/or support group – we are continuing to improve our efforts to integrate mental health care and HIV care. (Learn more about why taking care of your mental health is an important part of HIV care at HIV.gov.)

An area where we may need to do more innovation and strengthening is addressing the mental health needs of individuals experiencing risk for HIV. As the American Psychological Association notesExit Disclaimer, behavioral health problems, including mental health and substance use disorders, play a critical role in HIV acquisition across populations, increasing the risk of HIV acquisition by four to ten-fold. Mental health challenges can interfere with regular HIV testing and adherence to PrEP, for example.

Importantly, and supporting both the President’s mental health strategy and the National HIV/AIDS Strategy, federal HIV partners are taking actions upon which we can build an even stronger, more integrated response to HIV and mental health:

• CDC-funded HIV prevention partners are expected to link HIV-negative individuals at risk of acquiring HIV to other services they need to remain engaged in prevention services to avoid getting HIV, including substance use disorder abuse treatment, mental health services, housing, and transportation.
• According to HRSA’s Ryan White HIV/AIDS Program Compass Dashboard, nearly 12% of all RWHAP clients received mental health services through the program in 2019.
• The Ryan White HIV/AIDS Program’s AIDS Education and Training Centers (AETCs) also support provider training on HIV care and mental health. For example, this month the New England AETC is launching a four-part webinar series on providing mental health care to people with HIV in primary care settingsExit Disclaimer, covering depression, pharmacotherapy for depression, anxiety disorders, and trauma- and stressor-related disorders.
• A recent Minority AIDS Initiative funding opportunity announcement from the Center for Mental Health Services, part of the Substance Abuse and Mental Health Services Administration, sought applications for projects that will help reduce the co-occurring epidemics of HIV, hepatitis, and mental health disorders through accessible, evidence-based, culturally appropriate mental and co-occurring disorder treatment that is integrated with HIV primary care and prevention services.
• NIMH partnered with HRSA and NIDA to solicit and fund "Implementation Research in HRSA Ryan White Sites: Screening and Treatment for Mental and Substance Use Disorders to Further the National EHE Goals." Eight funded projects are designed to test innovative approaches for integrated care, improving service delivery and client outcomes immediately while also advancing the science evidence base. Collectively, the projects are being implemented across 68 Ryan White care sites, using telemedicine and low-barrier HIV care combined with collaborative team mental health care, mental health stigma-reduction training, peer navigation, and integrated mental health and HIV care for Black gay and bisexual men.

As we work together to modify often siloed services and improve availability of and access to mental health services, our enhanced efforts need to consider the specific mental health needs of key subpopulations, including young people, older adults with HIV, transgender women, gay and bisexual men, and justice-involved individuals.

Please join me this month in thinking strategically about what more we can do to strengthen the integration of HIV services and mental health services to improve outcomes and quality of life for people who need both.