HIV A Global Perspective
The challenges that the world encounters these days vary from increasing reports of drug -
resistant pathogens, the impact of the environmental pollution and climate change, outbreaks
of preventable diseases as measles and diphtheria and numerous humanitarian crises. WHO
and its partners plan is to focus their attention in 2019 on issues as climate change and air
pollution, non-communicable diseases as diabetes cancer and heart disease, global influenza
pandemic, fragile and vulnerable settings, antimicrobial resistance, Ebola and other
pathogens, weak primary healthcare, vaccine hesitancy, Dengue, and HIV.
HIV (immunodeficiency virus) weakens the ability of the body to fight infections and
illnesses and destroys the cells within the immune system. The cells that HIV is targeting are
the t helper cells. and macrophages. Consequently, the ability of the body to fight infections
diminishes and the individual becomes ill with numerous sicknesses. Several opportunistic
infections that an individual develops because of HIV are defined as AIDS.
With the pandemic HIV outbreak and increasing death counts in the 1980s (HIV.GOV
2018), dedicated professionals have long researched the illness, in order to find a cure. This
has led to the discovery of more effective medication, which only slows down viral
replication rates. Despite the current strategies targeting all audiences regarding HIV
prevention, numbers are still alarming. However, the most uncharted territory is that of
mental health in HIV, which begs the question: is mental health a key-point in the HIV
therapy or not?
In the past due to the lack of treatments HIV infection would lead to AIDS and to an early
death. Starting with 1995 researchers have a better understanding of HIV and its life cycle.
Even dough there is no cure for AIDS, there is a treatment, that is very efficient called
antiretroviral therapy (HAART). HAART it stops HIV duplication in such a way that the
viral load becomes undetectable. The medication that is prescribed is Ziduvine which
interferes with the life cycle of HIV
According to the 2018 report by the Joint United Nations Programme on HIV and AIDS
(UNAIDS) approximately 37 million people were living with HIV, while only 21.7 million
were accessing anti-retroviral therapy, and an estimative 75% of those affected knew their
status. The same report indicates nearly 1.8 million people discovered that they have HIV in
2017 alone (UNAIDS Data Sheets, (2018). Within the last 2 decades, the HIV-related
deaths average is 1.25 million/year, and only 3 people being known to have been cured of the
disease (CROI Conference, Feb 2019). The same happens with HIV-related deaths, as we
can see an approximate 33% decrease since 2000 (UNAIDS Data Sheets,2018) On a brief
overview of the UNAIDS statistics most of the new infections occurred predominantly in
Eastern Europe and central Asia and the Middle East and North Africa (95%), while 16% of
new HIV infections occurred in Eastern and Southern Africa.
People living with New HIV infections HIV-related deaths
HIV
2017 36900000 1800000 940000
2016 36300000 1900000 990000
2015 35600000 1900000 1000000
Fig. 1
HIV trend comparison between France and
Lesotho - UNAIDS
4195000
2017 00 3200
452300
5198000 200000
2016 0 31000
452400
6149000 200000
2015 300000
450400 190000
0 50000 100000 150000 200000 250000 300000 350000
HIV-related deaths - Lesotho New HIV infections - Lesotho
People living with HIV - Lesotho HIV-related deaths - France New HIV infections - France People living with HIV - France
Fig. 2
Out of these figures, and in accordance with the points raised by both UNAIDS and the
National Institute for Mental Health (NIMH 2018), most of HIV-related deaths occur within
patients who have interrupted their treatment, as most suffer from depression and anxiety. It
was discovered that most individuals reported that they refuse to determine their status, start
therapy or continue therapy in fear of stigma and discrimination. Despite this, HIV-related
mental health issues have not been researched enough to address the situation globally
(UNAIDS Case Study on mental Health -2018).
The UNAIDS committee also brought to public attention that dedicated mental health
services are needed, in support of their HIV-prevention action plan (2013-2020) to prevent
HIV infections, during a meeting from October 2018. Aside from indicating the main root
causes (unprotected sex – predominantly between same-sex male partners, injectable drug
abuse, and low access to educational programs in low-income countries, stigma around the
disease), the emphasis was made on those already suffering from the illness who may no
longer seek support, while the risks of exposure are increased among those who are suffering
from a mental condition (UNAIDS Case Study on mental Health 2018). During the same
conference, UNAIDS indicated that HIV-African patients are with 24% more likely to
experience a mental illness.
Given the nature of the disease, as well as the numerous side effects stemming from ART
(Anti-Retroviral Therapy), chemical imbalances occur, subsequently leading to a direct
impact on mental health (UNAIDS Case Study on mental Health 2018). In recent years,
this has been a widely researched subject, and more institutions in charge of mental health
have specialized their services to accommodate these needs. The general pool of symptoms
pertaining to this category of affection includes: apathy, trouble maintaining concentration,
irritability, low self-esteem, social isolation (UNAIDS Case Study on mental Health 2018).
According to National Centre for Biotechnology Information NCBI (2017) the main
mental disorders faced by HIV patients are anxiety and depression. These illnesses, though
unseen, have other secondary effects and largely impact one’s quality of life. In some
instances, these illnesses are correlated to stress which, in return, can lead to other more
noticeable affections. Prevalence of depression and anxiety disorders in HIV positive
outpatients in rural Tanzania (2017). As stated by NCBI (2017) depression or mixed
anxiety and depression was identified in 15% of individuals, with 4,5% suffering from other
anxiety disorders. Therefore, routine HIV care should involve assessment and treatment of
mental health issues in Sub-Saharan Africa.
Another interesting aspect is that upon further studies (Disease Control Priorities in
Developing Countries. 2nd edition – 2006), depression and anxiety were also deeply
connected to extreme fatigue and a general state of exhaustion. Given this context, some
individuals even reported they feel ashamed of disclosing their status to family and friends, in
fear of stigma surrounding the illness, further deepening their condition and reluctance
towards seeking specialized assistance. When looking at behavioural patterns, it was also
identified that insomnia or abnormal sleeping patterns stem from the mental and emotional
impact HIV has on these individuals. Most of the time, when sleeping disorders, improper
diet and treatment administration, vices and societal stigma occur most individuals maintain
the same secluded and destructive patterns. At times, their interest in education on the topic
turns to ignorance and a delusional perception of their own reality, denying the medical
condition that they have (UNAIDS Case Study on mental Health 2018).
In other words, HIV can be considered both a physical impairment, targeting specific
immune cells, as well as a mental and emotional catalyst, as it opens pathways towards other
mental illnesses, with a direct negative impact on the afflicted one’s experience of life.HIV
could also led to suicide. According to NCBI (2017) a significant predictor of suicide risk
was the impaired immunological status defined as CD4 cells count whereas the CD4 cells
were under 200 cell/mm cube. As stated by this study the numbers reported in suicide
attempts among HIV positive women were around 26% following HIV diagnosis. A different
factor that would lead to anxiety and even to suicide is discrimination. Even in developed
countries as France, health services and family were the two discrimination contexts
frequently reported by People living with HIV/AIDS (PLHIV) with suicide risk (21% and
23%) of individuals.
Even though we are far from discovering a cure or knowing everything about the
disease, studies have greatly helped with identifying causes and effects, thus leading to new
experimental avenues, in hopes of discovering more effective ways to deal with the situation.
Moreover, it appears that rather than focusing on the physical aspects of the illness, we will
need to continue in raising awareness towards its impact on one’s mind, and help suffering
individuals at a psychological and emotional level.
References
AIDS(UNAIDS)/(2018), J. U. N. P. o. H., 2018. Factsheets-World AIDS Day. [Online]
Available at: http://www.unaids.org/sites/default/files/media asset/UNAIDS FactSheet en.pdf
[Accessed 1 Apryl 2019].
AIDS, A. t. o. H. a., 2019. Joint United Nations Programme on HIV and AIDS (UNAIDS).
[Online]
Available at: http://www.unaids.org/en/story-type/press-release [Accessed 1 Apryl 2019].
Bertozzi, s. et al., 2006. Disease Control Priorities in Developing Countries. [Online]
Available at: https://www.ncbi.nlm.nih.gov/pubmed/25117961 [Accessed 1 Apryl 2019].
The UNAIDS Programme Coordinating Board(PCB), 4. M., 2018. Mental Health and
HIV/AIDS-Promoting human rights,an integrated andperson-centred approach to
improvingARTadherence,well-being and uality of life. [Online]
Available at: http://www.unaids.org/sites/default/files/media asset/20181123 UNAIDSBN
thematic- segment-mental-health-and-HIV EN.pdf
[Accessed 1 Apryl 2019].
