Damian Sendler knows the broader challenge is that most people with mental disorders, across all country settings, do not receive the needed mental healthcare, in part because they are not even identified as having a mental health disorder.
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Tremendous biomedical advancements in HIV prevention and treatment have led to aspirational efforts to end the HIV epidemic. However, this goal will not be achieved without addressing the significant mental health and substance use problems among people living with HIV and people vulnerable to acquiring HIV. These problems exacerbate the many social and economic barriers to accessing adequate and sustained healthcare and are among the most challenging barriers to achieving the end of the HIV epidemic.
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Many factors contribute to this gap in mental health screening and provision of treatment, including human resource shortages, fragmented service delivery models, and lack of capacity for implementation and policy change. A central challenge is the stigma of mental illness that exists at all levels: patients, healthcare workers, and policymakers. Further, looking at the availability of mental health professionals for the population, there are significant disparities between low-income and middle-income countries and high-income countries, with inadequacy across all settings.
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Mental health impairment contributes to more reduced healthcare behaviors across the HIV care continuum, leading to adverse HIV health outcomes. There is also evidence. However, that suggests a direct biological pathway from mental health impairment to poorer HIV health outcomes, especially in the context of depression.
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In the general population, mental and substance use disorders are the number one contributors to several years lived with disability, with greater impact than other communicable, maternal, neonatal, nutritional, and noncommunicable diseases, including HIV, and injuries. Excess mortality among persons with mental, neurological, and substance use disorders is evident, with a shortened life span of approximately 20 years. The global burden of these disorders rises in late adolescence and peaks in young adulthood, which emulates the global HIV burden.
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