Mental health is one of the most important problems faced by people with HIV. And, furthermore, it is a problem that has never been taken seriously enough, denounced Jeffrey Lazarusfrom the Barcelona Institute for Global Health, “partly because the efforts were focused on diagnosing and treating people who needed it”, during his speech at the XX National Congress on AIDS and STIs held last week in Bilbao.
Likewise, there is another issue that makes it difficult to identify mental health. Lazarus notes that professionals in the field of infectious diseases “may not be the best people, because you need a referral to mental health specialists, and not all centers have experts in this field.”
In this sense, points out Rodrigo Oraa, from the Bizkaia Mental Health Network Addictions Service (Osakidetza – Basque Health Service), the chronicity of HIV makes the importance of mental health increasingly relevant when considering the quality of lives of people with HIV.
“When we refer to mental health we have to see it as a continuo. Simplifying a lot, the state of mental health is a balance between the coping abilities that a person has, and the situation that they are experiencing at that moment. That is where personal, biographical, social determinants, illness… In moments of discomfort, adaptation capacities are overwhelmed by the demands of life situations. The balance can be restored by improving these stressors and reinforcing the supports », he explains.
Oraa points out that the needs of people with HIV can be very varied. “Some will be at one extreme, with addictions and other mental disorders, and will possibly require a specialized approachwhich may include psychopharmacological and psychotherapeutic treatments.
The chronicity of HIV has brought with it new challenges for the health of patients, such as a greater burden of disease (comorbidities) and treatment (polypharmacy), and for the medical care they receive, greater clinical complexity and greater care needs, says Juanse Hernández , of the Working Group on HIV Treatments (gTt-HIV). “Stigma and discrimination, in their different manifestations, continue to be an additional source of suffering for people with HIV and one of the main barriers to preventing and treating this infection.”
Objective: quality of life
All these circumstances have an impact on well-being, which is why, at present, no one questions that improving the quality of life is the goal to be achieved in the care of people with HIV and that the medical response to this infection is accompanied by a response based on human rights that guarantees non-discrimination and equal treatment.
There are factors related to mental illness, such as situations of stress, low self-esteem, anxiety or depression, which make this quality of life lower than that of the rest of the population, says Alicia González Baeza, Professor at the Faculty of Psychology at the Autonomous University of Madrid.
The expert refers to the stressors associated with the process of living with HIV; that is, to the effects of HIV itself on the central nervous system or of treatments. It is necessary to consider, he said, “factors as relevant as the impact of the diagnosis, discrimination and stigma, expectations of rejection, the internalized stigma itself that interferes with day-to-day life and social relationships, concerns about not having a cure, for possible sexual transmission, adherence, medical complications, body image changes.
However, the current model of HIV care –focused on the disease and on services– has limitations to achieve the objective of improving the quality of life of patients.
From the European Union, says Lazarus, and through the project HIV Outcomeswork is being done to implement and develop comprehensive and person-centered care models that can improve mental health needs.
Regarding the interventions to address this important problem, González Baeza points out that they should be of different types: Preventive, to “reduce barriers and stressors, and accompany and promote adaptive strategies”; for the detection of mental health problems, “in order to intervene as soon as possible”; individualized psychological, “focused on stressful life events, emotional regulation and coping strategies, and finally, through therapeutic groups based on coordinated and combined interventions…”.
The World Health Organization (WHO) recognizes that the strategy of comprehensive and person-centered care must be the axis to improve health and long-term care services. This strategy, Hernández points out, is organized around the health needs and expectations of people, jointly responsible in their own health care and involves them in the decision-making process.
For Oraa, these models of relational care continuity are “the opposite of the current trend in which health professionals change frequently and users cannot identify a referent with whom to share their concerns.”
Oraa warns that there are no “continuous conversations, which allow acting on mental health from prevention, the adoption of healthy habits, anticipating the fragility of accelerated aging… And when crises occur, knowing the determinants of discomfort, and look for concrete solutions.