MENTAL HEALTH ISSUES AMONG PLHIV

Two weeks back, we were talking about the challenges of referring patients with mental health issues to psychiatry service.  During the discussion, we mentioned how stigma and discrimination can lead to depression and suicidal ideations, especially among newly diagnosed people living with HIV (PLHIV).

The process of testing itself is imbedded in a private and confidential setting, with counselling to provide psychological support when one finds out about the diagnosis.  Disclosure to family and loved ones of one’s status becomes difficult, considering that one needs to open oneself up to the risk of rejection and isolation.  It is painful to realize that you may not be accepted, and that you may be shunned from polite society. 

I know of a prominent Filipino doctor who died of suffocation, refusing intubation.  He had an opportunistic fungal pneumonia, and he wanted to die because he could not accept that he had HIV/AIDS.  So he refused all interventions, and signed an advance directive to allow him to die.  Had he received psychiatric help for the depressive feelings he must have had, who knows? He might have been helping the Filipino poor today, providing health service delivery.

Last week, we had a technical meeting with the Department of Health, WHO and UNICEF on the implementation of the prevention of mother to child transmission of HIV in the Central Visayas.  During this meeting, we discussed the challenges of treating, caring and supporting pregnant women living with HIV and their families.  There is a new administrative order being drafted which integrates prevention of mother to child transmission of HIV in all levels of healthcare.  In an instant, I could imagine all the challenges we would have, so we requested that this new order be implemented with strong programs on stigma reduction and HIV awareness programs especially for healthcare providers.

During a regional forum with the Health Policy Development Program discussing the challenge of reaching the poor through a continuum of care, it was mentioned that almost 50% of people who inject drugs were HIV-positive.  These people also deal with mental health issues which drove them to use drugs in the first place.  How do we integrate HIV in all levels of healthcare without addressing first the basic mental health issues of key affected population – male who have sex with males, IV drug users, female sex workers?

Have you had an HIV test?  Until the HIV test becomes as routine as a complete blood count, it may be difficult to encourage HIV testing at the community level, and in all levels of healthcare.  We’ve got a lot of things to talk about HIV yet.

The Duke and Duchess of Cambridge and Prince Harry had a conversation about putting their HeadsTogether for mental health.  They realized that all their personal advocacies had the central point of mental health – that simply talking about things can already be therapeutic, like medicine. 

What are examples of mental health issues faced by PLHIV?

How can mental health issues affect the programmatic approach to prevent HIV/AIDS?

What strategies may help reduce stigma and discrimination among PLHIV.

How do we move forward?


We had a #HealthXPH tweetchat on this topic last Saturday.  Here are some of the inputs from those who participated:

Yenyen Delgado shares an infographic for healthcare workers. 

T3 This is a great infographic for healthcare workers. #HealthXPH pic.twitter.com/lRM6C2rvwR

— Yenyen Delgado (@yenerts) July 15, 2017

Roland talks about testing.

Filipino teens generally think that getting tested is a message itself that you could have HIV, or a sexually active person, etc #HealthXPh https://t.co/Ght7Y5ZS3W

— Roland Vergel Acasio (@Sir_Lando) July 15, 2017

Cocoy mentions reaction to diagnosis.

The reaction to diagnosis is highly influenced by culture, level of understanding, and upbringing. #HealthXPh

— Cocoy Calderon, M.D. (@cocoycalderonmd) July 15, 2017

Shereese talks about careers of PLHIV.

Careers don't need to be destroyed due to contracting a disease. We now know, w/ tx & precautions, ppl can lead normal lives #healthxph

— ShereeseM, MS/MBA (@ShereesePubHlth) July 15, 2017

Renier talks about access to services.

To address PLHIV mental health, stakeholders should make sure HIV services, whether health-related or otherwise, are accessible. #healthxph

— Renier Louie B. Bona (@renierbona) July 15, 2017

Stephanie suggests screening for anxiety and depression among PLHIV.

T3 Anxiety and depression screening for those with the PLHIV status, asking the right questions yields helpful answers. #healthxph

— Stephanie Miaco, MD (@thestreetgazer) July 15, 2017

Chin-chin talks about HIV awareness to reduce stigma.

T3. Awareness about HIV is important to reduce stigma. Knowledge leads to understanding and with understanding comes Compassion. #HealthXPh

— Chin-Chin (@chinchinmd) July 15, 2017

Miko sends a positive outlook for the Philippine HIV epidemic.

Let's all work together in a HIV-Free Philippines. We have so much experts that can work on this. #HealthXPh https://t.co/8tnRjXUjAg

— Miko (@ohitsmiko) July 15, 2017

...and with that, we remove the elephant in the house and continue to talk about HIV to improve awareness and attitudes towards PLHIV.