These percentages on HIV and mental health, taken, among others, from a study carried out in 2019 by the Hospital Universitari de La Pau in Madrid which had the support of Gilead, support a reality that is nevertheless underdiagnosed
To get to know the subject closely and on the occasion of World AIDS Day, EFEsalut has interviewed José Muñoz Moreno, clinical psychologist, doctor in neuroscience and member of GeSIDAwhich is the study group of the Spanish Society of Infectious Diseases and Clinical Microbiology (Seimc)
These were the answers to the following questions.
?What are the most common disorders?
In people with HIV there are different mental health problems and, to a large extent, they have to do with emotional problems, either mood or anxiety, and it has even been seen that they can be quite common.
There are many studies done on the subject and the rates of depression or mood disturbance are around 50%, but the prevalences fluctuate a lot. It also happens that the population with HIV has changed a lot and this means that today we have many different profiles.
Insomnia is a disorder that is highly referred by people with HIV, some studies even speak of 90%, but we believe that due to methodological issues, we could place it today at 70%, of course it always depends on the study and the population you look at.
There are also other types of psychological disorders related to the physiological state. For example, women suffer from hormonal disorders, but are referred to in lower proportions than mood problems are referred.
?Are people with HIV twice as likely to suffer from these types of disorders?
Yes, they are more likely to suffer from them for several reasons.
The first, because often the way you get infected is already a basic problem, that is to say, the way we protect ourselves when we have sex has a lot to do with self-esteem and how we take care of ourselves.
Second, when someone gets infected and has to live with a new health problem, logically this triggers or can trigger psychological health problems.
And the third reason, of which I am not very much in favor, points to the biological effect of the virus. There are studies that say that the virus intervenes in certain areas of the brain, which cause mental problems to appear and cognitive disorders are an example, and this causes worse memory, less verbal fluency, low concentration…
On a psychiatric level, they say that too, that is, that depression and other mental problems have something to do with it.
HIV and mental health, the influence of drugs
?Do antiretroviral drugs influence?
For me, this aspect is not very important, in the sense that side effects from antiretroviral treatment are rare because these drugs have evolved a lot.
And yes, they sometimes happen, they are related to the nervous system, but they are usually mild, that is to say they are not severe or even moderate, and they usually disappear.
Essentially they involve either headaches or difficulty sleeping, but I insist that this issue for me, today, is not very relevant, and the benefits of antiretroviral treatment are so many that it is a minor issue.
For example, antiretroviral treatment clearly improves cognitive disorders, as well as mood and anxiety.
What happens is that some antiretrovirals, only some and specifically, can cause specific symptoms of the nervous system, such as headache and headaches or insomnia.
But, for example, it does not cause more anxiety or a worse mood, nor more memory problems, it is rather the opposite.
It’s also another thing when years go by and long-term antiretroviral treatment can cause some symptoms in some more vulnerable people, but it’s also not a big issue today.
And what does it mean to receive the diagnosis and the subsequent stigma and fatigue of the treatment?
When you receive the diagnosis, logically the impact can be great, but not everyone reacts the same, some worse and others better…. and it is clear that the initial phases of avoidance and denial grief can occur.
Regarding the stigmatoday, unfortunately, discrimination still exists and exists, but it is true that we have evolved as a society, and in the case of Spain it has been changing but it persists and continues to have a lot of blame and many erroneous beliefs…which are stigmatizing and yes they influence the mental health of patients, to a greater or lesser extent, depending on the person, the emotional, family, work situation… and the psychological style of each one.
We cannot generalize about this, but we can, on the other hand, in relation to the resources allocated to the mental health of people with HIV, which are insufficient, and there are very few professionals in Spain dedicated to this task.
And about the treatment fatigue of course it also influences mental health. We see it as an impact of what we call chronicity, and it is seen at different levels: one is the chronicity of the infection or the disease itself, that is, the more years you have had HIV, the more health problems you have , and this has an impact on the level of emotional and physical exhaustion.
Treatment is on another level because it’s also exhausting being on medication for many years, it’s mentally draining and it causes toxicity.
?How does fear affect?
Fears and worries have always existed for people with HIV but they have been changing. In the past there was a lot of fear of death, a lot of fear of lack of health and also of the reaction of the family.
Today, these fears are not the most common and the fear of death is rare, for example, but instead there is a fear of other social aspects, or that other people will find out, or that they will know at work.
As much as we have helped people with HIV a lot, and because of that they live better and have a better quality of life, the problems and concerns are different and people with HIV today are generally working, have a partner… and in the past no, besides there were more physical health problems.
Is the mental health problem underdiagnosed in HIV patients?
It is totally underdiagnosed at all levels and three very clear ideas should be noted.
The first is that there are few mental health resources for HIV patients.
There is usually no psychologist in HIV units, so patients are not helped from the start and those who have been infected for years usually lack support, both at hospital and community level , because NGOs do fantastic work but are limited in resources, and hospitals don’t usually have mental health professionals.
secondand apart from this question, I would like to talk about the most vulnerable populations, the migrated
Today we have many movements, people who migrate either due to war, social conflicts or globalization itself. There is a lot of movement, and at a cultural level, the approach is different, and the response is also different, and a person who has migrated is more likely to leave treatment due to different circumstances and this must be taken into account.
But there are also other vulnerable groups, those with low economic levels, victimized people, abused women… and these populations must be taken into account, because HIV is often very common.
And the third idea, concludes this GeSIDA psychologist, is the subject of mental health training for HIV professionals, doctors, nurses, community associations. More efforts need to be made to make doctors understand more about mental health, be more informed, and nursing too and there is a lot to be done here.
It’s very common for someone to be diagnosed with HIV and to be prescribed anti-depressants, and this is a mismanagement of mental health, it doesn’t work like that at all, and you have to start by asking the person how they are, if they have insomnia , or a cognitive disorder… but often doctors have a lot of clinical visits and don’t have that time to ask.