TREAT Asia Think Tank on Mental Health of Adults Living with HIV

Adults living with HIV, like children and adolescents with HIV, have higher rates of mental health issues than their uninfected peers. Conditions such as depression and anxiety not only worsen quality of life, but can also affect HIV clinical and treatment outcomes, including how well people adhere to their HIV treatment. Despite such concerns, mental health problems in those living with HIV in Asia have been inadequately studied and treated. In order to consider and address these gaps, TREAT Asia invited researchers, clinicians, and Dr. Iris Chan, Clinical Psychologist at Queen Elizabeth Hospital in Hong Kong SAR; and Dr. Isabel Melgar, Clinical Psychologist at the Research Institute for Tropical Medicine in the Philippines and Assistant Professor, Ateneo de Manila Universitypsychologists from across Asia and from Columbia University in New York City to an adult mental health think tank this past January in Bangkok.

While adequate mental health care is a concern across the region, different countries face specific challenges. Think tank participants highlighted some central issues, as well as strengths, in their countries’ approaches and resources for assessing and treating depression in adults with HIV.

“This think tank comes at a time when HIV treatment centers in the Philippines lack the appropriate tools and manpower to psychologically assess and counsel thousands of clients with HIV,” expressed Dr. Isabel Melgar, Clinical Psychologist at the Research Institute for Tropical Medicine in the Philippines and Assistant Professor, Ateneo de Manila University. “We also lack prevalence and other key data on the mental health problems experienced by people living with HIV in our country,” she said. “While it is important to monitor HIV infection, we must start looking at our clients as persons coping with depression, trauma, and anxiety—and, with TREAT Asia, take steps to address these needs.”

“There is a serious need for more research to determine which types of intervention are most appropriate for which people,” added Dr. Iris Chan, Clinical Psychologist at Queen Elizabeth Hospital in Hong Kong.

Participants at the Mental Health Think Tank, January 31, 2018, Bangkok, Thailand
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The think tank was extensively supported by faculty of the Department of Psychiatry at Columbia University, who brought a wealth of clinical, research, and capacity development experience to bear on discussions: Co-Director of Columbia’s HIV Center for Clinical and Behavioral Studies and Professor of Medical Psychology Claude Mellins outlined approaches to mental health assessment and key mental health assessment tools, Professor of Clinical Psychiatry Francine Cournos covered the treatment of depression in adults living with HIV in resource limited settings, and lead trainer and Professor of Clinical Psychiatry Milton Wainberg spoke of capacity development and the integration of mental health and HIV care in resource-limited settings.

“Ending the HIV epidemic will not be achieved as long as public health initiatives ignore public mental health care.”“Mental and substance use disorders are more prevalent in people living with HIV compared to the general population and are one of the biggest obstacles to accomplishing adherence to HIV care,” said Dr. Wainberg, who is also Columbia’s Director of Global Mental Health Research. “Accessing psychiatric help is a challenge for multiple reasons. Mental illness adds another layer of stigma to the already existing stigmas associated to living with HIV and homosexuality, for some.”

“Further, most countries, especially those with low-resources, lack professionals trained to provide mental health care,” continued Dr. Wainberg. “Effective strategies to decrease this mental health treatment gap include training and supervising lay-personnel to provide psychiatric care within HIV and or primary care. Ending the HIV epidemic will not be achieved as long as public health initiatives ignore public mental health care.”

The participants proceeded to consider research, policy, and capacity development activities that might help address some of the gaps in mental health management in HIV care settings in the region.

“The think tank was extremely helpful in building momentum and partnerships in support of TREAT Asia’s development of mental health-related research and training activities,” concluded Dr. Jeremy Ross, Director of Research at TREAT Asia. “It was a key step toward addressing what is clearly a substantial unmet need in the region.”