Integration of Mental Health into HIV Care

General Session Summary

Session Leader: Laio Magno Santos de Sousa, Professor, University of the State of Bahia, Brazil

This 90-minute plenary session was among the most impactful of the conference, addressing the critical integration of mental health services into HIV care. The session highlighted both global challenges and innovative local solutions.

Local San Diego Resources

San Diego offers numerous community-based, culturally tailored, holistic approaches to HIV and mental health care:

  • Christie’s Place – Support services for women
  • CASA in South Bay
  • POZabilities NExT program – Multiple social events and support
  • Serenity Yoga – Twice-weekly yoga classes and annual retreats

These organizations provide comprehensive physical, emotional, and spiritual support for people living with HIV (PLWH).

Global State of Mental Health in HIV Care

Key Statistics

  • 25-40% of PLWH experience mental health problems, including depression, anxiety, substance abuse, suicidal ideation, and PTSD
  • Only 2% or less of global healthcare budgets are allocated to mental health
  • The U.S. spends 5.5-6% of its healthcare budget on mental health care
  • 85% of PLWH with mental health issues face increased HIV transmission risk, poor treatment adherence, and negative clinical outcomes

Current Challenges

  • The aging HIV-positive population faces a dual burden of HIV and non-communicable diseases, compounded by PTSD and stigma
  • After more than 40 years of the HIV pandemic, stigma and discrimination persist as major barriers
  • Depression, anxiety, and trauma lead to missed appointments, treatment discontinuation, and delayed diagnosis

Healthcare Provider Shortages (United States)

  • National average: 30 psychologists and 16.6 psychiatrists per 100,000 people
  • Rural areas: Only 9.1 psychologists and 3.4 psychiatrists per 100,000 people
  • Significant regional disparities create access barriers

The Rwanda Model: A Success Story

Following the 1994 genocide that killed over one million people, Rwanda implemented comprehensive mental health reforms:

Post-Genocide Impact

  • 1 in 5 Rwandans experienced mental health problems
  • Highest rates occurred among women and children living with HIV

System Improvements

  • Healthcare Integration: Mental health nurses now staff over 80% of healthcare facilities
  • Universal Screening: National healthcare system enables comprehensive screening
    • Child Depression Screening Tool (CDST) for children
    • PHQ-9 for ages 15 and older
  • Peer Support: Trained peers educate and support PLWH, reducing stigma and improving mental health outcomes

Recommendations for Improving Mental Health Care

Core Strategies

  • Integration of mental health services into HIV care settings
  • Community-based approaches that are culturally tailored and holistic
  • Trauma-informed care models
  • Recognition of mental health as a fundamental right

Evidence-Based Interventions

  • Mindfulness and acceptance-based interventions: The Notice, Advisor, and Values (NAV) model shows significant reductions in depression, anxiety, and stigma among adolescents
  • Community involvement: Essential for ownership, accountability, and sustainability

Successful African Models

  • Zimbabwe’s Friendship Bench: Community-based problem-solving therapy
  • South Africa’s Integrated Chronic Disease Model: Comprehensive care approach
  • WHO mhGAP Toolkit: Currently under discussion at San Diego HIV Consortium and UCSD HIV Research Center (AVRC/HNRC)

Key Takeaway

Dr. Santos concluded with a powerful statement: “We will not end AIDS if we continue to ignore mental health, and mental health must be recognized as a right, not a luxury, for every person living with HIV.”

Selected Research Abstracts

1. PrEP Access and Mental Health (Peru Study withUSC)

  • Participants: 4,643 respondents aged 18+
  • Demographics: 62.5% male, 48.9% bisexual, 16.1% transgender/non-binary, 28% gay/lesbian
  • Findings: Suicidal ideation associated with impeded PrEP access; anxiety and depression linked to reduced condom access

2. CHAMPS Program Success Story

Community Champions HIV/AIDS Advocates Mobilization Project – Appalachia

  • Scale: Trained 150+ community health workers (CHWs)
  • Impact: Screens 10,000+ for HIV and 5,000+ for HCV annually
  • Success Rate: 90% linkage and retention rate
  • Training: Comprehensive 147-hour paid CHW program including 22+ hours of specialized HIV education
  • Location: Lost City, West Virginia (Abstract 4039, H. Arnold et al.)

Question for San Diego: Can we mobilize similar large-scale peer training programs locally?

3. PrEP Experiences Among Transgender Women(ENCORE Cohort)

  • Participants: 2,506 participants across U.S. and Puerto Rico
  • Early Adoption: 35% were using PrEP before FDA approval
  • Adherence Challenges: About 1/3 had difficulty remembering oral PrEP
  • Satisfaction: No significant differences by PrEP modality (injection vs. oral) or demographics
  • Abstract: OAD0503, E. Conway et al.

4. Violence Among Transgender Women in France

  • Population: Transgender women living with HIV, with and without sex work involvement
  • Findings: Face multidimensional violence regardless of sex work status
  • Impact: Precarious housing and sex work conditions lead to ART interruptions and mental health issues
  • Abstract: #1590, M. Florentino et al.

5. Uganda Post-Anti-Homosexuality Act 2023

  • Focus: Mental health integration in key population HIV programming, Kalangala Islands
  • Key Message: “Survival is not enough” – comprehensive care including mental health is essential
  • Abstract: OAE0104, E. Jjemba et al.

Additional Research Themes

Stigma and Mental Health

Multiple abstracts demonstrated links between depression, anxiety, PTSD, substance abuse, stigma, and poor adherence. Notable quote from attendee: “Substance abuse is part of HIV care for many of us.”

Example: Vietnam study on stigma leading to substance use among MSM and transgender women living with HIV (Abstract#3773, Minh Nguyen Thien)

Digital Mental Health Solutions

Growing focus on technology-based interventions, including:

  • TWIIN Digital Assistant: Enhancing health access among key populations in Ukraine (Abstract OADO605, M. Malakhova et al.)

Resources

  • Free Abstract Book: [IAS 2025 Abstracts] (searchable database)
  • Conference Summary: IAS provides comprehensive meeting summary with excellent section on broadly neutralizing antibodies (bNAbs)

This summary represents key highlights from the Integration of Mental Health into HIV Care session at IAS 2025, emphasizing both global perspectives and local San Diego resources.