ASHM Report Back
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
The path to success starts with a right state of mind.
Speaker - Brian Pence from the University of North Carolina
His talk addressed a very common barrier to HIV care and treatment - mental health concerns, discussing previous publications in the early years of the epidemic about responding to psychological crisis of HIV/AIDS. It is still a challenge faced by many of us, more than 30 years later. He gave an overview of psychological trauma and the heavy burden of stressful life events of many people living with HIV leading to chronic mental health issues in addition to stressful risk behaviours, immune suppression and side effects of antiretroviral therapy.
He showed data on depression and mortality in modern ART era from the WIHS cohort (in press) as well as in the early ART era from HERS cohort (Ickovics et al.JAMA 2001) where chronic depressive symptoms were reported commonly in patients with CD4 <200.
Barriers to addressing mental health concerns among people living with HIV;
- Lack of mental health expertise in HIV care settings
- Stigma around mental health services
- Access to specialty metal health services
- Fragmentation of care
The concept of depression care managers where a nurse, social workers or a medical assistant is trained to assess and help clients with depressive symptoms under the supervision of psychiatrists,helping the HIV care providers to deal with mental health concerns of patients was a highlight in his talk.
The ways to move forward - it is necessary to think of,
- How best to integrate evidence-based mental health approaches into HIV care
- How to engage patients in mental health services
- How best to address multiple psychiatric co-morbidities
- How best to integrate mental health treatment with other adherence/retention support strategies