The progress we’ve made in the fight against HIV has been remarkable. As a doctor, I’ve seen first-hand how life-saving HIV treatment now means people diagnosed with the virus can expect a normal, healthy life and when on treatment cannot, I repeat, cannot pass on the virus. Yet, these great leaps that we’ve made in dealing with the physical impact of HIV have not been matched with addressing the psychological impact of HIV.
Just a few months ago the nation was shocked to see the destruction the HIV epidemic unleashed during the broadcast of It’s A Sin. Thankfully those heartbreaking scenes of people left to die on their own in hospital beds and lives being cut short are a thing of the past. But that stigma we saw on screen, the fear and misunderstanding of HIV among many, that sticks to this day.
The fear from the 1980s still looms large over conversations about HIV and is one of the reasons why there are still 6,700 people living with HIV but are undiagnosed. It also explains why people living with HIV are twice as likely to experience poor mental health, including depression, anxiety, and isolation, with stigma often fuelling these experiences. At a recent roundtable on the issue, organised in association with Terrence Higgins Trust, one participant said ‘living with HIV-stigma is worse than living with the HIV virus’.
Mental health and HIV are intertwined for a number of reasons. People living with HIV are more likely to have poor mental health and people with poor mental health are more likely to be at increased risk of HIV. Groups that HIV impacts most already face multi-levels of discrimination, including gay and bisexual men, trans people, Black African and other minority ethnic communities, and migrants.
Despite the clear need to have comprehensive and tailored mental health support, people living with HIV continue to be let down. According to a report by the All-Party Parliamentary Group on HIV/AIDS, 40% of HIV clinics have no psychological or mental health support within the clinic. This leaves people either unable to access any mental health support at all or relying on general mental health services, where there is often limited understanding of HIV.
The national HIV Commission found that it’s within healthcare services that people living with HIV encounter the highest levels of stigma and discrimination related to their HIV status. Cases of professionals ‘double-gloving’ and only offering people living with HIV appointments at the end of the day still happen.
We need a long-term approach to ridding this stigma within our health and social care settings by providing regular and robust training for professionals so they understand the modern-day realities of HIV.
Evidence tells us that the better someone’s mental health, the more likely they are to take their daily HIV medication, be physically well and not be able to pass on the virus, known as becoming undetectable. The right support for those living with depression sees an 83% increase in successful HIV medication adherence. Despite the clear public health benefits to treating mental health issues in people living with HIV, it is usually not until someone reaches a crisis point in their mental health that they are offered the appropriate support.
I applaud the work of Terrence Higgins Trust that over the last 12 months has expanded its support services to provide free online counselling to anyone living with HIV in the UK. This has been a lifeline for many people who have experienced loneliness and isolation during the national lockdown. The charity has also been providing regular wellbeing and resilience sessions to be there for people living with HIV during a time that has put a real strain on people’s mental health.
But we need to see the Government step upon mental health support too. Ministers have promised to end new cases of HIV in England within the decade. This is something I wholeheartedly support. Better mental health is integral, not an add-on.
Matt Hancock has pledged to publish a new HIV Action Plan this year that will set out the roadmap to 2030. This plan must be worthy of its name by providing a robust commitment to fund mental health services for people living with HIV and roll out a new public health awareness campaign to tackle the stigma that has stubbornly stuck over the decades.
We have all the tools to end new cases of HIV and we know what works, now we need to use them all.
Rosena Allin-Khan is the Shadow Minister for Mental Health.