Suffering in Silence: Why the HIV Community Can No Longer Ignore Mental Health

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The reality is that the HIV community is in the middle of a mental health crisis, the stakes could never be higher and our lives are on the line. We are focusing on the exterior rather than the interior and quantity over quality. Our tunnel vision has blinded us to the serious situation in which we find ourselves.

Dr. David Fawcett, Ph.D., L.SC.W., who is a contributor to and and author of Lust, Men and Meth: A Gay Man's Guide to Sex and Recovery, has provided professional insight into this issue:

"Those of us living with HIV/AIDS must be vigilant about mental health. In any given 12-month period, more than one quarter of us will meet criteria for anxiety disorder, and over half will have a serious depressive episode. This can affect medication adherence and it impacts our psychological and physical health."

We live in a society that doesn't fully understand mental health, one that tells us to think positive and snap out of it. Meanwhile, in many cases doctors are overprescribing medication because we live in a day and age when happiness comes in the form of a pill.

Even when someone seeks help, navigating the complex mental health system is difficult. Most insurances don't cover mental health and, when they do, patients are often stuck with below average physicians.

When I was diagnosed HIV positive in 2012, I experienced the broken mental health care system first hand. Even with a very good private insurance plan, I found myself sitting in a county clinic where it seemed that my mental health was simply a box to be checked off on my health care team's to do list. This was followed by a local AIDS Service Organization (ASO) that was more interested in signing me up for services I did not need than in providing me with information on mental health or support groups.

Although the odds already stacked against people living with HIV, the community is turning a blind eye. The National HIV/AIDS Strategy barely scratches the surface when it comes to mental health and, when it does, it offers -- at best -- vague solutions.

Many ASOs that are strapped for cash face difficult decisions about how best to distribute funds. Professional mental health is not always at the top of the priority list and free support groups soon become the solution. Support groups are helpful and often vital; however, people often have deeply rooted mental health issues requiring professional help.

In my opinion, this approach is creating a formula for people to fail. Many are suffering in silence, which has serious consequences. This disconnect can contribute to substance abuse, decline in adherence and increased infections.

For years, the focus has been on treatment adherence instead of analyzing all parts of people's health. As seen in a study from 2011, if someone isn't mentally ready, adherence rates decline. I feel that if we do not address mental health in a much greater capacity, the rates of mental illness are going to continue to climb and the challenge of treatment adherence will become all the more difficult.

Moreover, those who live with mental illness are far more likely to become HIV positive than the regular population. If the HIV community makes mental health a priority, we will not only help those living with the virus, but also prevent more infections.

As a society, we can put pressure on insurance companies to increase coverage for patients and reimbursements to doctors. Physicians need better education about the subject because treating mental health problems is much more complex than is taught to those who do not specialize in the field.

It's evident that we have our work cut out for us; however, change has to start somewhere. The elephant in the room can no longer be hidden, and while society as a whole needs to revaluate its solution to the mental health epidemic, the HIV community and we, ourselves, need to play a part in the process.

David Fawcett has some advice about what we can do as patients to improve the quality of our lives on a micro-scale level:

"There are many mental health tools we can use besides medication for symptoms. These include self-care like good nutrition and adequate sleep, along with meditation, conscious breathing and, most of all, staying as socially connected as we can to our support systems."

As for the HIV community as a whole, change begins with integrated care starting from the initial HIV diagnosis. The first hours, days, weeks and months after diagnosis are crucial for someone living with HIV. The focus for ASOs should not be on the number of members but rather on the quality of care being provided. We are more than a dollar sign; we are human beings in need of help. We need to make mental health a priority for the National HIV/AIDS strategy in order to ensure that resources are made available to make these changes possible.

Above all, we need to raise awareness to break down stigma to show the world that there is nothing wrong with saying, "I live with a mental health disorder and I need help." Our mind is a powerful tool unlike any other on earth. Let's make sure we are doing everything to keep it in tip-top shape. If you are struggling with mental illness, please know that you are not alone; I, myself, live with depression. Feel free to share your story in the comments below or via email. You can also join the discussion on mental health on forums. Together we can get through this!

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Read Josh's blog, PozitiveHope.