Intervening for HIV prevention and mental health: a review of global literature

Abstract

Introduction Numerous effective HIV prevention options exist, including behaviour change interventions, condom promotion and biomedical interventions, like voluntary medical male circumcision and pre‐exposure prophylaxis. However, populations at risk of HIV also face overlapping vulnerabilities to common mental disorders and severe mental illness. Mental health status can affect engagement in HIV risk behaviours and HIV prevention programmes. We conducted a narrative review of the literature on HIV prevention among key populations and other groups vulnerable to HIV infection to understand the relationship between mental health conditions and HIV prevention outcomes and summarize existing evidence on integrated approaches to HIV prevention and mental healthcare. Methods We searched five databases for studies published from January 2015 to August 2020, focused on HIV prevention and mental health conditions among key populations and individuals with serious mental illness. Studies were included if they evaluated an HIV prevention intervention or assessed correlates of HIV risk reduction and included assessment of mental health conditions or a mental health intervention. Results and discussion We identified 50 studies meeting our inclusion criteria, of which 26 were randomized controlled trials or other experimental designs of an HIV prevention intervention with or without a mental health component. Behaviour change interventions were the most common HIV prevention approach. A majority of studies recruited men who have sex with men and adolescents. Two studies provided distinct approaches to integrated HIV prevention and mental health service delivery. Overall, a majority of included studies showed that symptoms of mental disorder or distress are associated with HIV prevention outcomes (e.g. increased risky sexual behaviour, poor engagement in HIV prevention behaviours). In addition, several studies conducted among groups at high risk of poor mental health found that integrating a mental health component into a behaviour change intervention or linking mental health services to combination prevention activities significantly reduced risk behaviour and mental distress and improved access to mental healthcare. Conclusions Evidence suggests that mental health conditions are associated with poorer HIV prevention outcomes, and tailored integrated approaches are urgently needed to address overlapping vulnerabilities among key populations and other individuals at risk.

‘I was in need of somewhere to release my hurt:’ Addressing the mental health of vulnerable adolescent mothers in Harare, Zimbabwe, through self-help groups

“…Despite growing evidence that both AGYW who sell sex and those who are young mothers experience multiple mental health challenges, there have been few interventions that holistically address these [ 5 , 36 , 37 ]. This study found that introducing an opportunity to build support, reduce isolation and provide practical and material assistance helped meet many of AGYW’s needs related to their struggles to cope with looking after their children in a context of severe economic deprivation.…”

Sexual Risk Behavior and Lifetime HIV Testing: The Role of Adverse Childhood Experiences

“…Additionally, ACEs have been linked to alteration of the neurobiological stress–response systems [ 21 , 22 ], resulting in negative physical health outcomes, such as cancer [ 23 , 24 ], respiratory problems, such as asthma [ 25 , 26 ] and chronic obstructive pulmonary disease [ 27 , 28 ], as well as premature mortality (Brown et al, 2009). ACEs are also linked with poor mental health and substance use outcomes in the extant literature [ 29 , 30 ], both of which are linked to engagement in HIV-related behaviors, both risk and preventative behaviors [ 31 , 32 ]. There is little literature on the relationship between ACEs, sexual risk behaviors, and engagement in HIV-related care outcomes, including testing.…”

Adequate funding of comprehensive community‐based programs for key populations needed now more than ever to reach and sustain HIV targets

“…While structural interventions seek to address the upstream factors that cause inequities, service integration and person‐centred care acknowledge these inequities and develop service packages addressing their downstream impact [ 46 ]. For example, programs among key populations have successfully integrated HIV‐related services with mental healthcare [ 47 ], gender‐affirming care [ 48 ], harm reduction [ 29 ], STI and viral hepatitis diagnosis and treatment [ 49 , 50 , 51 ], tuberculosis [ 52 ], sexual and reproductive health [ 53 ] and services that address gender‐based violence [ 54 ]. As one specific example, through EpiC Kenya, 220 key population clients who were initially reached with services to address violence (e.g.…”