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HIV/AIDS and mental health



The first of December was World AIDS Day.


HIV/AIDS

The human immunodeficiency virus (HIV) is a retrovirus that causes a cellular immune deficiency in the human body, characterized by a decrease in the number of lymphocytes. The acquired immunodeficiency syndrome (AIDS) is the final stage of HIV's clinical evolution.

HIV infection is prevalent throughout the world, with a higher prevalence in Africa, where approximately 25.6 million people are living with HIV. According to the General Directorate of Health (DGS), 61 433 cases of HIV infection were identified in Portugal (diagnosed between 1983 and 2019), with 22 835 progressing to AIDS. Although the number of infected people has been decreasing in recent years, Portugal stands out for its high rates of new cases of HIV and AIDS among Western European countries (DGS, 2020), making it extremely relevant to address this topic.


Symptomatology

The initial period of HIV infection is characterized by the presence of several symptoms, many of which are non-specific, making diagnosis difficult. Frequently, the individual will exhibit symptoms similar to a common flu or viral infection. Following this initial period, there is a long period of clinical evolution. This evolution is usually silent and can last up to ten years, during which time the immune system degrades without causing symptoms in the vast majority of cases. During this time, the patient is known as a virus carrier or HIV positive.

The final stage of this clinical evolution is known as AIDS, and it is characterized by a very low number of lymphocytes in the human body. During this stage, the body's defenses fail, leading to complications like common infections becoming more severe and opportunistic infections like pneumonia and neoplasms, as well as other health issues.


Transmission

HIV transmission can occur in three ways: 1) sexually, that is, through sexual relations with an HIV-positive individual without using a condom; 2) parenterally, for example, through sharing syringes or through instruments that have not been sterilized, such as piercing and tattooing instruments; 3) vertically, from mother to baby, with a higher risk during delivery and breastfeeding.


It's important to note that certain conditions and behaviors can increase an individual's risk of transmitting the virus. For instance, having sex with someone who is HIV-positive or of unknown HIV status, having a high number of sexual partners, sharing contaminated needles or other injectables, or experiencing an accidental prick from a source with positive HIV status, such as among healthcare workers.


Treatment

Unfortunately, there is no cure for HIV/AIDS. The virus is highly infectious and mutates frequently, making it difficult to treat. However, antiretroviral therapy (ART) has been shown to be effective in reducing mortality and the incidence of opportunistic infections.

To prevent the spread of the virus, the most effective strategy is prevention. This means reducing behaviors and conditions that increase the risk of transmission, such as risky sexual behavior. Promoting safe sex practices and testing the population for HIV and other STDs are important steps in preventing the spread of the virus.”


Eradicating HIV/AIDS by 2030

Overall, in the past decade there was a decline in new HIV/AIDS-related infections and deaths. WHO and its partners have supported campaigns and the scaling up of new HIV prevention and treatment technologies, provided guidance on HIV prevention, testing and treatment, increased access to affordable medicines and health technologies, and supported national recovery plans for HIV treatment in West and Central Africa.

However, progress is slow and inequalities in HIV prevention, testing, and treatment services persist. The UN Secretary General, António Guterres, has called for the world to eradicate HIV/AIDS by 2030, but he believes that this goal is not achievable without addressing these inequalities.


It is therefore essential to develop laws, policies, and practices to combat the stigma and exclusion faced by people living with HIV, and to invest in health services for treatment, testing, and prevention of the virus, which requires additional financial resources. The COVID-19 pandemic and other global crises have disrupted progress towards HIV eradication, reduced resources, and put millions of lives at risk.


Psychology and HIV/AIDS

HIV/AIDS not only affects patients' physical health, but also their mental health. Systematic reviews suggest that people with HIV/AIDS are more likely to experience depressive and anxious symptoms, as well as challenges in adapting to a chronic illness. These challenges and symptoms can reduce motivation to seek healthcare and compromise treatment adherence, impacting patients' quality of life. Some studies also suggest that HIV/AIDS patients may be at increased risk of developing neuropsychiatric disorders, such as dementia and motor disorders, which also affect their quality of life.


As a result, psychologists play a crucial role in HIV/AIDS prevention and intervention. On the one hand, they can help raise awareness among the general population about HIV risk behaviors, safe sex practices, emotional difficulties, and couple and family relationships. On the other hand, they can provide psychological assessment and counseling to patients at the individual, couple, or family level, but they must be adequately trained to work with this population.


If you have been diagnosed with HIV/AIDS, seek professional help to deal with the challenges and difficulties you may face along the way. You don't have to go through this alone. Take care of yourself and your health.



References

Ahmed, A., Saqlain, M., Bashir, N., Dujaili, J., Hashmi, F., Mazhar, F., ... & Awaisu, A. (2021). Health-related quality of life and its predictors among adults living with HIV/AIDS and receiving antiretroviral therapy in Pakistan. Quality of Life Research, 30(6), 1653-1664. https://doi.org/10.1007/s11136-021-02771-y

Collins, P. Y., Holman, A. R., Freeman, M. C., & Patel, V. (2006). What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review. AIDS, 20(12), 1571. https://doi.org/10.1097/01.aids.0000238402.70379.d4

Martins, A. (2022). Risco e experiência de viver com a infeção por VIH: Correlatos da perceção de risco de infeção por VIH e do ajustamento de casais serodiscordantes [Dissertação de Doutoramento não publicada]. Universidade de Coimbra, Portugal.

Nyblade, L., Mingkwan, P., & Stockton, M. A. (2021). Stigma reduction: An essential ingredient to ending AIDS by 2030. The Lancet HIV, 8(2), 106-113. https://doi.org/10.1016/S2352-3018(20)30309-X

Remien, R. H., Stirratt, M. J., Nguyen, N., Robbins, R. N., Pala, A. N., & Mellins, C. A. (2019). Mental health and HIV/AIDS: The need for an integrated response. AIDS, 33(9), 1411. https://doi.org/10.1097/QAD.0000000000002227

https://www.afro.who.int/pt/regional-director/speeches-messages/dia-mundial-de-luta-contra-sida-2022

https://scml.pt/media/agenda/dia-mundial-da-luta-contra-a-sida

https://www.unaids.org/sites/default/files/media_asset/2022-global-aids-update-summary_en.pdf

https://unric.org/pt/mensagem-do-secretario-geral-por-ocasiao-do-dia-mundial-da-luta-contra-a-sida/