Mental illness puts young people at risk of infection and makes them less likely to seek care, says King’s College London’s Melanie Abas.

Over the last two decades, the world has made huge gains in the control of the HIV epidemic. But now, these gains are at risk of stalling.

 This is because advances in HIV testing and in improving the lives of people with HIB are not spread evenly across countries and age groups. One group frequently struggling to access these advances is young people.

 Older teens and young adults are the most likely to become infected and tend not to go for testing, so they are delayed in getting onto treatment. 

Early adulthood is also the peak age for emergence of mental disorders. The risk of acquiring HIV goes up for people living with conditions like depression, anxiety, alcohol misuse and substance use disorders, and for people who have experienced trauma. At the same time, once a person acquires HIV, their risk of developing a mental disorder increases. This adds up to a critical situation: psychiatric care for young people at risk of acquiring, or already living with, HIV must improve.

 One major barrier to increasing the number of people undergoing HIV testing is fear: fear of receiving a positive diagnosis, of being judged by peers, of a lack of confidentiality, and of death. Yet life expectancy for someone who tests positive for HIV and sticks to anti-retroviral therapy is close to normal, and an undetectable viral load makes their HIV virtually untransmittable to others. Mental health specialists could advocate for testing programmes that address such fears and increase understanding.

Global mental health specialists could also urge governments, NGOs and the pharmaceutical industry to roll out modern drug treatments for those with severe mental disorders. This should be combined with routine inquiries about intimate relationships, provision of sexual health care and behavioural interventions for reducing risky sexual behaviour.