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HIV/AIDS and Mental Health: A Discussion Paper Prevalence of Mental Disorders in PLWHA The Relationship between HIV/AIDS and Mental Health Lifetime Occurrence of Psychiatric Disorders 38-73% Central Nervous System (CNS) Lesions 75% Multiple CNS Lesions 30% Cognitive Impairment 50% Dementia* 20% • HIV/AIDS causes Mental Disorders: HIV/AIDS itself can lead to psychological conditions due to circumstances surrounding the disease, and psychiatric conditions resulting from HIV- related neurological changes. One or More Episodes of Major Depression 60% • Mental Disorders may lead to New Strains of HIV: There is a strong correlation between MH disorders and noncompliance with HIV/AIDS treatments. Therefore, addressing mental disorders is critical for preventing the emergence of deadlier strains of AIDS. Substance Abuse Disorder • Mental Disorders Influence Behavior: Cognitive disorders, substance abuse, and disorders of personality can lead to a greater possibility of HIV infection and spread by reducing the likelihood of treatment and increasing risky behavior. Psychosis 0.2-15% Mania (with no family history) 8% 20-73% * Reported in fewer than 2% of people taking AZT Psychosocial Risks and Vulnerabilities for HIV/AIDS • Poverty leads to trading sex to meet basic needs, less choice over condom use, and possibly multiple sexual partners for economic protection. • Humanitarian Crises lead to weakened social services, widespread unemployment, social displacement and desperation. • Conflicts precipitate forced displacement and sudden destitution, the collapse of social structures and breakdown of rule of law. • Childhood Sexual Abuse leads to early sexual activity, prostitution and promiscuous sexual practices. • Educational Level is linked to condom use. • Gender Inequality leaves women socially, biologically and economically more vulnerable to HIV/AIDS. • Stigma and Discrimination prevent the infected from seeking treatment and modifying risky behavior. • Mental Illness can impair judgment, leading to a higher risk of infection. • Substance Abuse can lead to initial infection and subsequent spread due to reduced inhibitions and clouded judgment. Consequences of Not Addressing Mental Health within the HIV/AIDS Pandemic 1. Mental and behavioral disorders constitute 10% of DALYS for non-communicable disease in developing countries. HIV/AIDS has been causally linked to all conditions except obsessive compulsive disorder. 2. Mental disorders are a major risk factor for non-adherence to drug regimens. Distribution of DALYs for Mental Disorders in Low and Middle Income Countries 24% 38% 8% 9% 10% 11% Unipolar Depression Bipolar Depression Alcohol Dependence Psychoses Obsessive Compulsive Disorder Other Neuropsychiatric Disorders 3. Mental disorders lead to risky behavior by impairing judgment, reducing fear of consequences, and increasing vulnerability to outside influences. 4. HIV/AIDS- related mental disorders lead to economic loss by disrupting functioning and reducing short and long-term productivity. If they are not addressed, the costs of travel to specialists and days of work forgone can be triple the health care costs of treatment.