Mental Health and Psychosocial Support: Key to Elimination of Vertical Transmission of HIV

By: Thebisa Chaava , Technical Advisor, Community Engagement and Psychosocial Support

As we prepare to commemorate World Mental Health Day, it is critical to reflect on the relationship between mental health and Psychosocial Support (MHPSS) and ending the HIV epidemic.  At the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), our mission is to end HIV/AIDS globally in children, youth, and families. Over the past few months, we have been driving an advocacy campaign on the elimination of vertical transmission which has had me reflecting on this commemorative day.

The Link Between Mental Health and HIV

MHPSS and HIV are intricately linked. Mental health challenges are common for people living with HIV, including depression, anxiety, and feelings of isolation.  Studies show that HIV patients have 100 times the suicide rate of the general population and greater rates of depression and other mental health issues. HIV-positive African women are more than twice as likely to have prenatal depression than other pregnant women.

MHPSS through care and protection services boosts mental, emotional, and spiritual well-being while enhancing social and cultural connections. MHPSS can be through individual and group counseling, peer support groups, and mentor mother programs, which have improved mental health, ART adherence, and overall well-being among HIV-positive mothers across various African countries. MHPSS are critical to HIV prevention and may enhance HIV treatment adherence and health outcomes; not only to halt the HIV pandemic but to also ensure those affected by HIV live healthy lives with enhanced confidence and reduced stigma.

There has been significant progress in reducing new pediatric HIV infections since 2010 by 62% but challenges persist. In 2023, there were approximately 120,000 new HIV infections among children under five, underscoring the critical importance of eliminating vertical transmission (EVT). The number of new HIV infections among adolescent girls and young women was 210,000 which directly co-relates with infections in children.

The 2023 UNAIDS data paints a stark picture of the HIV epidemic's impact on young women and girls in Africa. Every week, 3,100 adolescent girls and young women aged 15–24 years become infected with HIV in sub-Saharan Africa. If current trends continue, there will still be some 183,000 annual new HIV infections among adolescents in 2030, fueling mother-to-child transmission; a direct threat to EVT.

Adolescents and young mothers living with HIV (YMHIV) are particularly vulnerable to mental health challenges, due to their health status, young parenthood, and social stigma. Battling with depression, anxiety, and PTSD makes it hard to stay motivated, remember dosages, and follow doctor’s appointments. This can cause a lapse in treatment adherence. Due to HIV stigma, young women may be afraid to speak up, alienated, and discriminated against; affecting their uptake of HIV medication and services that prevent mother-to-child HIV transmission.

However, it's important to note that there is still a need for psychosocial interventions designed for YWHIV. Existing interventions often do not sufficiently address the unique needs of younger mothers, such as balancing childcare responsibilities with self-care and treatment adherence. This gap underscores the need for targeted research and program development to better support this vulnerable population.

 Putting a Focus on Mental Health

Focusing on MHPSS in HIV care for young women can enhance treatment adherence, reduce transmission risk to newborns, and contribute to the elimination of mother-to-child HIV transmission.

A meta-analysis conducted to examine whether treatment of depression and psychological distress improves antiretroviral therapy adherence found that the odds of a person adhering were 83% better if they were treated for depression.  When taken consistently ART can suppress the HIV to undetectable levels, reducing the risk of transmission to the baby. Moreover, irregular ART use can lead to the emergence of drug-resistant HIV strains, limiting future treatment options for both mother and child. 

Integrated care models that combine HIV treatment with mental health support in the context of EVT are crucial for improving treatment adherence and achieving the goal of eliminating vertical transmission. However, implementing comprehensive psychosocial support programs faces challenges, including limited resources, the stigma surrounding mental health, and a shortage of trained mental health professionals in many high-burden HIV settings. However, the potential benefits far outweigh the costs.

Healthcare systems and policymakers must recognize the interconnectedness of mental health and HIV prevention and treatment outcomes. By integrating comprehensive psychosocial support into EVT programs, we can enhance the effectiveness of ART, improve maternal health, and significantly reduce the risk of mother-to-child HIV transmission.

About the Author

Thebisa Chaava is an experienced international public health and social work professional with a master’s degree and broad expertise in HIV/AIDS, health, and development. For the past 10 years she has worked at the Elizabeth Glaser Pediatric AIDS Foundation where she has lent her expertise and passion for community engagement to further the fight for an AIDS-free generation.