Sexual and mental health: Two sides of the same coin

By Laurie Edmiston

The attendees at the 2016 Canadian Mental Health Association (CMHA) conference, Mental Health for All, were a new audience for CATIE. This was the first time CATIE was invited to attend as an exhibitor to a mental health conference. Most people who stopped by our booth had never heard about us, but after chatting to one mental health worker from the Niagara region, she said: “I wish I had known about you guys six months ago.”

This woman had shared a story about an HIV-positive client who was having sex without a condom. I asked, “Have you heard about treatment as prevention? Undetectable viral loads or pre-exposure prophalysis (PreP)?” She was somewhat familiar with these forms of HIV prevention, but only after researching these topics on her own.

Another person stopped by, this time from correctional services. He picked up some client brochures on HIV basics and safer injecting. He didn’t realize that CATIE offered so many printed resources on harm reduction and that some were created with prisons in mind.

Both of these service providers didn’t know that CATIE provides all frontline workers with information on HIV and hepatitis C, whether they work in the field or not. We could have saved them a lot of time by giving them the information their clients need.

These are just two encounters from one meeting that took place last year in Toronto. But these stories highlight the importance of sexual health organizations working with mental health organizations to increase knowledge around health and harm reduction.

Physical health + mental health = overall health

Physical health and mental health are two important aspects of our overall health. These two branches interconnect and contribute to a person’s overall well-being. HIV and mental health also intersect and should not exist in silos. In order to improve the lives of people living with HIV or at risk of HIV, we need to partner with people working in mental health so that both sectors can share expertise and build skills and capacity.

This is what we know.

Mental health conditions are risk factors for HIV transmission. There is a correlation between poor mental health and engaging in risky behaviours. Some people use drugs, sex or alcohol as a coping mechanism for stress, anxiety or low self-esteem. Using substances or sex as ways of coping can lead to dependency. When a person is dependent on something, their judgement can be impaired when having sex or injecting drugs, putting them at risk of HIV or hepatitis C.

Mental health conditions can affect the other health outcomes of people living with HIV. Sometimes an HIV diagnosis can provoke mental health conditions due to the fear or the isolation of coping with a new illness. Other people living with HIV may feel lonely or depressed throughout periods of their life because of the stigma and discrimination they might encounter. Studies show that people living with HIV are more likely to be diagnosed with one of several mental health conditions. We also know that HIV, the disease itself, can impact the brain due to its effects on the central nervous system. All of the above affect quality of life.

People living with HIV who are on treatment can live long lives and they can be happy and healthy too, but only if they are connected to the proper care and services. We must help them receive this care and make sure they do not fall through the cracks. Research also shows that poor mental health also makes it harder for some HIV-positive people to stay adherent to treatment, find HIV care and stay in care.

What can we do as service providers?

The HIV and mental health sectors should come together and collaborate on a number of initiatives that would improve the health of people living with HIV or at risk of HIV. Here’s just a short list:

  1. Screen HIV-positive people for mental health conditions and offer mental health referrals to people in need. Integrating mental health services into HIV care can increase access to support and decrease the stigma associated with HIV and mental health.
  2. Develop skills-building workshops that promote positive mental health. CATIE, for example, offers a workshop for frontline workers called “HIV and Emotional Health”. This workshop stresses the importance of building healthy relationships, developing positive self-esteem, and adopting sex-positive and harm reduction approaches. Teaching clients these skills leads to resiliency and improved overall health.
  3. Use peer-based approaches to provide information on HIV and to build positive mental health. CATIE and a national group of healthcare providers developed the resource Practice Guidelines for Peer Health Navigation for People Living with HIV, after it became evident that peers serve as role models, helping HIV-positive people develop self-esteem and a positive outlook. It has also been shown that peer health navigation allows people living with HIV to better navigate healthcare systems, putting them in touch with the services they need to thrive.
  4. Provide training for staff to learn more about HIV, hepatitis C, mental health and how manage these conditions. This could be as simple as providing resources, tools and courses designed for frontline staff working with people living with HIV. CATIE has range of materials available for order, free of charge. We also offer online courses through eduCATIE.ca.

It’s our job as community health program planners, social workers, corrections officers, public health nurses and doctors, to work together to make sure that people at risk of HIV or living with HIV get the treatment and support they need, whether that be antiretrovirals, cognitive behavioural therapy, opioid substitution therapy or a peer-led discussion group. Let’s work together to make that happen!

For more information on HIV and emotional wellness, contact CATIE: call our toll-free line at 1-800-263-1638, browse the website at www.catie.ca or email us at questions@catie.ca. CATIE offers information in English and French.

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