“Dear AIDS God …” HIV/AIDS & mental health, by Adam Donaldson Powell

DEAR AIDS GOD …

by Adam Donaldson Powell (Norway)

DEAR AIDS GOD … or whomever it is that decides how aids funding gets used.

Three major issues need to be addressed urgently in the fight against hiv and aids: decriminalization, destigmatization and attention to the relationships between hiv/aids and mental health.

There are now many studies regarding aids and mental health compared to five or six years ago. However, the needs for more research in this area are increasingly evident.

My own concerns regarding this topic center around the following:

1) receiving the message that one has become infected with the aids virus is often a huge shock, and stigmatization of hiv/aids (and of homosexuality) makes this experience even more uncomfortable for the pwha;
2) persons with previous mental health challenges or who are “different” can experience the message that they have become infected as a sort of trigger mechanism — setting off negative and unhealthy forms for thinking and behavior;
3) the aids virus hides itself in internal organs and in parts of the brain, in spite of aids medications. Aids dementia and other forms of mental illness are a concern for most pwas;
4) one needs to have a solid understanding of aids medications, how they interact with other medications and of their side effects when prescribing anti-depressive medications to pwhas. This because some aids medications can worsen mental health problems when taken together with anti-depressive medications;
5) adherence/compliance (taking aids medications properly and regularly) and practicing safe sex can be more difficult when struggling with mental health challenges;
6) as far as i know, there are few or no countries that regularly measure statistics regarding pwhas that commit suicide; and
7) as far as i can see, there are few or no countries that have good competency regarding hiv/aids and mental health challenges in their psychiatric and mental health treatment institutions.

At a lecture for aids physicians on hiv/aids and psychological dysfunctions/disorders, that I was invited to attend as an aids activist, I recently learned that:

– the incidence of mental illness amongst persons with hiv/aids is most prevalent amongst those that have the hiv virus subtype B (which is most common in Europe and the USA),
– research from 1994 shows that as many as 1/3 of adult pwas may be at risk for brain infection,
– post HAART treatment: it is estimated that 5% of pwas develop aids dementia but 20% or more develop other neurocognitive problems. The number of pwas that develop these milder forms for neurocognitive illnesses can range up to 50% of all pwas; and the longer a person has lived with the virus the worse are the statistics.
– contributing factors include: CD4 figures, viral load and how advanced the illness progression is. Low cd4 figures, high viral load and an advanced stage of sickness progression = more neuropsychological damage and failure.
– other contributing factors include: drug abuse, alcohol abuse, depression, anxiety, stress, other infections such as Hepatitis C etc.
– neurological failure can also happen in an early hiv-developmental stage, but that is less common than with those patients that have lived with the virus for many years.
– even though the incidence of aids dementia has dropped since HAART was introduced, the number of incidences of milder forms of psychological illnesses (including depression etc.) has risen dramatically with longer life spans for pwas.

I asked the lecturer and the aids physicians 2 questions:
– is there much research as to the interactions between HAART medications and anti-depressant medications (which is of importance since most pwas visit several specialists for their problems and get prescriptions from gp’s, aids doctors and psych services – none of whom have any real competency regarding drug interactions where hiv/aids meds are concerned); and
– does anyone know of any countries that register statistics regarding pwas that commit suicide because of psychological illness?

The answer to both questions was: “no … unfortunately.”

I wish for AIDS organizations and several aids activists to make this issue one of their future (2012 perhaps?) banner issues, so that several governments and aids organizations can begin to work for improvements in the form of:
– information campaigns about the dangers of having indiscriminate sex when mentally impaired due to depression, emotional or relationship problems, alcohol abuse, drug abuse, etc., and to encourage persons that have in fact had indiscriminate sex while impaired in these ways to get tested for stds
– outreach programs for persons that are infected with the aids virus that tell them of the facts that I have outlined above, and that encourage local and state governments to increase competency levels as regards to hiv/aids and mental illness, and further more to make mental health follow-up programs for pwas more readily available
– a message to governments to encourage them to give more research funding to develop aids meds that work better against these effects, and research as regards the interactions between aids meds and anti-depressants etc.

In short, the message to “just use a condom” or “stop having sex” is outdated and useless. People need to think about when they have sex and how – what their state of mind is, and how that can impair judgment in regards to safe sex. This will reduce stigmatization, reduce the number of persons that do not test themselves, reduce the number of infections by persons who are “impaired”, and will also help to provide much needed mental health services to pwas. In most countries little or no funding is available to gay organizations or other “minority group” organizations that work with alcohol abuse, depression, suicide etc. but money is given to work with hiv/aids. Let us begin to connect some dots.

Much of the important research in the area of hiv/aids and mental illness comes from France, but on the internet it is now possible to read about new projects popping up in the USA to deal with these issues. Hiv/aids infection is generally dealt with as a somatic illness and most of the research in the area of neurocognitive problems in pwhas has been in a biological context. That is only one aspect of the problem. Neurospecialists must be encouraged to carry out research, and pharmaceutical companies must also be granted funding help to do more research in the area of aids medications and how they interact with anti-depressants, anti-psychotic meds etc. Psych services must receive training about aids dementia and aids-related mental illness and aids medications. Aids physicians must receive information and coaching in regards to addressing their patients’ mental health needs and concerns. Social security and disability bureaucrats and politicians must be updated regarding the problems now revealed with having the disease over longer periods of time. And the general public must be encouraged to think about states of mind when having indiscriminate sex or sex with strangers — not as a moral issue, but just common sense. If you are fucked up in your head, emotional, depressed, drunk, high on drugs etc. then you are probably not going to make the best or safest judgments. The condom you have in your wallet will probably remain there – just that one time … (many of us have done that).

Many pwhas are still struggling with the stigma of being labelled as sex addicts, whores, pigs, irresponsible, loose etc. — especially gays. Not all gays with hiv/aids are/were “sex addicts”. In fact, I would venture that most heterosexual and bi teenagers and young adults today have far more sex than their gay counterparts. And young heterosexuals definitely need to improve upon their safe sex behavior, as that problem is a ticking bomb waiting to explode.

That being said, not enough attention has been given to the state of mind many pwas were in when they became infected. Alcohol abuse, drug abuse, depression, emotional problems, relationship problems, feeling physically or mentally or emotionally tired or frustrated, a previous history of hepatitis C etc. can all contribute to a person more easily becoming infected. This was the case with me some 18 years ago. I had just recently experienced several family tragedies, was very unhappy in my relationship with my live-in partner and I was depressed. One night out in the city, one unplanned sexual affair, a stupid and naive act of trust and lapse of judgment in regards to using a condom … and voilà: I joined the ranks of those infected with the hiv virus.

The way I see it, we can either start addressing the issue of behavior and state of mind or we can continue to dig our heads in the sand and pass out condoms that we know only get used arbitrarily, and pretend that no one is having sex anymore. We know how that ends up.

However, being an aids activist rather than an hiv-prevention activist, I am very much concerned with quality of life for pwhas. What is the point of keeping us alive on “life support pills” when we are literally “losing our minds” and all too many of us take our lives in one way or another? Let us address this issue finally. It need not be stigmatizing to admit that we have the aids virus … nor that we have mental illness issues that we are learning to live with. Pwhas that are healthier mentally and who enjoy a better quality of life automatically contribute to a better society and humanity; and aids prevention is the most successful form of hiv prevention that I know — especially since so few hiv-negative persons actually use condoms every time they have sex.

I know that most people do not give a damn about pwas or about hiv/aids, but THERE IS AN AIDS GOD … IS THERE NOT?!!!

AIDS IS ALSO GENOCIDE … STOP THE GENOCIDE!

(All art copyright Adam Donaldson Powell)