Clinical care for mental health conditions is a particular challenge in resource-limited settings. In the U.S., there are an estimated 12 psychiatrists and 30 psychologists for every 100,000 people, but across Southeast Asia, there is less than one of each for the same number of people. People living with HIV who also have a mental illness face pervasive double stigma, which exacerbates the effects of both conditions.
Research has shown that adolescents who have grown up with HIV are at higher risk of mental health disorders. U.S. studies have estimated that as many as 60% have mental health issues such as attention deficit hyperactivity disorder, anxiety disorder, and depression. Unfortunately, there are very few studies in Asia to characterize the scope of mental illness in these adolescents.
In response, TREAT Asia organized a think tank in Bangkok in January, bringing together regional investigators and youth advocates from Cambodia, Indonesia, Malaysia, Thailand, and Vietnam to discuss how the network can begin to address research and clinical training gaps. Participants were guided by global mental health experts, including Dr. Claude Mellins and Dr. Warren Ng from Columbia University in New York City, Dr. Kay Malee from the Children’s Hospital of Chicago and Northwestern University, and Dr. Jackie Hoare from Groote Schuur Hospital and the University of Cape Town in South Africa.
Adolescent mental health think tank participants in Bangkok, Thailand, January 2017
“For youth with perinatally acquired HIV, adolescence is a particularly risky time for mental health problems,” said Dr. Mellins. “Young people have to navigate their health issues in conjunction with the individual, social, and environmental stressors that often go hand in hand with HIV, including stigma, discrimination, parental illness and death, community violence, and poverty.”
“Unfortunately, there are few studies on adolescent mental health needs in low- to middle-income countries, where the burden of pediatric HIV is greatest,” she continued. “TREAT Asia could fill a critical gap by identifying mental health needs that can inform treatment options for Asian youth.”
“A particular crisis affecting the TREAT Asia network sites has been the emergence of deaths due to treatment adherence failure,” commented Dr. Ng. “Some of these have been understood as suicidal actions, spurring the think tank participants to brainstorm on necessary mental health screening tools, interventions and treatments.”
As a result of the think tank discussions, the TREAT Asia team is developing a new initiative to conduct trainings on mental health management for pediatric HIV providers, and pilot research studies to evaluate the prevalence of mental health disorders among adolescents and their caregivers.
“Mental health training for pediatricians that has been successful within the United States could be adapted for use in the region,” noted Dr. Ng. “Understanding the mental health needs of HIV-infected youth can strengthen all treatment successes and health outcomes. TREAT Asia's mental health initiatives will provide precious insights and resources for the future of persons living with HIV/AIDS.”
From left, Dr. Jackie Hoare, Dr. Kay Malee, Ms. Chutima Saisaengjan from the Thai Red Cross AIDS Research Centre, Dr. Warren Ng, Dr. Claude Mellins, TREAT Asia Director Dr. Annette Sohn, and Project Managers Ms. Chuenkamol Sethaputra and Dr. Thida Singtoroj