The HIV epidemic has changed a lot within the past 20 years, and still yet, continued high risk behaviors have remained the same. Contributing factors to these behaviors include a lack of power or oppression, marginalization, sexual abuse, sexual compulsivity, low self esteem, depression, and loneliness. These are not issues that can be fixed quickly. Addressing these issues requires effort and time and may extend beyond the capabilities of many HIV programs for prevention.
An important thing learned from HIV prevention research is one size doesn’t fit all. Programs require different components that address the various different needs of clients. Increased access to syringes for people who inject drugs, and condoms to those who have sex are necessary to win the battle against HIV. Skill building and increasing knowledge about HIV are good methods for prevention, but they don’t work for everyone. For most, the obstacles related to behavior changes involves dealing with mental health problems.
What people experience and what they do have effects on their mental health. Substance abuse and use (even when the drugs are not abused), marginalization, poverty, and discrimination are all serious factors that can have a big impact on one’s mental health and can place some people at a higher risk for contracting an HIV infection.
Do Issues with Mental Health Affect HIV Risk?
Yes. When someone decides to engage in a risky drug or sexual act, it doesn’t always occur due a consciously made decision. Instead, these decisions are sometimes based on an attempt to get satisfaction for another need related to a mental health condition. For example:
- Low self-esteem: For many men who have sex with other men (MSM), internalized homophobia and low self-esteem can impact their risk of of contracting HIV. Internalized homophobia is a feeling which results in a person having a lack of self-acceptance, feeling unhappy, or self-condemnation for being gay. In one study, it showed that men who did test positive for HIV were the ones that were in fact the ones that experienced internalized homophobia. These men seemed to spend less time with others who lived the same lifestyle, and they also showed less satisfaction in their relationships.
- Male to female transgender persons, also known as MTFs, identify depression, rejection, feelings of isolation, and low self esteem as barriers to risk of HIV reduction. Many MTFs state that they take part in unprotected sex because it verifies their identity and helps boost their self esteem.
- Post traumatic stress disorder: People who are diagnosed with PTSD seem to partake in high-risk sexual behaviors. One study showed that 59% of the women who were HIV positive had full PTSD due to traumas, such as rape, assault, or witnessing a murder. Non-violent traumas including serious accidents, loss or children, or homelessness. Still yet, these women were not being treated for PTSD. A national study performed on veterans found that substance abusers who had PTSD were more than 12 times as likely to be HIV infected than those veterans who were not suffering from PTSD or substance abuse.
- Depression and anxiety: Those suffering from depression and anxiety are more likely to take part in high- risk sexual activities, such as substance abuse, including injection drug use, prostitution and choosing a high-risk partner. A study following city youths for over a several year time period found that the change in risk behaviors wasn’t associated with access to information, counseling or knowing someone had AIDS.
What can be done?
As you can clearly see, mental health conditions by far increase risky sexual behaviors. In order to address mental health issues, it is important that a person visit an individual therapist or counselor, as well as a physician to be put on appropriate medication(s). It’s also important for such people to have access to structural and community level programs that address mental health needs and HIV.