Lessons from Research Innovations in Depression and HIV in Low- and Middle-Income Countries.

Antiretroviral therapy has transformed HIV into a manageable disease, preventing the progression of HIV to AIDS and improving quality of life for people living with HIV. Increasing the number of people who test for HIV, initiating people living with HIV on antiretroviral therapy, and supporting them to adhere to their regimen have become central goals to the global strategy to end AIDS by 2030. Although we have seen extraordinary achievements, we are not on track to achieve these goals. People living with HIV face considerable emotional and social challenges which are known to adversely impact on their capacity to engage fully with HIV care and to maintain adherence to HIV medication. Among formally diagnosed mental disorders in people living with HIV, depression has received the most attention. However, in many settings where HIV is endemic, there is no single word for depression and emotional responses may be seen as “weakness” and something to be hidden (Aggarwal et al., Int J Soc Psychiatr 62(2):198–200, 2016). Sub-Saharan Africa carries the highest burden of HIV and has limited numbers of trained mental health care professionals. This chapter describes the global challenges to reducing new infections and HIV related deaths and illustrates innovative ways in which depression can be treated alongside HIV to allow people living with HIV to benefit from antiretroviral therapy and maintain healthy survival. Examples of innovations from sub-Saharan Africa provide evidence to support the urgent need for integrating mental health care into primary HIV services.