This week, we will be discussing an article that was published in the AIDS Care Journal of Psychological and Socio-medical Aspect of AIDS/HIV in May of 2019. In this article, Saberi and colleagues describe the relationship between mental health, substance use, and HIV medication adherence among individuals aged 18-29 years. The authors also discuss barriers and facilitators to mental health care access that were commonly reported by young individuals living with mental health difficulties and accompanying HIV.

What did they do?

The primary purpose of this article was to provide information regarding common barriers to mental health care and substance abuse services reported by youth living with HIV. The authors succinctly describe the ways in which antiretroviral medication adherence is impacted when individuals are experiencing comorbidities such as depression.

Why did they do it?

There are a variety of factors that influence accessibility to mental health care in the general population, but these barriers are often amplified in vulnerable populations, and/or chronic illness populations (e.g., individuals living with HIV). The authors of this article recognize and highlight that youth and young adults living with HIV are at a particular disadvantage when seeking mental health services. In this article, the authors explored the ways in which substance use and mental health disorders disrupt the continuum of care for individuals with HIV. The authors explore the associations between untreated mental health/substance use disorders and low retention in HIV care, delays in antiretroviral initiation, poor medication adherence, and increased HIV progression and transmission.

How did they do it?

The authors of this article used a mixed-methods approach that included the administration of both quantitative surveys and qualitative interviews to 100 individuals aged 18-29 years who are living with HIV. Mental health was assessed using the Patient Health Questionnaire-9 (PHQ-9), the Post-Traumatic Stress Disorder Checklist-5 (PCL-5), and the Adverse Childhood Experiences (ACE) measure. Substance use was assessed using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), the Drug Abuse Screening Test (DAST), and the Alcohol Use Disorders Identification Test (AUDIT). The quantitative survey included questions pertaining to participant demographics, technology use, and self-report medication adherence throughout the past 30 days.

In depth individual interviews were also conducted with a subset of participants. The interviewers gathered information regarding participants’ experiences with substance use and with seeking out/enrolling in mental health and/or substance use services. Participants were also asked to address their thoughts and perceptions about incorporating technology into their treatment regimens.

What did they find?

Participants who reported not seeking out mental health services provided a variety of reasons as to why they did not seek out mental health support, including the experience of negative childhood events and medical mistrust. Conversely, participants who reported receiving mental health services indicated that their primary desire was for clinicians to be responsive and adaptive to their individual situation. Individuals living with HIV also reported additional barriers related to the stability of access and maintenance of services such as frequent staff turnover, and financially motivated barriers.

With regard to substance use, a large portion of participants reported that they used substances as a way to address untreated mental health related factors (e.g., anxiety, depression, trauma), or as a way of coping with long-term illness, with some participants specifically citing substance use as a way to escape their HIV status. Participants with a history of substance use also reported that being under the influence of drugs often affected their adherence to antiretroviral medications.

Participants were largely in favor of the use of technology as a facilitator of mental health and substance use treatment. Researchers, based on existing literature in support of video-based therapy, probed participants to assess possible facilitators and barriers to using this particular method. An overwhelming majority of participants were in support of the video-conferencing method, and highlighted the convenience associated with such a modality.

What does it all mean (our take)?

We found this article to touch on an incredibly salient ongoing issue, which is the issue of unaddressed mental health problems in chronically ill individuals, and how these problems can impact treatment adherence. This becomes critically important when put into the context of medical illnesses that require high levels of treatment adherence to ensure treatment efficacy.

What we found to be an important discovery in this article is the participants’ openness in using technology as a means to receive mental health intervention. The high accessibility and confidentiality components that come along with delivering interventions through technology leads to a highly promising area in need of continued research.

In 2020 there are thousands of intervention mobile applications (no exaggeration!). The challenge now is being able to determine the good from the bad, and the useful from the useless. We suspect there is still much ground to cover, but we fully support the continued endeavors to use technology to help treat as many people as possible. Let’s keep moving in the right direction!

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