Addressing mental health and psychosocial consequences of hiv for women and girls

Addressing the Mental Health and Psychosocial Consequences of HIV/AIDS for Women and Girls

Henia Dakkak, MD, MPH

UNFPA

[email protected]

Basic Facts of Mental Health 1

• Mental problems are not imaginary construct, not karma or the negative effects of past action.

• 450 million people suffer from mental/neurological or psychological problems.

• 1 out of 4 people experience mental disorders at least once in his/her life.

• 1 million people/year die by suicide and 90% of them are associated with mental disorders.

• Suicide is the 3rd leading cause of death in young people.

Basic Facts of Mental Health 2

• 1 out of 5 patients at the primary health care settings have mental disorders.

• Mental health problems are shown to be a risk factor for physical morbidity and mortality.

• Mental health problems occur as consequence of physical health problems.

• Mental health problems affect health seeking behaviors and compliance to treatment regiments.

• Mental health problems increase risky behaviors (alcohol, drug, violence and sexual behaviors).

Leading Causes of Mortality and Burden of Disease. World, 2004 (WHO, 2008)

%

1. Ischaemic heart disease

12.2

2. Cerebrovascular disease

9.7

3. Lower respiratory infections

7.1

4. COPD

5.1

5. Diarrhoeal diseases

3.7

6. HIV/AIDS

3.5

7. Tuberculosis

2.5

8. Trachea, bronchus, lung cancers 2.3

9. Road traffic accidents

2.2

10. Prematurity, low birth weight 2.0

%

1. Lower respiratory infections

6.2

2. Diarrhoeal diseases

4.8

3. Depression

4.3

4. Ischaemic heart disease

4.1

5. HIV/AIDS

3.8

6. Cerebrovascular disease

3.1

7. Prematurity, low birth weight 2.9

8. Birth asphyxia, birth trauma

2.7

9. Road traffic accidents

2.7

10. Neonatal infections and other

2.7

Mortality DALYs

Facts affecting Women and Girls

• Of all adults living with HIV in sub-Saharan Africa, 61% are women.

• Between 15% and 71% of women around the world have suffered physical or sexual violence committed by an intimate male partner at some point in their lives irrelevant of social or economic backgrounds of these women

• Violence has serious health consequences for women, from injuries to unwanted pregnancies, sexually transmitted infections, depression and chronic diseases.

• Some studies show that up to 1 in 5 women reports being sexually abused before the age of 15.

• 100 Million girls will marry before the age of 18 over the next 10 years – Young girls often lack the knowledge about sex and the risks of STIs and HIV/AIDS

• Interaction between biological and social vulnerability play some role in the higher prevalence of depressive and anxiety disorders among women

• Women may also experience considerable psychological distress and disorders associated with reproductive health conditions and problems

Mental Health Aspects in Sexual and Reproductive Health

Mental Health of People Living with HIV and AIDS (PLWHA)

• Up to 40% of PLWHA experience depression.

• Their family, partner and care provider also suffer from mental health problems due to stigma, fear, bereavement, etc.

• HIV and AIDS themselves can biologically cause mental health problems such as depression, acute psychotic disorders and dementia.

• Mental health problems can decrease adherence to treatment which is crucial for antiretroviral treatment to keep the medicines effective and to prevent from developing new resistant strains of the virus.

• Mental health problems make people more vulnerable to be infected with and to pass on HIV (with impairment of judgment and decision making).

Linking Mental health HIV/AIDS and Gender

1 in 4 women experience depression1 in 4 women experience depression 10% to 15% or more women experience depression 10% to 15% or more women experience depression

during pregnancy or after childbirthduring pregnancy or after childbirth Suicide is a leading cause of pregnancy-related Suicide is a leading cause of pregnancy-related

death in some countries (e.g in Viet Nam, 14% of death in some countries (e.g in Viet Nam, 14% of pregnancy related death is attributed to suicide)pregnancy related death is attributed to suicide)

1/3 of rape victims suffer from post traumatic stress 1/3 of rape victims suffer from post traumatic stress disorderdisorder

Up to 40% of people living with HIV suffer from Up to 40% of people living with HIV suffer from depressiondepression

Mental Health in UN

Past

• WHO Dep. of Mental Health and Substance Abuse (Guidelines and tools development + technical support)

• No implementing parties in the UN so far.

difficult to realize mental health on the ground

2006-

UNFPA-WHO Joint Programme on Mental Health• Integrate mental health into UNFPA priority areas/MDGs

(not to develop mental health standalone projects)

• Use existing UNFPA programmes, human resources & networks

(broader coverage, sustainability, no need to invent from scratch)

Mental Health is;

a critical consequence of global priority issues (poverty, disasters, maternal health, HIV etc.)

and also

a key determinant of global priority issues

What is UNFPA?

UNFPA Mission Statement:UNFPA, the United Nations Population Fund is an international development agency that promotes the rights of every woman, man and child to enjoy a life of health and equal opportunity. UNFPA supports countries in using population data for policies and programmes to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect.

5 Regional + 112 Country Offices (Programmes in 150 Countries)

Mental Health in Reproductive Health

International Conference on Population and Development (ICPD) (1994)

ICPD defined Mental Health as a key component of Reproductive Health.

“Reproductive health is a state of complete physical, mental and social well-being in all matters relating to the reproductive system and to its functions and processes.”

Mental health is part of reproductive health

Mental Health Programme in UNFPA

• WHO-UNFPA Joint Programme on Mental Health (2006-)- Maternal mental health

- Adolescent mental health- Gender based-violence and mental health

- HIV/AIDS and mental health- Suicide prevention

• Inter-agency Standing Committee (IASC) Reference Group on Mental Health and Psychosocial Support in Emergency Settings (2007-)

UNFPA Programme Areas

Area 1: Population and Development (Census, Urbanization, Aging etc.)

Area 2: Reproductive Health and Rights (MDG5) (Maternal Health/MDG5, HIV Prevention/MDG6, GBV etc.)

Area 3: Gender Equality (MDG3)

Cross-cutting Concerns:• Mainstreaming Young People’s Concerns

• Emergencies and Humanitarian Assistance• Special Attention to Marginalized and Excluded Populations

Mental Health Programme in UNFPA: Global Advocacy

• Executive Director’s Statement: Statement for the World Mental Health Day 2008 to call for “Making Mental Health a Global Priority.” (http://www.unfpa.org/news/news.cfm?ID=1195)

• Executive Director’s Statement: Statement for World Suicide Prevention Day 2006 to call for more "attention to mental health and psychological implications of SRH" (http://www.unfpa.org/public/News/pid/143)

• UN Joint Press Release: on Statements on mental health by three heads of UN entities (UN, UNFPA, WHO).

• (http://www.un.org/apps/news/story.asp?NewsID=28512&Cr=mental#)

Mental Health is part of UNFPA Mandate

Mental Health is;

a critical component of UNFPA priority issues (SRH, maternal health, gender and adolescent)

and also

a key determinant of UNFPA priority issues

“Now is the time to pay more attention to the mental and psychological implications of sexual and reproductive health.”

- Thoraya A. Obaid, UNFPA Executive Director

8

Mental Health Programme in UNFPA: Awareness Raising

Awareness Raising Brochures:• (SRH and Mental Health): “UNFPA Emerging Issues: Mental,

Sexual & Reproductive Health” (http://www.unfpa.org/webdav/site/global/shared/documents/publications/2008/mental_rh_eng.pdf)

• (Maternal Health and Mental Health): “Improving Maternal Mental Health: Millennium Development Goal 5 – improving maternal health” (http://www.who.int/entity/mental_health/prevention/suicide/Perinatal_depression_mmh_final.pdf)

Mental Health Programme in UNFPA: Inter-Agency Policy Documents

• IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. Geneva, IASC: 2007. (http://www.humanitarianinfo.org/iasc/pageloader.aspx?page=content-subsidi-tf_mhps-default)

• IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings: Checklist for Field Use. Geneva, IASC: 2008. (http://www.humanitarianinfo.org/iasc/pageloader.aspx?page=content-products-products&sel=22)

• WHO-UNFPA Policy and Programme Guidance Notes on Mental Health in MDGs.

(Mental health in maternal health, HIV, GBV and Adolescents) (in process)• WHO-UNFPA Intervention Guidance Notes on Mental Health in MDGs.

(Mental health in maternal health, HIV, GBV and Adolescents) (in process)

Mental Health Programme in UNFPA: Technical Information

Research Compendium

• WHO-UNFPA Mental Health Aspects of Women’s Reproductive Health: A Global Review of the Literature. Geneva, WHO: 2009. (http://www.who.int/reproductive-health/docs/mental_health_women_reprohealth.pdf)

• WHO-UNFPA Adolescent Mental Health: Global Review. (In Progress)

Meeting Reports

• WHO-UNFPA Expert Meeting on Mental Health Aspects in Sexual and Reproductive Health: Hanoi Meeting Report. (In Print)

• WHO-UNFPA Maternal Mental Health and Child Health and Development in Low and Middle Income Countries: Report of the Meeting Held in Geneva, Switzerland. (http://www.who.int/entity/mental_health/prevention/suicide/mmh_jan08_meeting_report.pdf)

Mental Health Programme in UNFPA: Country Programmes

• Eritrea: supported Government to integrate mental health into the new reproductive health policy

• Eritrea: facilitated a maternal mental health programme with WHO.• Liberia: integrated psychological support into services for survivors of

gender-based violence• Russia: provided psychological support for sex workers and young people

living with HIV• Indonesia: support development of 10 psychosocial support centres for

Tsunami survivors• Iran & China: supported mental health and psychosocial support after

earthquakes• Afghanistan & OPT: supported mental health centres through capacity

development of health workers and medical students.• OPT: facilitated workshops on Women’s Reproductive and Mental Health and

providing psychosocial support to women and their families in Gaza

“UNFPA joins others in calling for

‘Making Mental Health a Global Priority’.

…Today, we call for greater integration of mental health and psychosocial support into humanitarian responses and efforts to achieve the MDGs…

Mental health is central to human dignity”

- Thoraya A. Obaid, UNFPA Executive Director

World Mental Health Day 2008