Now is the Time: Ending Stigma Around Mental Illness and Improving Mental Health 

I’m relatively new to the Global Alliance (GA), but a long-time mental health advocate and I have been working in HIV prevention for nearly a decade now. Utilizing that nexus, I became more involved with the GA and helped craft the new resolution on the inclusion of mental health and psychosocial services (MHPSS) in HIV/AIDS programming, which led to my attending portions of the United Nations High-Level Meeting on AIDS (8-11 June 2021). My first time attending a UN meeting, I found it to be quite an enlightening experience, given the setup, formality, and multiple languages and translation. It’s no doubt that the only reason I was able to attend a UN meeting at all was due to virtual events being open to the public as a result of COVID-19. It is also not a coincidence that this meeting was being held forty years after the first cases of AIDS were reported. 

Over the last forty years, the fields of HIV prevention and treatment have come a long way. We now have options for people who live with HIV (PLWH) and those at risk of acquiring HIV, such as PrEP (pre-exposure prophylaxis) to prevent acquisition. Monthly, long-acting injectable Cabotegravir (an integrase inhibitor, with Rilpivirine) has been FDA approved for treatment and is just on the horizon as PrEP for both adults and adolescents. These accomplishments are due, in essence, to the advocacy base that the HIV/AIDS field has built over this time, which has led to political will and financial investment to fund research, educational campaigns, and community-based interventions. This advocacy base has, ultimately, greatly helped to bust HIV stigma. I consider stigma to be the primary culprit to the prevention of progress. ACT UP is one of the first and most influential advocacy organizations that comes to mind. More recently, public campaigns such as U=U (Undetectable=Untransmittable), informing the public about the fact that an undetectable viral load means that an individual cannot transmit HIV, are doing even more to end HIV-related stigma.

But how will we bust through the stigma that continues to pervade both HIV/AIDS and mental illness? PLWH often hold intersecting identities, such as a person identifying as a sexual and gender minority (SGM), and/or someone with a mental illness. All of these intersectional identities, by very definition, do not play out in their own bubbles. Living with these multiple identities compounds the stigma felt.  Evidence explains that those with mental illness are at higher risk for HIV and those with HIV are at higher risk for mental illness. The co-occurrence of HIV and depression, for example, can exacerbate psychosocial impairment and further complicate treatment for both. People who identify as SGM are also at higher risk for both acquiring HIV and developing mental illness.  

During the side event entitled Driving Faster Progress in the Fight Against HIV: How Integrating Mental Health is a Win-Win, Kali Lindsey from the Elton John AIDS Foundation replied in response to a chat comment about support within the context of stigmatization, especially in countries which criminalize same-sex behaviors:

“Our support for policy/advocacy includes support for efforts to decriminalize or promote social inclusion where you live. This is not going to be easy but is essential to decreasing the demand for mental health support downstream.”

This comment was made with regards to stigma towards people identifying as SGM, but this sentiment is relevant to mental illness stigma as well. Read that last sentence again. “…essential to decreasing the demand for mental health support downstream.” I believe Kali was talking about improving global mental health to a point where individuals would know when to ask for help, but also have the skills (coping, technical, and logistical) to begin to be self-sufficient in maintaining their mental health – and in a world where that would actually be possible.

How else can we diminish the harm done by stigmas around mental illness, HIV, and SGM and, as Kali indicates, improve population mental health to a point where demand of mental health support would be decreased? Just as elements of synergies (and, unfortunately, syndemics) interact with each other, I think we will accomplish this goal by ramping up mental illness and health advocacy, in order to decrease stigma around mental illness and improve mental health. Can we push mental health research, programming, and services to stomp mental illness stigma like ACT UP did for HIV? In another 40 years, can we look back to say “Look how far we have come!”, instead of still asking “How far have we really come?” We should celebrate our discoveries and accomplishments but continue to work diligently toward being the generation to end the HIV/AIDS epidemic – and that includes eradicating mental illness stigma. COVID-19 has changed our world forever. Stigma surrounding mental illness is at an all-time low due to mental health finally being prioritized, in response to the COVID-19 era. Now is the time to build on this momentum and say goodbye to the stigma around mental illness - for good.