Public awareness campaigns on HIV/AIDS have helped challenge misconceptions and educate the public on this infectious disease; this approach could be emulated by mental health advocates. — Filepic
World AIDS Day, observed annually on Dec 1, remains a vital platform to raise awareness and advocate for action to address this global health issue.
In 2024, the theme “Building Resilience Together” resonates deeply, emphasising the shared responsibility to create inclusive care systems.
Yet, as we reflect on the remarkable strides made in HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) advocacy, prevention, treatment and stigma reduction, an unsettling parallel emerges: the persistent gaps in mental health care systems and the slow progress in addressing mental health stigma.
Let us explore the intersections between HIV/AIDS and mental health, highlighting how lessons learned from the HIV/AIDS movement can catalyse transformation in mental healthcare.
The HIV/AIDS transformation
Over the past four decades, the global response to HIV/AIDS has undergone a radical transformation.
In the early years of the epidemic, HIV/AIDS was shrouded in fear and stigma, perceived as a death sentence and a consequence of “immoral” behaviour.
Discrimination against individuals with HIV/AIDS was rampant, often denying them basic rights, healthcare access and dignity.
A turning point came with the tireless advocacy of activists, healthcare professionals and affected communities.
The AIDS crisis galvanised a global movement that achieved several key milestones.
The most significant milestone was the development of antiretroviral therapy (ART), a revolutionary advancement that transformed HIV/AIDS care from a terminal illness to a chronic, manageable condition.
This progress instils hope and optimism for similar breakthroughs in mental health care.
Public awareness campaigns helped challenge misconceptions, educate the public, and encourage testing and treatment.
International and national policies now emphasise human rights-based approaches, ensuring that people living with HIV/AIDS are protected from discrimination.
The role of peer support networks and grassroots organisations has been pivotal in fostering acceptance and resilience among individuals living with HIV/AIDS.
Our country too has made significant strides in addressing HIV/AIDS through comprehensive advocacy, prevention, treatment and efforts to reduce stigma.
The Malaysian AIDS Council (MAC) has been a key player in advocating for fair treatment and the inclusion of vulnerable populations in public health policies.
Malaysia also introduced harm reduction strategies like needle and syringe exchange programmes and methadone maintenance therapy to curb HIV transmission among people who inject drugs.
These efforts have contributed significantly to reducing HIV transmission rates.
Treatment programmes such as pre-exposure prophylaxis (PrEP) and awareness campaigns focus on high-risk groups like men who have sex with men (MSM) and transgender individuals, helping prevent new infections.
By the end of 2022, approximately 68% of people living with HIV were on ART, leading to improved health outcomes and reduced transmission.
Community organisations in Malaysia play a vital role in empowering individuals, especially those in marginalised communities, to access testing and treatment without fear of discrimination.
The MAC and other organisations have implemented initiatives to combat HIV-related stigma and discrimination, such as the MAC CARE platform, which enables individuals to report incidents of stigma and receive support.
These efforts align with global campaigns to normalise living with HIV.
New HIV infections in Malaysia have declined by over 65% from 2002 to 2022, showcasing the effectiveness of combined efforts.
Today, while there is still fear and stigma attached to HIV/AIDS, it can also be identified with resilience and hope.
Yet, this transformation starkly contrasts to the stagnation seen in mental health care.
Mental health needs
Mental health care remains an underfunded and underprioritised sector in most parts of the world, including Malaysia.
Despite increasing awareness of its importance, mental health still carries a significant stigma, often equated with personal weakness or moral failing.
Many of the barriers that the HIV/AIDS movement overcame – e.g. fear, misinformation and systemic neglect – remain entrenched in mental health.
Unlike the robust networks established for HIV/AIDS, mental healthcare systems often lack adequate resources, especially in low- and middle-income countries.
Even in countries with advanced health care systems, mental health services are frequently fragmented and difficult to access.
While HIV/AIDS awareness campaigns have significantly improved knowledge and reduced stigma, mental health education remains sparse.
Misconceptions about mental illness perpetuate fear and discrimination, discouraging individuals from seeking help.
Comprehensive mental health policies are a rarity, and the enforcement of existing policies is often weak.
Stigma within healthcare systems can lead to substandard treatment or outright neglect.
It is crucial to push for comprehensive policies and their strict enforcement to ensure quality care for all.
Although mental health research is growing, it still lags behind other areas of health.
Breakthroughs akin to ART for HIV/AIDS are urgently needed to revolutionise mental health treatment.
The HIV/AIDS movement offers valuable lessons for advancing mental health care.
Placing human rights at the centre of mental health advocacy can challenge discrimination and promote dignity for those with mental illnesses.
This rights-based approach is particularly relevant in those with chronic psychosocial disabilities who are in private in-patient facilities throughout the country.
Just as people living with HIV/AIDS have been at the forefront of advocacy, individuals with lived experience of mental illness must lead the charge for reform.
Their voices are essential for shaping policies and interventions that reflect real-world needs, adhering to the principle of “nothing about us without us”.
The integration of HIV/AIDS care with other health services has significantly improved outcomes and reduced stigma.
Similarly, integrating mental health care into primary healthcare systems can enhance accessibility and provide holistic care.
Initiatives like the mental health certificate course by the Malaysian Society for Academic Psychiatry for primary care doctors are steps in the right direction.
To change societal attitudes, mental health must be normalised through large-scale campaigns that challenge stereotypes and promote understanding.
Malaysia’s advancements in addressing stigma associated with HIV/AIDS highlight the potential of integrating community-driven advocacy with government support.
This model could inspire similar progress in addressing mental health challenges.
Bridging the gap
Despite the stark contrasts, there are glimmers of hope.
The global mental health movement is gaining momentum, with initiatives such as the World Health Organization’s (WHO’s) Mental Health Action Plan 2024–2030 emphasising universal access and stigma reduction.
The Covid-19 pandemic, which underscored the importance of mental well-being, has also catalysed conversations around mental health.
Yet, progress remains slow and uneven.
HIV/AIDS demonstrates that stigma is not an insurmountable barrier, but breaking it requires sustained effort, collaboration and investment.
Mental health advocates must draw inspiration from the HIV/AIDS movement to build a similarly powerful coalition for change.
World AIDS Day reminds us of the transformative power of advocacy, science and community in addressing health crises.
The HIV/AIDS movement has shown that stigma can be dismantled, lives can be saved, and hope can flourish even in the face of immense challenges.
The mental health movement must harness this blueprint to achieve a similar transformation.
As we commemorate the resilience of those living with HIV/AIDS, let us commit to a future where mental health is treated with the same urgency, empathy and respect.
By connecting the lessons of HIV/AIDS to mental health, we can build a world where every individual, regardless of their health condition, can lead a life of dignity and fulfilment.
This is not just an aspiration, but an imperative for a healthier, more compassionate world.
Prof Datuk Dr Andrew Mohanraj is a consultant psychiatrist, the Malaysian Mental Health Association president and Taylor’s University Impact Lab on Mental Health & Wellbeing director. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
