Turning HIV/AIDS boundaries into frontiers

Over the past three decades, HIV/AIDS has come to occupy a very different space in health policy and the public consciousness than it did in the years immediately following its discovery. 

Eight million people have gained access to antiretroviral treatment, compared with a few tens of thousands a decade ago, and mortality from AIDS and the number of new infections have decreased worldwide by 25 per cent in the past five years.

But great obstacles still exist, and HIV/AIDS remains a global condition with a unique set of challenges to address on a local level. 

Cato Chair of Psychiatry at the University of Melbourne and the Royal Melbourne Hospital Ian Everall (pictured) has devoted decades of his life to improving understanding of the cause and treatment of neurocognitive impairment in HIV: an effect of HIV that is relatively unknown by those outside the health and public policy sectors. Cognitively impaired people may have trouble thinking, understanding, and remembering, and often develop associated mental illnesses such as psychosis, bipolar disorder or depression.

“We’ve known since the late 1980s that people with HIV infection could develop a terrible dementia: a neurological process that occurs at the same time as the profound psychological and social impact of the diagnosis,”  Professor Everall says.

“On a day-to-day level, people living with HIV who are cognitively impaired have higher rates of unemployment, are less likely to be able to maintain independent living and have greatly increased mortality rates.”

Professor Everall has made significant breakthroughs in the field. 

In 1991 he was the first person in the world to identify that HIV infection killed nerve cells in the brain. 

With colleagues at the University of California San Diego, he has gone on to demonstrate the other damage that occurs in the brain as a result of HIV infection, and will soon launch a phase two trial in Melbourne and Sydney to determine whether lithium is an effective treatment in protecting the brain from HIV.

The psychological burden of HIV/AIDS, coupled with the neuropsychiatric complications occurring as a result of cognitive impairment, means that often people living with HIV/AIDS are exposed to a ‘double stigma’: experiencing discrimination and judgment associated with mental illness as well as their HIV-positive status. 

Third year University of Melbourne medical student Carolina Radwan believes that through education, we can continue to change community attitudes, fundamentally transforming the way people think about HIV and mental illness. 

In May, Ms Radwan was involved with organising an HIV fundraising and awareness event as part of the Melbourne Medical School Student Conference, which she co-convened. Speakers from People Living With HIV/AIDS Victoria (PLWHA) spoke to students about some of the realities of living with HIV/AIDS and cognitive impairment. 

Ms Radwan says the experience was “incredibly moving”.

“As medical students we’re mostly exposed to a very clinical perspective on HIV, and for a lot of us, this was a real eye-opener. Clinically speaking, huge advances have been made. But a lot of work still needs to be done to improve community attitudes and understanding,” she says.

The students intend to use funds raised from the event to organise similar talks for students from a range of disciplines across the University, with the goal of improving understanding and reducing fear, myths and discrimination surrounding HIV within the student community. 

Ms Radwan says although the challenges are daunting, she is optimistic about what can be achieved.

“We shouldn’t underestimate the impact of education and working together.”

Professor Everall agrees that collaboration is critical. 

“If you can collaborate with people who have skills and expertise outside your area; if you can listen to the community about what it needs and wants; if you build powerful partnerships moving forward: these are really the first steps in turning boundaries into frontiers and ultimately improving quality of life for people with HIV.”

www.psychiatry.unimelb.edu.au/