Men’s Mental Health Matters in HIV Care

Mona Balani 1 April, 2025

India has an estimated 2.4 million people living with HIV (PLHIV), according to the National AIDS Control Organization (NACO). Among these, more than 19 million people are on antiretroviral therapy (ART). Approximately 50% of those on HIV management treatment are men, including cisgender men, trans men, men who inject drugs (PWID), and men engaged in sex work.

Mental health issues such as depression, anxiety, sleep disturbances, stress, suicidal ideation, and substance use disorders disproportionately affect men living with HIV. Research shows that 40-50% of PLHIV experience mental health challenges, but this is often underreported and undertreated among men due to societal, cultural, and systemic barriers.

Major challenges as per experience in the national care and support program-Vihaan, faced among men living with HIV and men in high-risk behaviour, include the following challenges:

1. Difficulty in Accepting HIV Status: Many men struggle to come to terms with their diagnosis, leading to denial, self-isolation, and poor adherence to HIV treatment, other prophylaxis, and oral substance therapy.
2. Disclosure: The majority of men do not disclose their status to their families or sexual partners due to social stigma, preventing open conversations about their HIV status and leaving them without adequate emotional support.
3. Substance Use and Risky Behaviour: To cope with mental trauma, some men resort to alcohol, drug use, further worsening their mental and physical health.
4. Socioeconomic Pressure: Men, often perceived as primary breadwinners, face financial stress and the pressure to maintain societal expectations of masculinity, exacerbating their mental health issues.
5. Layered Stigma: As household breadwinners and decision-makers, men face compounded stigma related to HIV, sexual orientation, or substance use, adding layers of discrimination and preventing access to mental health and social support services.

A study by the National Health Institute highlights emerging concerns regarding mental health. While some cases are reported at ICTC and ART centres, many men voice their complaints at drop-in centres or care and support centres, or report them through grievance portals.

• Studies indicate that 30-60% of men living with HIV experience depressive symptoms, significantly higher than the general population.
• Men with HIV are nearly three times more likely to consider or attempt suicide than their HIV-negative counterparts.
• A significant proportion (30-40%) of men living with HIV engage in harmful alcohol use or drug dependency.

There are many barriers preventing men from seeking mental health services. Deeply entrenched societal norms that expect men to suppress emotions and maintain a strong façade. In cases where a wife is diagnosed first, men may face accusations of infidelity, disputes, or stigma, complicating family dynamics. Men from low socioeconomic backgrounds face compounded stigma and limited access to mental health services.

Recommendations to Address Men’s Mental Health in HIV Care

1. Integrated Mental Health Services: Evidence from the NACP programme highlights gaps in coordination and integration of data for PLHIV in need of mental health services. There is a need to establish mental health services at HIV care and treatment service delivery points, offering counselling, peer support, and psychological interventions. Healthcare providers should be trained in gender-sensitive approaches to address men’s mental health needs.
2. Community-Based Support: Social support groups should be created under ongoing care and support programmes within the NACP, specifically for men living with HIV, to foster open dialogue. Local community leaders should be involved to destigmatise conversations around mental health and HIV.
3. Collaborations and Policies: Strengthening collaboration between NACO and the Department of Mental Health is crucial to integrating mental health services into HIV programmes at all levels. Community leaders should be capacitated to advocate for policies addressing co-occurring conditions, such as HIV and mental health disorders, and their links to co-infections like TB, diabetes, and cardiac diseases.
4. Awareness and Advocacy: Targeted campaigns should be launched to raise awareness about men’s mental health, particularly among young and adult populations living with HIV. Increased funding from local and international donors is needed for tailored interventions for men because men’s health matters.

Conclusion

The intersection of mental health and HIV among men remains a largely underexplored yet critical issue in India. By creating safe spaces, integrating mental health into HIV care, and challenging societal norms, we can break the silence and ensure that men living with HIV receive the care and support they need. It’s time to recognise that men’s health matters, and a holistic approach to mental health can significantly improve the lives of men living with HIV.

Note: The data and insights presented in this article have been referenced from studies conducted by the National AIDS Control Organisation (http://naco.mohfw.gov.in/hiv-facts-figures) and research published on PubMed (https://pubmed.ncbi.nlm.nih.gov/21153958/).

Images on the banner are for representation only and do not indicate their HIV status.