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Improving HIV Treatment
Beyond Viral Suppression: Supporting Mental Health to Improve HIV Treatment Satisfaction

Released: April 24, 2025

Expiration: April 23, 2026

Renslow Sherer
Renslow Sherer, MD
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Key Takeaways
  • Mental health challenges stemming from HIV-associated stigma are common causes of poor HIV treatment adherence.
  • Good communication, support, and solidarity from healthcare professionals are key methods to reduce stigma.

Mental Health Challenges During Uncertain Times
Mental health challenges are among the most common causes of poor HIV treatment adherence and low patient satisfaction; perhaps no surprise in this era of political chaos and during our collective, prolonged recovery from the COVID-19 pandemic. Worsening isolation, anxiety, and stigma toward people living with HIV can compromise quality of life and the ability to adhere to medications. Housing instability is associated with a significant increase in poor adherence and virologic failure. In addition, immigrants, transgender individuals, and other members of the LGBTQ+ community are particularly vulnerable to healthcare barriers and lacking a sense of community. 

These issues have been familiar to people living with HIV and HIV care teams since the beginning of the epidemic. However, the intensity of the stigma and sudden withdrawal of legal and national protections for their rights, as well as the threat of funding withdrawal for programs such as the Ryan White CARE Act, the AIDS Drug Assistance Program, and CDC-funded HIV prevention and surveillance programs have created an atmosphere of fear and intimidation.

Practical Remedies for HIV-Associated Stigma
There are no simple solutions for healthcare professionals (HCPs) and caregivers in this environment, but there are practical ways to address the mental health consequences of HIV-associated stigma. Communication, support, and solidarity with people living with HIV­—as well as their families and caregivers—are critical remedies to stigma. Now, more than ever, HIV care teams need to stand together with people living with HIV, share the impact of these realities, and speak out to support people living with HIV and their families.

An essential first step for HIV wellness is asking patients the simple question, “How are you doing?” accompanied by active listening to responses. HIV HCPs know to ask about medication adherence at each visit, but a deeper dive can often reveal a more serious issue that may interfere with medication adherence or clinic visits. Stable housing is also critical in HIV care, so it is important to touch base regularly about housing stability, and to engage with social services when homelessness is present or housing is threatened. The profound anxiety and demoralization associated with these times have increased the risk of depression and substance use, so documenting a careful history of these situations is also an essential component at each visit.

Asking “Whom do you talk with regularly?” and “Whom can you trust with your most personal issues?” may offer a window into patients’ experiences with isolation and social withdrawal. Sometimes regular, low-pressure contact with an HIV care team member can offer a way out of isolation and the beginning of healing.

The Importance of Physical Activity
Another conversation that I often initiate with patients at each visit is whether they exercise, as well as the frequency and type of activity or activities. As more than one half of our patients are older than 50 years of age, the increasing incidence of comorbidities and complications of aging are an added burden. Furthermore, physical inactivity is associated with an increased risk of depression and mental health challenges. 

In a study that assessed frailty, one half of participants were people living with HIV older than 50 years of age who engaged in weekly low-stress exercise classes for 3 months as part of their HIV care. After the 3 months, those who exercised regularly had significantly less frailty and prefrailty compared with those who did not.

I advise people of all ages to be active and to exercise 2-3 times weekly. We know that exercise is beneficial for all common HIV-related comorbidities such as heart disease, depression, osteopenia and osteoporosis, HIV-associated neurologic diseases, and chronic kidney and liver disease in addition to mental health.

In summary, it is essential for HIV HCPs and caregivers to offer solidarity and support to people living with HIV and their loved ones, to recognize and treat mental health issues and substance use, to address housing instability, and to encourage people living with HIV to exercise regularly and engage with nature as often as possible.  

We will discuss HIV wellness further in a series of free, live sessions at academic medical centers across the United States. To request one of these free, CME-certified, expert-led sessions at your institution, click here. 

Your Thoughts
How do you incorporate mental health care for your people living with HIV? Leave a comment to join the discussion.