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Email this article Psychosocial Mechanisms and Multilevel Barriers to Access Mental Health Services among Older People Living with HIV: A Narrative Review
Abstract
Background
The widespread availability of antiretroviral therapy (ART) has transformed HIV into a chronic, manageable condition, resulting in a rapidly aging population of people living with HIV. Older people living with HIV experience a disproportionately high burden of depression, anxiety, trauma-related disorders, cognitive impairment, and frailty. These conditions emerge not as isolated comorbidities but through complex interactions among biological, psychosocial, and structural determinants specific to aging with HIV.
Aim
This narrative review aims to synthesize evidence on the mechanisms underlying mental health disorders in older people living with HIV and to examine multilevel barriers to mental health service accessibility across diverse resource settings.
Methods
A narrative review of peer-reviewed literature was conducted using PubMed (MEDLINE). Studies addressing mental health outcomes, biological and psychosocial mechanisms, stigma, social determinants, and healthcare access among older adults living with HIV were included. Evidence from both high-resource and low- and middle-income settings was considered. Findings were thematically synthesized within a biopsychosocial and social-ecological framework.
Results
Evidence indicates that mental health disorders among older PLWH are shaped by interrelated biological pathways, including chronic neuroinflammation, accelerated aging processes, and neuroendocrine dysregulation, alongside psychosocial mechanisms such as loneliness, accumulated trauma, chronic stress, and intersecting stigmas. These factors interact to create self-reinforcing cycles of psychological and physiological vulnerability. Despite the high burden of mental morbidity, access to mental health services remains inadequate globally. Barriers operate at structural, organizational, provider, and individual levels, including fragmented care systems, limited geriatric HIV expertise, workforce shortages, and stigma. Promising approaches include integrated HIV and mental health care models, holistic geriatric programs, telehealth expansion, task-shifting strategies, and peer-based interventions, though implementation varies substantially across settings.
Conclusion
Mental health disorders among older PLWH arise from complex, multilevel mechanisms that require coordinated and age-responsive responses. Strengthening mental health care for this population necessitates integrated service delivery, trauma-informed and culturally sensitive interventions, enhanced provider training, and structural reforms to reduce fragmentation and stigma. As the global population of older PLWH continues to grow, health systems must adapt to address their intersecting biological, psychological, and social vulnerabilities.
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