Fans of the British rock band Queen cannot fail to have noticed the recent release of Bohemian Rhapsody, a biopic directed by Bryan Singer and produced by the band’s one-time manager Jim Beach. The film charts the journey of Farrokh Bulsara, the aspiring Parsi singer-songwriter who would later metamorphose into Freddie Mercury. In a moving (if perhaps overly sanitised) portrayal of Queen’s rise to fame, Freddie struggles with his sexuality, his rather parasitic second manager, and the alienation of his fellow band members before a reconciliation that ultimately climaxes with what is arguably the most memorable of the Live Aid performances. Around this time (allowing for a little poetic licence), Freddie tells his band mates that he has AIDS. As fans will know, he ultimately succumbed to his illness on November 24, 1991, aged just 45.

Perhaps the release of the film is timely given that World AIDS Day falls on December 1, a date that has been marked annually since 1988. Its purposes are to raise public awareness of the pandemic caused by the spread of HIV and to remember all those who have died from the disease. It is one of eight official global public health campaigns instigated by the World Health Organization, and is credited as the brainchild of James W Bunn and Thomas Netter of the WHO’s Global Programme on AIDS – now known as UNAIDS. Each year has carried a different theme, ranging from matters of gender, to young people, to stigma and discrimination, to the role of the community, to human rights and universal access issues, to prevention of spread. Since 1993, the US President has made an official proclamation each year for World AIDS Day, raising its profile considerably.

According to the WHO, 36.9 million people were living with HIV in 2017, around 21.7 million (just shy of 59%) of whom were receiving antiretroviral treatment.¹ Unsurprisingly, the WHO reports that most people (some 25.7 million) with AIDS live in Africa, while 3.5 million live in South-East Asia and 3.4 million live in the Americas. Around 1.8 million people were newly infected with HIV in 2017, a figure that is down from 2.8 million in 2000. In 2017 meanwhile, around 940,000 people died as a result of the illness, down from 1.5 million in 2000. However, at present the WHO estimates that only 75% of people with HIV are aware of their disease status – a figure that is as low as 46% among women in Africa aged 15-24. In most regions across the world, more women than men receive antiretroviral treatment – Europe being the only exception.¹

A recent paper by Abas and O’Clerigh in the Lancet Psychiatry makes reference to the UNAIDS objectives for 2020 that 90% of people with HIV will know their status, that 90% will be in receipt of antiretroviral treatment and that 90% of the latter will be virally suppressed.^2,3 By meeting these targets worldwide, it is predicted that the AIDS pandemic will end by 2030. According to the authors, ways in which those working in psychiatry can assist include the promotion of HIV testing in the context of stigma and traumatic experience, better advocacy for interventions that acknowledge the prevalence of mental disorders among people with HIV and finally the provision of practical training in techniques such as, for example, motivational interviewing to enhance adherence to medications. It won’t bring back Freddie but it may benefit many others. 

References

1. Miles to go – closing gaps, breaking barriers, righting injustices. Global AIDS update 2018. Joint United Nations Programme on HIV and AIDS, Geneva; 2018 

2. Abas M, O’Clerigh C. Global mental health and the ambition to end AIDS by 2030. Lancet Psychiatry (2018); 5(11):867-9

3. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. UNAIDS - UNAIDS JC2684. Joint United Nations Programme on HIV/AIDS (UNAIDS), 2014 - UNAIDS Geneva