HIV and mental health: The elephant in the room


In his famous poem “The Blind Men and the Elephant”, John Godfrey Saxe retells an Indian parable about three blind men who went to see an elephant. Of course, being blind, they could only ‘see’ the elephant by touching it. When asked to describe the elephant, one grabbed it by its trunk and said, “An elephant is like a snake!” The second man took his turn to touch it, pulled it by the leg, and confidently determined, “No, an elephant is like a tree trunk!” The third and final person to touch the elephant grabbed it by its tusks and said, “Tsk, tsk, tsk, you are both wrong: an elephant is smooth, cold and hard.” Each of the men touched the elephant, yet from their perspectives, the experiences of the elephant were totally different.

Most of us know that people living with HIV experience higher rates of mental health concerns including anxiety, depression, substance-use problems and post-traumatic stress disorder. We are also aware of the challenges around mental health services and public health insurance and the huge waiting lists for counselling. What we’re not aware of is the full perspective of the elephant, from both the HIV and mental health fields. What are the innovations in mental health service provision across the country that can be shared, adapted and scaled up?

In a time of deepening integration of health services and financial constraints, when we are all being asked to do more with less, it is critical for HIV and mental health workers to strategize together to ensure that the mental health needs of people living with HIV are being addressed. It is the elephant that is being viewed by different sectors from different perspectives.

This past September, 70 people from across the country gathered for the 2017 Realize Forum about HIV and mental health in Canada, with a focus on meeting unaddressed challenges in policy and community action. We wanted to zero in on what mental health services work and what needs to be improved by examining the issue from the perspectives of people living with HIV.

The day was an opportunity to listen to people who developed and implemented innovative programs – from ensuring all frontline workers (clinicians, clerical and janitorial staff) receive basic training in harm reduction, to health centres increasing drop-in hours (versus scheduled appointments) so they can better serve clients with mental health concerns. The day was a chance to learn what programming can be adapted elsewhere and how others can do it, and finally to explore where these services can go next.

The dialogue must continue if we are to learn, share and work together. The Forum was an opportunity for people engaged in HIV and mental health work to network and collaborate in a supportive and innovative way. Realize will continue to encourage these types of exchanges so that this work takes place on an ongoing basis and at a national level.


To learn more about Realize’s National Network on HIV and Mental Health, contact Wendy Porch, manager of Episodic Disabilities Initiatives, at or at 416-513-0440 ext. 222.

 In February 2015, Tammy C. Yates became the first black woman to be appointed as executive director of a national partner organization in Canada’s HIV response when she was named to lead Realize. She has over a decade of senior management, administration and communications experience in the non-profit and international development sectors.



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