The world is undergoing an epidemiological transition. While infectious diseases like HIV, TB, and malaria remain major public health challenges, noncommunicable diseases and mental health conditions are rapidly rising. Mental health is now one of the biggest contributors to poor health and disability worldwide. Yet mental health receives just 0.3% of development assistance for health.
If you had told us 5 years ago that the Global Fund – the world’s largest funder of HIV, TB, and malaria programmes – would highlight the importance of mental health in its strategy, we might have paused with cautious optimism. Today, we’re pleased to see it’s happening. It’s more than just words – it has been backed by funding and action.
However, this funding remains under threat. We are facing a pivotal moment.
The landscape has changed, and major global health financing mechanisms are now experiencing severe budget pressures. Pledges are shrinking, priorities are shifting, and we are already seeing the consequences. Mental health, which has only recently started to gain recognition in global health priorities, is once again at risk of being left behind.
Let us be clear—this would be a serious setback in the global HIV and TB response.
Why Mental Health Integration Matters
The data is unequivocal: people living with HIV and TB are 2 to 3 times more likely to experience depression and other mental health conditions. Studies have consistently shown that poor mental health significantly reduces treatment adherence, disrupts retention in care, and leads to worse health outcomes. When mental health is sidelined, the effectiveness of HIV and TB programmes is fundamentally compromised. Integrating mental health is not optional. It is essential to achieving sustained viral suppression, treatment success, and meaningful improvements in quality of life.
Advocacy in Action
We at United for Global Mental Health and the Elton John AIDS Foundation launched a bold $500,000 advocacy effort in 2022 to prioritise mental health. Through an intensive ecosystem advocacy approach spanning the global, regional, and national levels, we worked across 32 countries to support the inclusion of mental health into Global Fund supported programming.
The results have been powerful. For example, in Nigeria, Pakistan, the Philippines, and South Africa, the inclusion of mental health in Global Fund funding requests has grown sixfold. Governments want mental health integrated into their HIV and TB responses.
Beyond just numbers, however, are human stories. Millions of people now have better access to mental health care as part of their HIV and TB services. Community health workers feel better equipped. Communities are no longer navigating these conditions in silence.
The Value of Advocacy
We estimate that for every $1 invested in advocacy, $75 in HIV and TB funding has potentially been unlocked for integrated mental health care. That’s extraordinary value for money.
But this is no time for complacency.
Global health programmes are under a lot of pressure right now. Across organisations, the rhetoric of “do more with less” is becoming the norm. When funding is tight, mental health services, often misunderstood, stigmatised and undervalued, are among the first to be cut. We cannot let that happen.
Now more than ever, we need smart, sustained, and strategic advocacy:
- We must continue advocating for mental health services to be an essential, not optional, component in HIV and TB programmes.
- We must listen to governments who are calling for investment in mental health.
- We must strengthen coalitions of advocates, implementers, and donors who work together to ensure that mental health remains a priority even in this shifting landscape.
- Lastly, we must fight for sustained investment in mental health.
Access to mental health services is critical for the delivery of integrated, person-centered care – and for achieving the ambitious goals we’ve set in the fight against HIV and TB.
To everyone working on the frontlines of this movement: we see you. Your work is more important now than ever.
To multilateral donors, global health financing institutions and other decision-makers, we urge you not to retreat. Please do not abandon mental health just as the world begins to understand its value.
When we talk about ending HIV and TB, we must also talk about mental health. There is no health without mental health.
And we won’t stop until that vision becomes reality.
Read more about our advocacy work.
