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Clinical nurse specialist David Munns provides vital mental health support to people living with HIV 

鈥淏eing diagnosed with HIV can be devastating for some people. They need time to adjust to how they鈥檙e going to live with the virus from that point on,鈥 says David, a clinical nurse specialist in mental health and HIV at the Kobler Clinic at Chelsea and Westminster Hospital.

鈥淭here has been progress, but there鈥檚 a need for more education about HIV because of the ongoing stigma towards those living with it. They can feel isolated and lonely; many develop anxiety and depression following a diagnosis. It can have a huge impact on their self-esteem and confidence, which in some cases leads to unemployment and financial problems.鈥

David鈥檚 role is to make sure people diagnosed with HIV are supported with their mental health and continue to take their antiretroviral medication. Not doing so can put them at risk of becoming physically unwell, leading to increased hospital appointments and possible admission.

Pictured above: David with patient Rebecca de Havilland and nurse colleague Louise McGrath  

David is one of just two nurses across London who specialise in supporting the mental health of people living with HIV. Increasingly, he gets referrals for people over 50, partly because people are living longer with the virus.

鈥淪ince the clinic opened in 1988, the management of patients with HIV has changed. Rather than managing a peaceful death, we manage how people live with HIV. Getting old can be a frightening and lonely experience and if you鈥檙e living with HIV, it can present even greater challenges.鈥

Depression is twice as common among people who have HIV and David often sees people with associated problems such as drug or alcohol addiction. Symptoms of post-traumatic stress disorder (PTSD) related to a diagnosis of HIV are also common. This can lead to depression, anxiety and insomnia.

It’s my job to make sure our patients receive good mental health care while living with HIV


David holds outpatient clinics, receiving referrals from the community HIV team and also from the specialist inpatient ward at the hospital where he works. He makes sure people have access to a counsellor or psychiatrist if needed but is also on hand to offer brief intervention therapy.

鈥淟ots of what I do is listening,鈥 he says. 鈥淪ometimes that鈥檚 all that鈥檚 needed; a listening and sympathetic approach to people鈥檚 problems. I also act as an advocate to help people get financial support and provide a bridge between the general hospital and mental health services. It鈥檚 my job to make sure our patients receive good mental health care while living with HIV.鈥

Cost savings

David鈥檚 role is vital in saving the NHS avoidable costs in the treatment of HIV-related illness caused by people stopping their medication when experiencing a mental health crisis.

鈥淵ou might think, 鈥榳hy would anyone not want to take their medication?鈥, but for people struggling with a mental illness, they may stop taking medication due to depression or suicidal thoughts. Taking a tablet every day for the rest of your life is a challenge for most people, but with a mental health problem, this challenge is increased hugely,鈥 says David.

鈥淚 regularly keep in contact with patients who are more vulnerable and offer follow-ups alongside their normal mental health care. It鈥檚 so important we monitor and maintain that level of adherence to medication.鈥

If people with HIV take their medication correctly, the virus can become undetectable, so it can鈥檛 be transmitted. It鈥檚 vital to maintain undetectable levels of HIV in the fight against transmission.

David Munns

Maintaining good health

David鈥檚 clinic is helping people to live well with HIV. The number of referrals he receives is falling as he provides ongoing support to people in his care.

鈥淔or some people living with HIV, the clinic is their only point of access to any kind of health care professional,鈥 he says.

鈥淭hey build up a trusting relationship with us over the years and find it difficult to discuss their problems with anybody else. We do however try to encourage patients 鈥 no matter how chaotic their lifestyle - to register with a GP. 

鈥淚 hope that highlighting the roles we do will raise awareness of the importance of mental health for those living with HIV.鈥

One of David鈥檚 patients, Rebecca de Havilland, talks about how with David鈥檚 support, she's turned her life around

I was diagnosed with HIV in 1987 when HIV was very taboo and a killer disease. As well as having HIV, I am transgender.

As a result of all of this, I lost family and friends and my career as a successful hairdresser in Ireland.

I became a heroin and crack addict and was in and out of rehab. In 2007, I ended up on life support. I was sectioned and hit rock bottom.

I stopped taking drugs and eventually, I got back in touch with family in Ireland. My HIV was undetectable from taking my medication regularly. But I stopped taking the medication and in 2013, I ended up in hospital.

Eventually I moved to London as part of a new drug trial for advanced HIV. It was bleak as I was homeless and the problems with my mental health kicked in again.

Around this time, I met David, a nurse at the Kobler Clinic in London which helps people with HIV and their mental health. His clinic really helped me get back on my feet. He helped with getting benefits and was ready to help me outside of appointments. 

David went beyond the call of duty. He would intervene if I needed more intense therapy and kept me from being hospitalised. Thanks to his support, my HIV became undetectable again.

In the last three years, I鈥檝e got a lot better. I have a flat, have written a book and run a boot camp for transgender women.

I still see David as you can鈥檛 take your mental health for granted, but I can honestly say now, David and the NHS saved my life.


What the RCN says鈥

Jason Warriner, Chair of the RCN Public Health Forum, says: 鈥淎cross the UK we are working on the challenge to end new HIV infections by 2030. Nurses, like David, working in HIV and sexual health have a key role in achieving this target by promoting testing and supporting people living with HIV to access care and treatment, which includes support for their mental health.鈥

More information

David has a for patients living with HIV and mental health problems where he offers support, advice and shares information.

The RCN has a number of resources you can read on sexual health.

Words by Susan Embley. Photography: Benjamin Mole Photography

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