Introduction   On October 10, 2024, the World Federation for Mental Health celebrated its 75^th anniversary under the theme "It's time to prioritize mental health in the workplace".  This theme is yet another reminder of the importance of mental health in the workplace, especially when working with marginalized communities with limited civic space   Before getting to the heart of the matter, let's recall one of the most widely recognized definitions of mental health. According to the World Health Organization (WHO), it is defined as "a state of mental well-being that enables us to cope with life's stressors, realize our potential, learn and work well, and contribute to community life. It is an integral part of health and well-being, which underpins our individual and collective ability to make decisions, build relationships and shape the world in which we live. Mental health is a fundamental human right. It is also an essential aspect of personal, community and socio-economic development."   Yet the mental health of activists defending sexual and gender minorities (MSG) remains largely ignored in programs to combat HIV, tuberculosis and malaria. In hostile legal contexts where the criminalization of sexual minorities persists, these human rights defenders find themselves on the front line, exposed to constant pressure and recurrent violations of their own fundamental rights.   The "Behind the Struggles" report, published by the Global Alliance of Communities for Health and Rights (GATS PLUS) on the occasion of World Mental Health Day 2024, highlights the psychological challenges faced by activists in Côte d'Ivoire, Guinea and Burkina Faso. By documenting their realities, it calls on donors, notably the Global Fund, to fully integrate mental health into their intervention and funding strategies.   Mental health, a blind spot in HIV programs   Efforts to combat HIV in sub-Saharan Africa, particularly in French-speaking Africa, are still largely focused on medical care, with psychosocial care taking a back seat. Although UNAIDS targets 95-95-95 and 10-10-10 aim for a global approach, they do not sufficiently integrate mental health, which is crucial for key populations and the activists who support them. The latter, on the front line in defending human rights, operate in highly discriminatory and anxiety-provoking environments, seriously damaging their psychological well-being.   While the Global Fund (GF) has taken steps to include mental health in its country programs, these efforts remain insufficient. In the last funding cycle (GC7), the mental health module was little used by countries, as revealed by the report of the Technical Review Panel for Windows 1 and 2. This low prioritization reflects a lack of systemic recognition of the inseparable link between mental health and the fight against HIV.   The Behind the Struggles report highlights the harrowing reality of activists working in contexts where laws criminalizing LGBTQI+ people remain in force. In Côte d'Ivoire, Guinea and Burkina Faso, these human rights defenders operate in a hostile social and legal environment that undermines their commitment and well-being.   While medical care is relatively accessible, psychosocial support remains largely neglected, exposing these activists to chronic stress, anxiety and post-traumatic stress disorder. The repercussions are manifold: burnout, severe depression, and a high turnover rate within organizations, exacerbated by the forced exile of many activists to countries in the North. This situation illustrates a major flaw in the response to the challenges of public health and the defense of fundamental rights.   Some of the mental health challenges facing activists   The report behind the struggles highlighted many challenges including:   Anxiety-provoking environment: The context of criminalization of identities in which community leaders evolve is a constant source of stress and anxiety. Many of them internalize this marginalization and see themselves as outlaws, living in perpetual anxiety. This oppressive climate drives many activists into exile as soon as an opportunity arises, weakening the rights movement and hampering the continuity of struggles.   Donor pressure: the demands of donors, often focused on rigid results-based management, rarely take into account the well-being of activists. The quest for efficiency takes precedence over the human factor: no matter how exhausted activists are, objectives must be met and reports submitted on time. This approach, insensitive to the realities on the ground, accentuates the psychological precariousness of human rights defenders.   The toxicity of the movement itself: the working environment for activists is itself a major source of stress. The scarcity of funding fuels fierce and sometimes unfair competition between organizations, forcing some to use questionable strategies to capture the attention of development partners. This unbridled competition, far from strengthening solidarity, contributes to the isolation and fragility of activists, already facing countless external pressures   Recommendations and prospects for an inclusive response   The Global Alliance of Communities for Health and Rights (GATS PLUS), through its "Behind the Struggles" report, calls on donors, including the Global Fund, to adopt a more holistic approach to the fight against HIV, tuberculosis and malaria in French-speaking Africa. The report's key recommendations include:   Increased funding for mental health services: It is essential to develop psychosocial support programs specifically for activists and key populations, to provide them with appropriate support in the face of the pressures of activism in hostile contexts.   Strengthen the training of healthcare professionals: The report calls for increased training of healthcare professionals in the areas of mental health and the needs of MSG. This includes the ability to manage trauma and respond sensitively to the realities of criminalized populations.   Create support spaces for activists: In the face of constant pressure, spaces for discussion and sharing must be created to enable activists to recharge their batteries and manage their stress. These spaces could be integrated into community initiatives supported by the Global Fund.   Advocacy for decriminalization: For activists to be able to carry out their work without fear of persecution, decriminalization of LGBTQI+ people is an imperative. The Global Fund and its partners must take clear positions to encourage legal reform in countries with repressive laws.   An invitation to technical and financial partners   The "Behind the Struggles" report calls for a renewed commitment from technical and financial partners to build the capacity of activists and address mental health needs in French-speaking Africa. The Global Fund, with its focus on community resilience, is ideally placed to integrate these recommendations into its next funding rounds, particularly as part of the 8th replenishment. The inclusion of a mental health component in funded programs could have positive spin-offs not only for activists but also for marginalized communities as a whole.   Conclusion   On the eve of the 8th re-enactment, it is essential to emphasize that struggles for health and human rights are not just about medical care, but also about protecting and supporting those working for equality and inclusion. For The Global Alliance of Communities for Health and Rights (GATS PLUS), and for all those who campaign alongside MSG, mental health is not a luxury, but a fundamental necessity. It is essential to ensure that rights defenders can continue their fight, resist repression and play an active part in building an inclusive French-speaking Africa, free of HIV and respectful of the rights of all.