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In a study of diagnostic classifications and service utilization patterns observed among persons of color living with HIV and receiving"culturally responsive" mental health services integrated into an urban HIV primary care clinic, Budin, Boslaugh, Beckett, and Winiarski (2004) found that 80 (86%) of 93 persons referred for psychiatric consultation presented for at least one encounter and the average number of encounters was 4.2. Psychotropic medications were more often prescribed to Hispanics (when compared with African Americans) and people living with HIV (when compared with people living with AIDS). The 25.5% of this sample with six or more visits ("high utilizers") consumed 67.3% of services offered. In terms of diagnosis,"[t]he frequency of Substance Use Disorders [38.7% of sample], Major Depressive Disorder [24.5%], Panic Disorder with Agoraphobia [11.3%], and Personality Disorders [13.2%] suggests that clinicians need to have a high index of suspicion for these conditions in HIV-positive persons of color in the urban primary care setting"(p. 376).
Blaney et al. (2004) analyzed data from interviews with 307 pregnant women living with HIV (71% African-American or black Caribbean, 20% Latino) and found that
[d]epressive symptomatology was considerable, despite excluding somatic items... to avoid confounding from prenatal or HIV-related physical symptoms [and that] psychosocial factors significantly predicted the level of prenatal depressive symptoms beyond the effects of demographic and health-related factors. Perceived stress, social isolation, and disengagement coping [(i.e., giving up)] were associated with greater depression, positive partner support with lower depression. These findings demonstrate that psychosocial and behavioral factors amenable to clinical intervention are associated with prenatal depression among women of color with HIV . Routine screening to identify those currently depressed or at risk for depression should be integrated into prenatal HIV-care settings to target issues most needing intervention. (p. 405)
Florence et al. (2004) surveyed 166 women living with HIV in seven European countries and found that 25% reported moderate to severe female sexual dysfunction (FSD). No single sexual disorder predominated in this sample, nor was dysfunction associated with any particular antiretroviral or antiretroviral combination. Rather, psychological distress (i.e., depression, irritability, and anxiety) was the sole risk factor associated with sexual dysfunction in this sample. Furthermore, reductions in sexual functioning were reported to have occurred since the time of HIV diagnosis, but not since initiating antiretroviral treatment. While this study was not representative of all women living with HIV disease, the authors nevertheless conclude that"FSD is frequent among HIV-positive women. Antiretroviral treatments do not seem to play an important role in this syndrome, which is probably mainly driven by psychological factors. Sexual function of HIV-positive women should be regularly investigated in daily clinical practice by standardized and validated tools" 4 (p. 556).
4 The instrument used in this study was the Female Sexual Function Index (FSFI; Rosen et al., 2000).
  
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Fall 2004 Newsletter /
Volume 6, Issue 1
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