2. Triple Whammy—HIV, Mental Disorders, African Americans
Summary
Determining specific estimates of mental disorders among the HIV-positive population is difficult, although some investigators have tried to develop estimates of the extent of HIV-positive people who also have mental health problems:
- Depression—22% to 45%
- Anxiety disorders—38%
- Schizophrenia—estimated incidence data are wide-ranging and not clear
The most relevant categories of mental disorders among HIV-infected African Americans are mood disorders (depression and bipolar disorder), anxiety disorders (generalized anxiety disorder, post-traumatic stress disorder, and panic disorder), and the psychotic disorder, schizophrenia.
Although the incidences of such mental disorders among HIV-positive African Americans are not available, the disproportionate number of HIV-positive African Americans and the extent of underdiagnosis and misdiagnosis of mental disorders in African American communities likely mean that the incidences are at least as significant as among HIV-positive people as a whole.
Effective patient management requires coordination among primary care physicians, infectious disease specialists, and mental health professionals. Key aspects of comorbid HIV disease and mental disorders include:
- Mental disorders can increase the risk of acquiring or transmitting sexually transmitted diseases, including HIV.
- Mental disorders, including substance abuse, can predate and or complicate HIV-related illness.
- Mental disorders can affect antiretroviral adherence.
The challenges of managing HIV-positive patients with mental disorders require an integrated approach that includes treatment for their HIV disease, any comorbid mental disorders, and substance abuse when present. Depending on where they practice, mental health professionals should become as educated as possible in the medical management of HIV patients, as they may need to simultaneously manage mental disorders, anticipate potential psychiatric effects of some antiretrovirals, make appropriate referrals for patients with severe mental disorders, and manage other potential situations.
Treatment of HIV-positive persons with mental disorders will also require skills in culturally competent patient care, including treatment of individuals from such diverse communities as MSM, IDUs, various ethnic and racial populations, women, young people, and older adults. Clinicians, mental healthcare workers, and other healthcare providers will, therefore, need to be prepared to provide appropriate services in a context that requires team approaches and knowledge of more than a single specialty.
