AETC-NMC
   

Case Studies

Caroline

Caroline is a 50-year-old African American married woman with a history of major depression.  It has been difficult to help her stabilize the depression because every time symptoms remit for about six weeks, she decides she is cured and stops taking her medicine. She has a history of high cholesterol and has come in for blood work. When you tell her your practice now recommends HIV testing as part of routine testing, she consents to be tested. She is shocked when she learns she has tested positive.  She says she has never used injection drugs and that her husband has been her only sexual partner for the past 25 years. She appears terrified of telling her husband. She says her family will never understand. She asks you what she should do now.

Discussion Questions

  1. How would you answer Caroline’s question?
  2. How will you proceed?
  3. How might Caroline’s depression affect HIV management?
  4. How might being African American and having depression interact to affect HIV management for Caroline?

Emmanuel

Emmanuel is a 16-year-old African American boy. He has been your patient for 10 years. Two years ago, shortly after he started high school, you referred him to treatment for anxiety disorder, which has been under control for over a year. His mother has brought him in for treatment of plantar warts. You advise him that your practice advises HIV testing as part of routine blood work, for which he is due. He receives rapid testing and asks to hear results without his mother present. Upon hearing he tested positive, Emmanuel bursts into tears and says, “My parents will kick me out when they find out I’m gay.” He then has a panic attack.

Discussion Questions

  1. How will you proceed?
  2. How do think cultural factors might affect clinical management for Emmanuel?
  3. What are your responsibilities regarding Emmanuel’s fear that his parents will kick him out?
  4. Emmanuel is taking a drug for anxiety disorder that interacts adversely with HAART. If he continues in your care, how will you help him to manage both diseases and avoid negative drug interactions?

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Howard University College of Medicine AIDS Education and Training Center - National Multicultural Center