Abstract
Major depressive disorder (MDD) is highly prevalent among HIV-infected (HIV+) individuals, and is associated with non-adherence to antiretroviral therapy (ART), and accelerated disease progression. MDD is underdiagnosed and undertreated among low-income African Americans, who are disproportionately impacted by the HIV epidemic. To improve detection and treatment of depression among African Americans living with HIV/AIDS, it is important to understand culturally and contextually relevant aspects of MDD and attitudes about mental health treatment. A focus group session was conducted with seven providers and staff at a primary care center that serves a largely African-American community heavily impacted by the HIV epidemic in Washington, DC. Data were analyzed using an inductive approach to distill prominent themes, perspectives, and experiences among participating providers. Five themes emerged to characterize the lived experiences of HIV+ African-American patients: (a) Changes in perceptions of HIV over time; (b) HIV is comorbid with mental illness, particularly depression and substance abuse; (c) Stigma is associated with both HIV and depression; (d) Existing mental health services vary and are insufficient and (e) Suggestions for optimal treatment for comorbid HIV and depression. This study reflects the views of providers from one clinic in this community. Substantial economic disadvantage, pervasive childhood adversity, limited education and limited resources jointly put members of this community at risk for acquisition of HIV and for development of depression and addictions. These contextual factors provide an important reminder that any patient-level depression identification or intervention in this community will have to be mindful of such circumstances.
Highlights
Major depressive disorder (MDD) is a significant public health problem among individuals living with HIV
Five themes emerged to characterize the lived experiences of HIV+ AfricanAmerican patients: (a) Changes in perceptions of HIV over time; (b) HIV is comorbid with mental illness, depression and substance abuse; (c) Stigma is associated with both HIV and depression; (d) Existing mental health services vary and are insufficient and (e) Suggestions for optimal treatment for comorbid HIV and depression
The compounding effect of depression and HIV is acute among urban-dwelling, low-income African Americans, because they are disproportionately affected by HIV/AIDS [8], and because they are less likely to be accurately diagnosed with depression, to seek or access mental health treatment, or to receive adequate treatment when they do access care, compared to other ethnic groups in North America
Summary
Major depressive disorder (MDD) is a significant public health problem among individuals living with HIV. The compounding effect of depression and HIV is acute among urban-dwelling, low-income African Americans, because they are disproportionately affected by HIV/AIDS [8], and because they are less likely to be accurately diagnosed with depression, to seek or access mental health treatment, or to receive adequate treatment when they do access care, compared to other ethnic groups in North America. When applied to members of a specific minority group, evidence-based psychosocial interventions are significantly more effective if these interventions are adapted to incorporate cultural values and beliefs, and to recognize salient community-specific and socio-economic factors [9,10,11,12,13]. Major depressive disorder (MDD) is highly prevalent among HIV-infected (HIV+) individuals, and is associated with non-adherence to antiretroviral therapy (ART), and accelerated disease progression. To improve detection and treatment of depression among African Americans living with HIV/AIDS, it is important to understand culturally and contextually relevant aspects of MDD and attitudes about mental health treatment
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