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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A longitudinal study was conducted to investigate the association between human immunodeficiency virus (HIV) infection, history of major depressive disorder (MDD), and persistent or recurrent MDD among intravenous drug users. Psychiatric disorders were assessed in a sample of HIV-positive (HIV+) and HIV-negative (HIV-) intravenous drug users every 6 months for 3 years. Results indicated that HIV status and baseline MDD independently predicted persistent or recurrent episodes of MDD after gender, drug use, ethnicity, income, and the presence other psychiatric disorders were controlled statistically. Among HIV+ intravenous drug users with baseline MDD, 90% experienced at least one subsequent episode of MDD and 47% experienced at least three subsequent episodes of MDD. However, less than 40% of intravenous drug users with current MDD received treatment for emotional problems. These findings indicate that intravenous drug users with HIV infection and a history of MDD are at considerable risk for future episodes of MDD or recurrent MDD, and that increased provision of treatment for intravenous drug users with MDD may be necessary.
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PMID:Recurrent major depressive disorder among human immunodeficiency virus (HIV)-positive and HIV-negative intravenous drug users: findings of a 3-year longitudinal study. 992 74

The Well-Being Institute (WBI), a community-based nursing organization in Detroit, Michigan, has developed and put into practice innovative intervention and service delivery models to assist HIV-positive women who have a history of substance abuse and mental illness. These multiple-diagnosed women are known to have special problems and barriers to accessing health care. The service delivery model is based on "hyperlinking" women into hard-to-get health care appointment slots through nurses' personal contacts in health care clinics. The intervention model is the personalized nursing LIGHT model. This article describes the service delivery and intervention models and discusses outcomes of the WBI Women's Intervention Program in practice. The program locates HIV-positive, substance-abusing women; enrolls them in primary medical and mental health care; and helps retain them in health care. The results of the model in practice demonstrate its success in hyperlinking hard-to-reach and hard-to-serve HIV-positive women with health care and other needed services and resources. In addition, these multiple-diagnosed women have shown positive effects with respect to improved sense of well-being and decreased psychosocial distress.
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PMID:Nurses decrease barriers to health care by "hyperlinking" multiple-diagnosed women living with HIV/AIDS into care. 1006 10

Recent guidelines from the US National Institutes of Health (NIH) mandate the inclusion of adequate numbers of women in clinical trials. Ought such standards to apply internationally? Walzer's theory of justice is brought to bear on the problem, the first use of the theory in research ethics, and it argues for broad application of the principle of adequate representation. A number of practical conclusions for research ethics committees (RECs) are outlined. Eligibility criteria in clinical trials ought to be justified by trial designers. Research ethics committees ought to question criteria that seem to exclude unnecessarily women from research participation. The issue of adequate representation should be construed broadly, so as to include consideration of the representation of the elderly, persons with HIV, mental illness and substance abuse disorders in clinical research.
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PMID:Selecting subjects for participation in clinical research: one sphere of justice. 1007 Jun 36

Major depression is a common psychiatric presentation during the course of many chronic illnesses. Although estimates of its prevalence in people with human immunodeficiency virus (HIV) infection and acquired immunedeficiency syndrome have varied widely in the literature, it has become increasingly clear that people with HIV infection experience depression or depressive symptoms frequently, and that major depression may be the most common psychiatric disorder. This report reviewed the currently reported data and clinical trials for treatment of depression or depressive symptoms in the course of HIV infection. We have reviewed both psychopharmacologic and psychotherapy trials and although blinded efficacy studies are the gold standard, because there is often a lack of data, we have included noncontrolled (open) trials for comparison. Pharmacologic medication trials show that selective serotonin reuptake inhibitors (SSRIs), although not more efficacious, may be more tolerable and have greater overall effectiveness. Furthermore, when medications are used to treat depression, it may be essential to evaluate for tolerability and potential drug interactions to increase efficacy. Psychotherapy trials have investigated a variety of treatment modalities including group, individual, and stress reduction techniques. In treatment trials, all of these modalities have been associated with a reduction in distress and depressive symptoms. With the advances in therapy for HIV infection, treatment of a major depressive episode or depressive symptoms has become increasing important because untreated depression could both compromise medication adherence and potentiate the disabling effects of the illness.
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PMID:Major Depressive Disorder and HIV-1 Infection: A Review of Treatment Trials. 1008

HIV/AIDS is one of the major issues to be faced by the mental health care sector over the next decade. Many mentally ill people already have or will become infected with HIV due to a range of factors including lack of information and poor risk prevention skills. Others without a previous history of mental illness will develop mental health problems because of the effects of HIV on the CNS. Most people with HIV/AIDS will also experience severe depression and anxiety related to their infection while others will develop AIDS related dementia. HIV/AIDS related training is necessary for mental health professionals so that people with HIV/AIDS are given high quality non-discriminatory care. The need for further research in the area of HIV/AIDS and mental health is also discussed.
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PMID:Mental health, HIV and AIDS: a review of the literature. 1011 55

No studies have reported HIV risk behavior in rural populations with severe mental illness. A total of 84 rural patients with severe mental illness in New Hampshire and 158 urban patients in Baltimore were interviewed about their HIV risk behavior in the past six months using the Risk Assessment Battery, a 38-item structured clinical interview. Rates of sexual and drug risk behavior among rural patients were significantly lower than among urban patients. Regression analyses showed that urban setting, younger age, never having been married, and a bisexual or gay orientation significantly predicted higher HIV risk scores. The differences in risk behaviors may reflect urban-rural differences in drug availability and sexual practices.
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PMID:HIV risk factors among people with severe mental illness in urban and rural areas. 1021 41

We conducted focus groups with 36 men and women who were receiving treatment for a severe and persistent mental illness (SPMI) to learn more about the social context of their intimate relationships and the psychological antecedents of their sexual decision-making. Qualitative analysis of focus group transcripts indicated that a) sexual activity tended to be unplanned and occurred in social networks where HIV risk may be elevated, b) HIV-related knowledge was superficial and insufficient to guide safer sexual behavior, c) participants' HIV risk perception was often based upon factors unrelated to their sexual behaviors, and d) communication skills for HIV risk reduction were poor. We discuss how qualitative methods yielded insights not readily available through quantitative approaches and offer recommendations for HIV risk assessment and prevention among persons with an SPMI.
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PMID:Understanding HIV-related risk among persons with a severe and persistent mental illness: insights from qualitative inquiry. 1022 53

The Swedish approach to HIV is based on HIV-positive individuals' fulfilling their societal obligation to prevent further spread of the disease. Under section 38 of the Communicable Disease Act of 1989, compulsory admission to hospital may be resorted to in cases where voluntary efforts have failed to bring about modification of high-risk behaviour. The article consists in a report of a retrospective study of the effects of such enforced isolation in the HIV-positive subgroup committed under the Act within an eight-year period. Relevant information was obtained from the records of medical and psychiatric hospitals, the social services and correctional care authorities. Modification of high-risk behaviour was assessed by enquiries involving attending physicians, the social services, and prison and police authorities, and by interviews with the patients. During the 8-year period, 1.5 per cent (44/2982) of registered HIV-positive patients in Stockholm County were committed by the county administrative court to compulsory admission. Of the 44 patients, 25 (57%) were born in Sweden, and 19 (43%) elsewhere (mostly sub-Saharan African countries where HIV is highly endemic). Intravenous drug abuse was very common in the subgroup, and 34 per cent of them were diagnosed as having a psychiatric disorder or intellectual handicap. Thirty-four (77%) of the subgroup were released after varying periods of isolation. Follow-up at 6, 18 and 36 months showed the overwhelming majority to be capable of maintaining a low-risk profile, and only 20 per cent to be characterised by continued high-risk behaviour (suspected or verified). The results thus suggest that individuals with the intellectual and psychiatric capacity to comprehend the serious nature of HIV infection and its modes of transmission can successfully modify risk behaviour by undergoing intensified individualised programmes, provided the duration of isolation is sufficiently long.
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PMID:[Evaluation of the law of communicable disease control: compulsory isolation can reduce the high-risk behavior of HIV-positive individuals]. 1219 38

Data were collected from 88 homeless persons in Port-of-Spain, Trinidad to assess HIV risk. 68% of the sample were engaging in unprotected sex with multiple partners, 25% were exchanging sex for money, and 29.5% were regularly smoking crack cocaine. Many had two or more of these behaviours that put them at high risk of HIV infection. Females were significantly more likely to be sex traders, to engage in bisexual behaviour and to have a history of psychiatric illness. The relationship between psychiatric illness and HIV risk behaviours among homeless female persons is explored. Educational interventions are suggested to reduce the public health risks in this population.
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PMID:Drug use, sexual behaviour and HIV risk of the homeless in Port-of-Spain, Trinidad. 1049 3

This study assesses the prevalence of specific traumatic stressors that meet criterion A for the Diagnostic and Statistical Manual of Mental Disorders' (DSM-IV) diagnosis of posttraumatic stress disorder (PTSD) and symptoms of PTSD in a representative sample of HIV-infected women. The study also assesses the impact of these stressors and symptoms on the clinical progression of HIV infection. The Life Stressor Checklist and the Impact of Events Scale-Revised were administered via interview to 67 Africa-American women beyond the initial stages of HIV infection. The ratio of CD4 t-cells to CD8 t-cells were abstracted from medical records at dates that approximated psychological interviews and were examined at two points in time 12 to 14 months apart. The prevalence of traumatic stressors and PTSD symptoms were high among HIV-infected women. Traumatic stressors were significantly associated with a lower CD4 to CD8 ratio at the 1-year follow-up. Among women who reported a traumatic event, those who also met criteria for PTSD evidenced a lower CD4 to CD8 ratio at the follow-up assessment. The study concludes that prevention and treatment efforts targeted at HIV-infected women must take into account traumatic stressors and PTSD symptoms and their potential impact on the course of the disease.
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PMID:Traumatic stress in HIV-infected women. 1049 56


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