ABSTRACT
Little diagnostic information is available for those who represent a significant part of the HIV epidemic: substance-using members of racial and ethnic minority communities. Our paper describes the rates of psychiatric diagnoses in a convenience sample of HIV-positive, African American and Hispanic clients in methadone treatment in the Bronx, NY. Out of 139 HIV-positive volunteers, 99 subjects had diagnoses in addition to opioid dependence on agonist therapy. The mean number of diagnoses was 3.84 (SD = 1.41). These findings confirm the need to target mental health as part of the national response to the HIV/AIDS epidemic in inner cities.
Subject(s)
Black or African American , HIV Infections/ethnology , Hispanic or Latino , Mental Disorders/diagnosis , Mental Disorders/ethnology , Methadone/therapeutic use , Narcotics/therapeutic use , Opioid-Related Disorders/ethnology , Opioid-Related Disorders/rehabilitation , Adult , Comorbidity , Diagnostic and Statistical Manual of Mental Disorders , Female , HIV Infections/epidemiology , Humans , Male , Mass Screening/methods , Mental Disorders/epidemiology , Opioid-Related Disorders/epidemiologyABSTRACT
We identify the psychiatric diagnoses and utilization patterns of HIV-positive persons of color who received culturally responsive mental health services integrated into a community medical clinic. Ninety-three patients were referred and 86% (n = 80) appeared for at least one encounter. Hispanics, compared with African-Americans, and HIV patients, compared with AIDS patients, were more likely to receive psychotropic prescriptions. Patients with six or more visits were defined as high utilizers: they comprised 27.5% of the patients but used 67.3% of the services. Development of a broader range of psychiatric interventions that address diagnoses, utilization, and psychotropics will better meet these patients' needs.
Subject(s)
Black or African American/psychology , Community Health Centers/statistics & numerical data , Delivery of Health Care, Integrated , HIV Seropositivity/epidemiology , Hispanic or Latino/psychology , Mental Disorders/ethnology , Mental Disorders/therapy , Mental Health Services/statistics & numerical data , Primary Health Care , Psychiatry/methods , Urban Population/statistics & numerical data , Adolescent , Adult , Aged , Female , Humans , Male , Mental Disorders/drug therapy , Middle Aged , Psychotropic Drugs/therapeutic use , United States/epidemiologyABSTRACT
Although antiretrovirals can prolong life, medication adherence also poses a constant challenge for HIV-infected individuals because the success of antiretroviral regimens demands nearly perfect adherence to medications. This paper describes the psychiatric and social barriers to adherence in a convenience sample of HIV-positive clients in methadone treatment in the Bronx, New York. The study sample was part of a national study of HIV treatment adherence and health care utilization among triply diagnosed populations, the HIV/AIDS Treatment Adherence Health Outcomes and Cost Study. The triply diagnosed study sample is defined here as HIV-infected individuals who screened into the study with at least one psychiatric diagnosis in addition to opioid dependence on agonist therapy (methadone treatment) and at least one substance use diagnosis. Interviewers utilized modified versions of the Structured Clinical Interview for DSM-IV Disorders (SCID-I), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), and the Addiction Severity Index (ASI-Lite), among a battery of Cost Study instruments. Results showed that within this sample, borderline personality disorder was significantly associated with nonadherence to HIV medications. A related finding showed a significant relationship between serious social/family problems and nonadherence. These findings build on previous research on the impact of psychiatric illness on HIV medication adherence and suggest that psychiatric assessment and treatment options be linked to adherence interventions.
