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      Mental Health in Women Living With HIV: The Unique and Unmet Needs

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          Abstract

          Women living with HIV (WLWH) experience depression, anxiety, and posttraumatic stress symptoms at higher rates than their male counterparts and more often than HIV-unaffected women. These mental health issues affect not only the well-being and quality of life of WLWH, but have implications for HIV management and transmission prevention. Despite these ramifications, WLWH are under-treated for mental health concerns and they are underrepresented in the mental health treatment literature. In this review, we illustrate the unique mental health issues faced by WLWH such as a high prevalence of physical and sexual abuse histories, caregiving stress, and elevated internalized stigma as well as myriad barriers to care. We examine the feasibility and outcomes of mental health interventions that have been tested in WLWH including cognitive behavioral therapy, mindfulness-based interventions, and supportive counseling. Future research is required to address individual and systemic barriers to mental health care for WLWH.

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          Patient-centered communication, ratings of care, and concordance of patient and physician race.

          Lisa Cooper, Debra Roter, Rachel Johnson … (2003)
          African-American patients who visit physicians of the same race rate their medical visits as more satisfying and participatory than do those who see physicians of other races. Little research has investigated the communication process in race-concordant and race-discordant medical visits. To compare patient-physician communication in race-concordant and race-discordant visits and examine whether communication behaviors explain differences in patient ratings of satisfaction and participatory decision making. Cohort study with follow-up using previsit and postvisit surveys and audiotape analysis. 16 urban primary care practices. 252 adults (142 African-American patients and 110 white patients) receiving care from 31 physicians (of whom 18 were African-American and 13 were white). Audiotape measures of patient-centeredness, patient ratings of physicians' participatory decision-making styles, and overall satisfaction. Race-concordant visits were longer (2.15 minutes [95% CI, 0.60 to 3.71]) and had higher ratings of patient positive affect (0.55 point, [95% CI, 0.04 to 1.05]) compared with race-discordant visits. Patients in race-concordant visits were more satisfied and rated their physicians as more participatory (8.42 points [95% CI, 3.23 to 13.60]). Audiotape measures of patient-centered communication behaviors did not explain differences in participatory decision making or satisfaction between race-concordant and race-discordant visits. Race-concordant visits are longer and characterized by more patient positive affect. Previous studies link similar communication findings to continuity of care. The association between race concordance and higher patient ratings of care is independent of patient-centered communication, suggesting that other factors, such as patient and physician attitudes, may mediate the relationship. Until more evidence is available regarding the mechanisms of this relationship and the effectiveness of intercultural communication skills programs, increasing ethnic diversity among physicians may be the most direct strategy to improve health care experiences for members of ethnic minority groups.
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            Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis.

            Jeffrey S. Gonzalez, Abigail Batchelder, Christina Psaros … (2011)
            We meta-analyzed the relationship between depression and HIV medication nonadherence to calculate the overall effect size and examine potential moderators. Overall, across 95 independent samples, depression was significantly (P < 0.0001) associated with nonadherence (r = 0.19; 95% confidence interval = 0.14 to 0.25). Studies evaluating medication adherence via interview found significantly larger effects than those using self-administered questionnaires. Studies measuring adherence along a continuum found significantly stronger effects than studies comparing dichotomies. Effect size was not significantly related to other aspects of adherence or depression measurement, assessment interval (ie, cross-sectional vs. longitudinal), sex, IV drug use, sexual orientation, or study location. The relationship between depression and HIV treatment nonadherence is consistent across samples and over time, is not limited to those with clinical depression, and is not inflated by self-report bias. Our results suggest that interventions aimed at reducing depressive symptom severity, even at subclinical levels, should be a behavioral research priority.
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              Mental health and HIV/AIDS: the need for an integrated response

              Robert Remien, Michael Stirratt, Nadia Nguyen … (2019)
              Tremendous biomedical advancements in HIV prevention and treatment have led to aspirational efforts to end the HIV epidemic. However, this goal will not be achieved without addressing the significant mental health and substance use problems among people living with HIV (PLWH) and people vulnerable to acquiring HIV. These problems exacerbate the many social and economic barriers to accessing adequate and sustained healthcare, and are among the most challenging barriers to achieving the end of the HIV epidemic. Rates of mental health problems are higher among both people vulnerable to acquiring HIV and PLWH, compared with the general population. Mental health impairments increase risk for HIV acquisition and for negative health outcomes among PLWH at each step in the HIV care continuum. We have the necessary screening tools and efficacious treatments to treat mental health problems among people living with and at risk for HIV. However, we need to prioritize mental health treatment with appropriate resources to address the current mental health screening and treatment gaps. Integration of mental health screening and care into all HIV testing and treatment settings would not only strengthen HIV prevention and care outcomes, but it would additionally improve global access to mental healthcare.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Int Assoc Provid AIDS Care
                Journal ID (iso-abbrev): J Int Assoc Provid AIDS Care
                Journal ID (publisher-id): JIA
                Journal ID (hwp): spjia
                Title: Journal of the International Association of Providers of AIDS Care
                Publisher: SAGE Publications (Sage CA: Los Angeles, CA )
                ISSN (Print): 2325-9574
                ISSN (Electronic): 2325-9582
                Publication date (Electronic): 21 January 2021
                Publication date Collection: Jan-Dec 2021
                Volume: 20
                Electronic Location Identifier: 2325958220985665
                Affiliations
                [1 ]Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Ringgold 12244, universityNorthwestern University; , Chicago, IL, USA
                [2 ]Department of Psychiatry, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
                [3 ]Division of HIV/AIDS Prevention, Ringgold 1242, universityCenters for Disease Control and Prevention; , Atlanta, GA, USA
                [4 ]Department of Social Work, College of Health and Human Services, Ringgold 49340, universityGeorge Mason University; , Fairfax, VA, USA
                [5 ]Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Ringgold 12244, universityNorthwestern University; , Chicago, IL, USA
                Author notes
                [*]Elizabeth M. Waldron, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 676 N. Saint Clair St., Suite 1000, Chicago, IL 60611, USA. Email: emwaldron@ 123456u.northwestern.edu
                Author information
                https://orcid.org/0000-0002-7764-8521
                Article
                Publisher ID: 10.1177_2325958220985665
                DOI: 10.1177/2325958220985665
                PMC ID: 7829520
                PubMed ID: 33472517
                SO-VID: ba37c65a-e2b7-4188-8998-89de20df43ec
                Copyright © © The Author(s) 2021
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 14 July 2020
                Date revision received : 10 November 2020
                Date accepted : 08 December 2020
                Funding
                Funded by: Third Coast Center for AIDS Research;
                Award ID: SP0029591
                Categories
                Subject: Sex and Gender Issues
                Subject: Review
                Custom metadata
                cover-date January-December 2021
                typesetter ts3

                Keywords: women living with hiv,hiv/aids,mental illness,mental health treatment
                Data availability:
                Keywords: women living with hiv, hiv/aids, mental illness, mental health treatment

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