ABSTRACT
INTRODUCTION: HIV-infected individuals face a tremendous burden of psychiatric comorbidity. This study evaluates a community health care system's effort to screen for psychiatric disorders among patients at an HIV clinic and evaluate adherence to psychiatric service utilization. METHODS: Standardized screening measures were used to identify participants who met diagnostic symptom criteria for post-traumatic stress disorder (PTSD), acute stress disorder (ASD) and depression. All participants who screened positive were referred for psychiatric follow-up. Rates of utilization were measured and barriers to adherence were investigated. RESULTS: Of the 210 participants, 118 patients met screening criteria for PTSD, ASD, and/or depression, and 116 of these had medical records available for review. Of the 116 patients with psychiatric comorbidity, 46.6% saw a psychiatrist and/or were prescribed a psychiatric medication. Thirty-two percent of Latinos, 40.5% of African Americans, and 38.5% of heterosexuals utilized referred psychiatric services, and these rates were significantly less than their counterparts. One hundred patients were seen by a social worker. DISCUSSION: While a large burden of psychiatric comorbidity exists among this population of HIV-positive patients, only half adhered to recommended psychiatric services referrals. Further research is warranted to examine cost-effective interventions to maximize psychiatric screening, referral, and follow-up with mental health services in this vulnerable population.
Subject(s)
Community Mental Health Services/statistics & numerical data , Depressive Disorder/therapy , HIV Infections/psychology , Patient Compliance/statistics & numerical data , Stress Disorders, Post-Traumatic/therapy , Stress Disorders, Traumatic, Acute/therapy , Adult , California , Depressive Disorder/complications , Depressive Disorder/diagnosis , Female , HIV Infections/complications , Humans , Male , Mass Screening , Middle Aged , Poverty , Program Evaluation , Referral and Consultation , Risk Factors , Stress Disorders, Post-Traumatic/complications , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Traumatic, Acute/complications , Stress Disorders, Traumatic, Acute/diagnosisABSTRACT
To describe the determinants of delayed HIV presentation in one Northern California County, the authors identify persons with an opportunistic infection (OI) at HIV diagnosis. From 2000-2002, a sample of HIV patients attending a public AIDS program (n=391) were identified. Immigrants composed 24% of our sample; 78.7% of immigrants were Hispanic. Immigrants, compared to U.S.-born patients, presented with lower initial CD4+ counts at diagnosis than U.S.-born patients (287 cells/mm(3) vs. 333 cells/mm(3), p=0.143), were more likely to have an OI at HIV diagnosis (29.8% vs. 17.2%, p=0.009), and were more likely to be hospitalized at HIV diagnosis (20.2% vs. 12.5%, p=0.064). We found only immigrant status was significantly and independently associated with delayed presentation. Interviews with 20 newly HIV diagnosed Hispanic patients suggest lack of knowledge regarding HIV risk, social stigma, secrecy and symptom driven health seeking behavior all contribute to delayed clinical presentation. The main precipitants of HIV testing for immigrants were HIV/AIDS related symptoms and sexually transmitted infection (STI)/HIV diagnosis in a sexual partner. These results support augmentation of STI/HIV voluntary clinical testing and partner notification services along the Mexico-California migrant corridor.
Subject(s)
Emigration and Immigration , HIV Infections/diagnosis , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/transmission , Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/transmission , Adult , Attitude to Health , California , Contact Tracing , Counseling , Female , HIV Infections/transmission , Hispanic or Latino , Hospitalization , Humans , Interviews as Topic , Male , Multivariate Analysis , Risk Factors , Sexual Partners , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/transmission , Transients and MigrantsABSTRACT
OBJECTIVES: To examine prevalence and patterns of smoked marijuana and perceived benefit and to assess demographic and clinical factors associated with marijuana use among HIV patients in a public health care setting. METHODS: Participants (n = 252) were recruited via consecutive sampling in public health care clinics. Structured interviews assessed patterns of recent marijuana use, including its perceived benefit for symptom relief. Associations between marijuana use and demographic and clinical variables were examined using univariate and multivariate regression analyses. RESULTS: Overall prevalence of smoked marijuana in the previous month was 23%. Reported benefits included relief of anxiety and/or depression (57%), improved appetite (53%), increased pleasure (33%), and relief of pain (28%). Recent use of marijuana was positively associated with severe nausea (odds ratio [OR] = 4.0, P = 0.004) and recent use of alcohol (OR = 7.5, P < 0.001) and negatively associated with being Latino (OR = 0.07, P < 0.001). No associations between marijuana use and pain symptoms were observed. CONCLUSIONS: The findings suggest that providers be advised to assess routinely and better understand patients' "indications" for self-administration of cannabis. Given the estimated prevalence, more formal characterization of the patterns and impact of cannabis use to alleviate HIV-associated symptoms is warranted. Clinical trials of smoked and noncombustible marijuana are needed to determine the role of cannabinoids as a class of agents with potential to improve quality of life and health care outcomes among patients with HIV/AIDS.