Women with depression are less likely to access anti-HIV medication, according to a US study published in the 1 August edition of the Journal of Acquired Immune Deficiency Syndromes. The study also found that African American women, drug and alcohol users and those without private health insurance were also significantly less likely to use HAART.
As part of a wider study to examine the response of women to HAART, investigators recruited 1668 HIV-positive women receiving HIV care in Chicago, Los Angeles, San Francisco, Brooklyn, the Bronx and Washington DC. Every six months between 1996 and 1998 trial participants attended their clinic for a range of medical tests and an interview about their HAART treatment since their last visit. Symptoms of depression were also measured every six months using a 20-item self completed questionnaire.
The women recruited to the study closely matched the wider demographics of HIV-positive women in US. The average age was a little over 36 and 57% were African American, 24% were Hispanic/Latina, and 19% white. Poverty and low educational attainment were widespread, with 41% defined as living below the conventionally recognised federal poverty level and 37% had not completed secondary education. Drug and alcohol use were common, with 42% reporting the use of street drugs or alcohol in the past six months and 41% using injection drugs at some time.
HIV-related symptoms had been experienced by over 50% of the study population throughout the period of the trial, and 74% of the women had a CD4 count of up to 500 cells/mm3. US treatment guidelines for the use of HAART between 1996 and 1998 HAART stated that treatments should have been offered to anybody with symptomatic HIV disease or a CD4 count below 500.
However, by 1998, only 45% of the women in the study were receiving HAART. A possible reason may have been the prevalence of depression in the study population. At the start of the trial, 51% of women were found to have depressive symptoms and over the course of the study 56% of the trial participants were defined as having symptoms of depression.
A statistically significant association was found between depression and drug use, a lack of a college education, no private health insurance and symptoms of HIV infection. It was established that 50% of women accessed mental health services during the course of the investigation, and that they were significantly more likely to do so if they were white, had a college education or had symptoms of HIV.
Worryingly, investigators also found that women reporting depressive symptoms were significantly less likely to have taken HAART. In addition, African American women, and those who used drugs or alcohol were also less likely to have used HAART. Conversely, white women and women with a college education were significantly more likely to report HAART utilisation.
The study authors emphasise that the rates of depression found in the trial were much larger than those in the general population or even amongst other groups of women who were chronically ill. In addition, HIV-positive women also displayed a much greater propensity to depression than men with HIV. The investigators also noted with concern that relatively few women living with psychological distress were accessing mental health services, with this being particularly notable amongst African American women and those with no college education.
In conclusion the authors note ‘HIV-seropositive women with poor mental health are less likely to use HAART…these findings suggest that efforts to enhance women’s access to mental health services may increase their use of HIV therapies. Given the complexities of these regimens, their expense, and their reliance on near-perfect adherence for efficacy, it is unlikely that women struggling to cope with serious psychiatric disorders and other emotional difficulties will successfully initiate complex multidrug regimens.’
Reference:
Cook JA. Effects of depressive symptoms and mental health quality of life on use of highly active antiretroviral therapy among HIV-seropositive women. Journal of Acquired Immune Deficiency Syndromes, 30:401-409, 2002.