PALM SPRINGS, Calif--Women with HIV represent the fastest growing segment of the epidemic and are among the most vulnerable for the undermanage-ment of both pain and psychological distress, Robert Boland, MD, and Margaret McDonald, CSW, said at the Academy of Psychosomatic Medicine meeting.
Although large epidemiologic studies have shown that depression is commonly associated with AIDS, the depressive symptoms of women with HIV have not been well studied.
Dr. Boland, of the Miriam Hospital, Providence, RI, reported on a longitudinal study (the HIV Epidemiology Research Study, or HERS, sponsored by the CDC) in which data were gathered on women at four urban sites (Baltimore, Providence, New York, and Detroit) using the Center for Epidemiologic Studies Depression Scale (CES-D).
In a group of predominately African-American women (261 asymptomatic HIV seropositive women and 234 at-risk seronegative women), depression scores for both groups were significantly higher than those in the general population.
Women in both groups reported a dramatic number of psychosocial stressors, Dr. Boland said, including insufficient money to pay for housing, unsafe housing, relationship difficulties, having been attacked or raped, and having their children taken away from them.
Increased Stressors the Key
Those women who were HIV seroposi-tive reported greater numbers of psycho-social stressors than did the women who were seronegative. Yet there were no significant differences between the two groups in depression scores (a mean of 20 for both groups, compared with an average of 8 for the general population).
Further analysis suggested that increases in stressors and IV drug use were associated with higher depression scores, but HIV status did not contribute to depression scores. Additionally, in the seroposi-tive group, neither CD4 count nor length of time since diagnosis affected depression scores.
At early stages of the infection, depression is not associated with HIV status but with the presence of psychosocial stressors, Dr. Boland suggested. "Maybe depression plays a role in acquiring HIV. Possibly the distortions in self-image inherent in depression may lead to reduced care in practicing safe sex or other preventive behaviors," he said, adding that this connection may have important implications for AIDS prevention programs.