Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 24228-24232 485

and drug use on depression. The results suggest that depression in IDUs is a
dynamic process involving multiple social-psychological and physical influences.
Depression treatment for HIV+ drug users should address the interconnectedness
of these physical and psychological states.
S24228 Bridging AIDS and assistance - Emotional issues
interfering in the relationship between professionals and
PWAs
Carmen F. Lent1, A.V. Menezes2, E. Losicer2, N.M. Munoz2. 1Rua Lopes
Quintas 211 Rio de Janeiro, RJ 22460 010; 21DAC, Rio de Janeiro, RJ, Brazil
Issue: Despite their technical knowledge, health care professionals are not always aware of and have very little resources to deal with the emotional burdens
of working on the field of AIDS care.
This lack of awareness affects severely both the quality of the medical treatment
- its onset and continuity - as well as the professional's well being and capacity
to carry on with work.
Project: A team of mental health professionals conducted a one year qualitative research focusing three groups: 1) PWAs, 2) Health care professionals
(physicians, nurses, social workers) and 3) Psychotherapist conducting long term
therapies with PWAs. They were approached through individual in-depth interviews, as well as group discussions, on the matter of the emotional impact of
giving/receiving assistance. Comparing the different data provided by each of
the 3 groups, allowed to state a range of emotional issues interfering in the
relationship between professionals and clients.
Results: The outcome of the research was published in the form of an educational material (called "Bridges") for health professionals, addressing the following
issues: changes in the epidemic; the emotional impact of HIV infection and how
it affects different groups; the professional-client relationship; professional burnout; the emotional reactions to the stages of HIV infection; the emotional cost of
medical treatment for the patient; the weight of the professional's own biases.
5000 issues were distributed nation wide, with high acceptance among different
professional groups involved in direct assistance.
Lessons Learned: This research stated the utmost importance of emotional
burdens in the relationship between professionals of direct assistance and PWAs,
showing that their impact, on both populations, may jeopardize the quality of the
treatment and its outcome. The absence of awareness of this situation results
in lack of necessary support for professionals in the field and calls for urgent
attention.
24229 Treatment of depression in HIV positive women
Stephen Ferrando1, J.G. Rabkins2, D. Heller2, J.L. Jacobs2. 1 Center for Special
Studies-NY Hospital 525 E. 68th St., F24 New York, NY 10021; 2Cornell Univ.
Medical College New York NY, USA
Background: Treatment of depressed HIV+ women has received little research
attention. This study aimed to assess the effectiveness of fluoxetine and sertraline in treating depressed HIV+ women and to document barriers to study
participation.
Methods: Ambulatory HIV+ women with major depression (SCID for DSM-IV)
were enrolled in an 8-week, open label trial of fluoxetine (N = 18) or sertraline (N
= 6) initiated at standard dosages. Outcome measures included Clinical Global
Improvement (CGI), Hamilton Rating Scale for Depression (HAM-D) and Anxiety
(HAM-A), Beck Depression Inventory (BDI), ratings of physical symptoms, CD4
count and beta-2 microglobulin level.
Results: 35 women were screened for the study and 24 enrolled. Subjects
had a mean age of 34, had acquired HIV through heterosexual contact (N = 12;
50%) and intravenous drug use (N = 12; 50%), nearly all were ethnic minorities
(Hispanic, N = 13, 54%; Black, N = 9, 38%; White, N = 2, 8%) and mean CD4 was
487 (range 21-1142). Psychiatric, social and medical comorbidity were common.
Fourteen (58%) completed the trial (12 fluoxetine, dose range 10-60 mg; 2 sertraline, dose 50 mg), while 10 dropped or were lost to followup. Of completers, 11
(79%) were clinical responders by CGI. Statistically significant reductions were
seen in HAM-D, HAM-A and BDI scores, but not in physical symptom severity,
CD4 counts or beta-2 microglobulin levels. The most frequent adverse effects
included anxiety, insomnia, nausea and headaches. Reasons for non-participation or dropout included hesitancy to accept antidepressants, adverse effects,
psychosocial issues such as childcare and relapse to illicit drugs.
Conclusion: While HIV+ women may benefit from antidepressant treatment,
multiple barriers to successful treatment may exist. Aggressive outreach, education and attention to the unique psychosocial needs of women are essential
components of depression treatment in this population.
|24230 | A survey of the mental health care needs of HIV positive
adolescents and young adults
Ron Henderson1, J. Colgrove2, H. Lusk2. 11242 Market Street, 3rd Floor San
Francisco, California; 2Health Initiatives for Youth San Francisco CA, USA

Issues: The mental health needs of HIV positive youth ages 12-24 are poorly
understood and inadequately addressed. Common psychological morbidities and
successful interventions with this population need to be more precisely documented.
Project: We conducted structured interviews with eighteen providers of mental
health care services to HIV positive youth in San Francisco and Los Angeles, CA.

The purpose of the interviews was to identify common psychological morbidities
seen in HIV positive youth; successful interventions that have been used; and
changes seen in mental health issues in light of recent advances in anti-HIV
drug therapies. Respondents represented a range of mental health backgrounds
and disciplines, including psychology, psychiatry, and social work, and a range
of professional settings, including social service agencies, primary care facilities,
and private practice.
Results: The most commonly reported psychological morbidities among HIV
positive youth receiving mental health care services included depression, anxiety,
bipolar disorder, and the sequelae of childhood sexual abuse. Substance use and
high sexual risk-taking were frequently seen in this population. Many of these
conditions predate the individual's HIV infection, and were exacerbated by testing
positive for HIV. A variety of treatment modalities, including individual counseling,
support groups, and art and recreational therapy have been used; linkages to
other supportive services such as housing and substance use treatment were
seen as important. Providers report widespread perception of increased hope
among youth, and a decreased sense of HIV infection as life-threatening.
Lessons Learned: HIV infection frequently complicates and exacerbates existing psychological morbidities in youth. Because of the interconnected needs of
this population, coordinated care is called for, with supportive services such as
substance use treatment, housing, and recreational activities readily available.
Complementary services are especially important in helping young people adhere
to new anti-HIV drug therapies.
24231 1 Evolution of depressive symptoms in HIV-infected
patients after linkage to primary care
Jacqueline B. Savetsky1, J.G. Clarke2, L.M. Sullivan1, M.D. Stein2, J.H. Samet1.
'Boston University School of Medicine, Suite 200, 91 East Concord Street,
Boston, MA; 2Brown University School of Medicine, Providence, RI, USA
Purpose: To examine among HIV-infected patients 1] the association between patient characteristics and depressive symptoms at initial primary care presentation
and 2] factors associated with improvement in depressive symptoms.
Methods: We assessed HIV-infected patients presenting for primary care at
two urban hospitals between 2/94 and 4/96 and reassessed them 6 months later.
At baseline and follow-up we collected data on depressive symptoms [Center
for Epidemiologic Studies Depression scale (CES-D)] and sociodemographic,
social support, disease related, substance use and medical care variables. Using
multiple linear regression analysis we examined associations between baseline
variables and CES-D score (range 1-60). We used logistic regression analysis
to examine factors associated with improvement in depressive symptoms. Improvement was defined as a decrease in CES-D by >6 points (0.5 standard
deviation).
Results: The initial cohort of 203 subjects had the following characteristics:
26% female; 46% black, 25% Hispanic; HIV risk factors 47% IDU, 32% heterosexual, and 20% gay/bisexual men. At baseline, 68% of the sample scored 16
or higher on the CES-D, a threshold considered indicative of depression. In a
multiple linear regression model relating the continuous CES-D score to independent variables, younger age, more HIV-related symptoms, less social support and
higher stress were significantly associated (p < 0.05) with more depressive symptoms at baseline. At 6 months, 36% of the subjects who were followed (53/146)
improved in depressive symptoms. In a multiple logistic regression model, higher
baseline CES-D scores, improvements in HIV-related symptoms and joining a
support group (OR = 2.8 95%, Cl = 1.16-6.6) were significantly associated with
improvement.
Conclusions: Depressive symptoms in an urban HIV-infected population are
highly prevalent. Improvement in these symptoms after 6 months occurred in
over one third of the cohort. Screening for and identification of depression in
patients entering care for HIV-disease is essential, and as support groups may
improve depressive symptoms in HIV-infected patients, efforts to encourage
patient participation should be both a provider and healthcare system goal.
24232 A framework for action: HIV and mental health
Nena Nera. Jeanne Mance Building, Tunney's Pasture, Ottawa, Ontario, Canada
Issue: HIV/AIDS impact greatly on the mental health of those most directly affected by the disease persons living with HIV and AIDS, as well as their families,
friends and caregivers. This impact was explored by a federally funded National
Working Group and documented in a report: "Ending the Isolation: HIV Disease
and Mental Health."
Project: As a follow-up to "Ending the Isolation," a National Workshop was
convened where participants took part in fifteen round-table discussions and
priorities for action in three subject areas were identified: financial security issues;
knowledge and skill building; and mental health support systems. The document
which ensued from the Workshops summarized the issues and priorities identified
in the three subject areas. "A Framework for Action" was thus developed.
Results: This paper/presentation will zero-in on the results of the response
to this "Framework for Action." The response to the issues and priorities to

the 'Framework' occurred on many levels. Response in the areas of HIV/AIDS
Prevention, AIDS Community Action Programs, Care Treatment and Support, professional organizations and others concerned with HIV and mental health, AIDS
service organizations and persons living with HIV/AIDS were critically analysed
and reviewed.
Lessons Learned: In this analysis, review and follow-up, it is clear that overall,
there has been an extensive response to the issues and priorities identified in