Expired CME Article

Minorities, the Poor, and Survivors of Abuse: HIV-Infected Patients in the US Deep South

Authors: Brian Wells Pence, PhD, MPH, Susan Reif, PhD, Kathryn Whetten, PhD, MPH, Jane Leserman, PhD, Dalene Stangl, PhD, Marvin Swartz, MD, Nathan Thielman, MD, MPH, Michael J. Mugavero, MD, MHSc


Background: The HIV/AIDS epidemic in the U.S. South is undergoing a marked shift toward a greater proportion of new HIV/AIDS cases in women, African-Americans, and through heterosexual transmission.

Methods: Using consecutive sampling, 611 participants were interviewed from eight Infectious Diseases clinics in five southeastern states in 2001 to 2002.

Results: Sixty four percent of participants were African-American, 31% were female, and 43% acquired HIV through heterosexual sex; 25% had private health insurance. Eighty-one percent were on antiretroviral therapy, and 46% had HIV RNA viral loads (VL) <400. Women and racial/ethnic minorities were less likely to be on antiretrovirals and to have VL <400. Probable psychiatric disorders (54%) and history of childhood sexual (30%) and physical abuse (21%) were common.

Conclusions: Prevention and care systems need to address the HIV epidemic’s shift into poor, minority, and female populations. High levels of trauma and probable psychiatric disorders indicate a need to assess for and address these conditions in HIV clinical care.

Key Points

* HIV, both nationally and particularly in the US South, is increasingly affecting minorities, women, the poor, and those living in rural areas, and is increasingly transmitted through heterosexual intercourse.

* Mental illness, substance use, and history of psychosocial trauma are common comorbidities of HIV-infected patients: three out of four patients meet criteria for at least one of the three, with overlap common.

* These psychiatric comorbidities have been linked to worse clinical outcomes for HIV-positive individuals, suggesting that significant clinical benefit could be achieved by routinely integrating mental health assessment and related services into HIV clinical care.

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