Optimization of health-related quality of life is particularly important now that HIV is a chronic disease with the prospect of long-term survival. Comorbid psychiatric conditions may serve as markers for impaired functioning and well-being in persons with HIV. Inclusion of sufficient numbers of appropriately trained mental health professionals to identify and treat such conditions may reduce unnecessary utilization of other health services and improve health-related quality of life in persons with HIV infection.
Despite the availability of effective treatments, most individuals who had co-occurring mental health and substance use problems were not receiving effective treatment. Efforts to improve the care provided to persons who have co-occurring disorders should focus on strategies that increase the delivery of effective treatment.
Background: Consumers and policy makers are increasingly interested in measuring treatment quality. We developed a standardized approach to measuring the quality of outpatient care for schizophrenia and used it to evaluate routine care.
OBJECTIVE: To distinguish the effects of drug abuse, mental disorders, and problem drinking on antiretroviral therapy (ART) and highly active ART (HAART) use.
DESIGN: Prospective population‐based probability sample of 2,267 (representing 213,308) HIV‐infected persons in care in the United States in early 1996.
MEASUREMENTS: Self‐reported ART from first (January 1997–July 1997) to second (August 1997–January 1998) follow‐up interviews. Drug abuse/dependence, severity of abuse, alcohol use, and probable mental disorders assessed in the first follow‐up interview. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) estimated from weighted models for 1) receipt of any ART, and 2) receipt of HAART among those on ART.
RESULTS Of our study population, ART was reported by 90% and HAART by 61%. Over one third had a probable mental disorder and nearly half had abused any drugs, but drug dependence (9%) or severe abuse (10%) was infrequent. Any ART was less likely for persons with dysthymia (AOR, 0.74; CI, 0.58 to 0.95) but only before adjustment for drug abuse. After full adjustment with mental health and drug abuse variables, any ART was less likely for drug dependence (AOR, 0.58; CI, 0.34 to 0.97), severe drug abuse (AOR, 0.52; CI, 0.32 to 0.87), and HIV risk from injection drug use (AOR, 0.55; CI, 0.39 to 0.79). Among drug users on ART, only mental health treatment was associated with HAART (AOR, 1.57; CI, 1.11 to 2.08).
CONCLUSIONS: Drug abuse‐related factors were greater barriers to ART use in this national sample than mental disorders but once on ART, these factors were unrelated to type of therapy.
Mental illness may play a role in initiating homelessness for some, but is unlikely in and of itself to be a sufficient risk factor for homelessness. In addition to outreach and treatment programs for adult mentally ill homeless persons, emphasis should be placed on interventions with children and on addressing more pervasive causes of homelessness.
We estimated the proportion of adults receiving HIV care who are involved in abusive close relationships and identified factors associated with abuse perpetration and victimization. A nationally representative sample of 1,421 persons in care for HIV included 51% who reported having a close relationship (a spouse or a primary relationship partner) during a 6-month period. Of those in a close relationship, 26.8%reported the presence of abuse. Forty-eight percent of all abuse was mutual, and abuse perpetration and victimization occurred equally often. Age, substance abuse, and psychiatric disorder, as well as characteristics of relationships (e.g., both partners seropositive) predicted perpetration and/or victimization. After adjusting for these factors, females were not found to differ from gay men in their likelihood of being perpetrators of abuse or victims. However, African Americans were more likely than Whites to be involved in an abusive relationship. Interventions for people with HIV must address the presence of abuse in close relationships, regardless of gender or sexual orientation, but may benefit from targeting people of color.
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