The findings suggest that providers be advised to assess routinely and better understand patients' "indications" for self-administration of cannabis. Given the estimated prevalence, more formal characterization of the patterns and impact of cannabis use to alleviate HIV-associated symptoms is warranted. Clinical trials of smoked and noncombustible marijuana are needed to determine the role of cannabinoids as a class of agents with potential to improve quality of life and health care outcomes among patients with HIV/AIDS.

Considerable evidence suggests that people with HIV disease are significantly more distressed than the general population, yet psychiatric disorders are commonly under-detected in HIV care settings. This study examines the prevalence of three stress-related psychiatric diagnoses--depression, posttraumatic stress disorder (PTSD), and acute stress disorder (ASD), among a vulnerable population of HIV-infected patients. Among approximately 350 patients attending two county-based HIV primary care clinics, 210 participants were screened for diagnostic symptom criteria for depression, PTSD, and ASD. Standardized screening measures used to assess for these disorders included the Beck Depression Inventory, the Posttraumatic Stress Checklist, and the Stanford Acute Stress Questionnaire. High percentages of HIV-infected patients met screening criteria for depression (38 per cent), PTSD (34 per cent), and ASD (43 per cent). Thirty eight percent screened positively for two or more disorders. Women were more likely to meet symptom criteria for ASD than men (55 per cent vs. 38 per cent, OR=1.94, CI95 per cent=1.1-3.5). ASD was detected more commonly among African-American and white participants (51 per cent and 50 per cent respectively), compared with other ethnic groups. Latinos were least likely to express symptoms of ASD (OR=0.52, CI95 per cent=0.29-0.96). Of the 118 patients with at least one of these disorders, 51 (43 per cent) reported receiving no concurrent mental health treatment. Patients with HIV/AIDS who receive public healthcare are likely to have high rates of acute and posttraumatic stress disorders and depression. These data suggest that current clinical practices could be improved with the use of appropriate tools and procedures to screen and diagnose mental health disorders in populations with HIV/AIDS.

To describe the determinants of delayed HIV presentation in one Northern California County, the authors identify persons with an opportunistic infection (OI) at HIV diagnosis. From 2000-2002, a sample of HIV patients attending a public AIDS program (n=391) were identified. Immigrants composed 24% of our sample; 78.7% of immigrants were Hispanic. Immigrants, compared to U.S.-born patients, presented with lower initial CD4+ counts at diagnosis than U.S.-born patients (287 cells/mm(3) vs. 333 cells/mm(3), p=0.143), were more likely to have an OI at HIV diagnosis (29.8% vs. 17.2%, p=0.009), and were more likely to be hospitalized at HIV diagnosis (20.2% vs. 12.5%, p=0.064). We found only immigrant status was significantly and independently associated with delayed presentation. Interviews with 20 newly HIV diagnosed Hispanic patients suggest lack of knowledge regarding HIV risk, social stigma, secrecy and symptom driven health seeking behavior all contribute to delayed clinical presentation. The main precipitants of HIV testing for immigrants were HIV/AIDS related symptoms and sexually transmitted infection (STI)/HIV diagnosis in a sexual partner. These results support augmentation of STI/HIV voluntary clinical testing and partner notification services along the Mexico-California migrant corridor.

These data suggest that medicinal use of marijuana may facilitate, rather than impede, ART adherence for patients with nausea, in contrast to the use of other illicit substances, which were associated with lower rates of ART adherence. To demonstrate any causal relationship between marijuana and adherence would require a longitudinal or controlled study.

While a large burden of psychiatric comorbidity exists among this population of HIV-positive patients, only half adhered to recommended psychiatric services referrals. Further research is warranted to examine cost-effective interventions to maximize psychiatric screening, referral, and follow-up with mental health services in this vulnerable population.