Previous research has been inconsistent in documenting a strong relationship between depression and HIV/AIDS, although a recent meta-analysis of studies examining this issue indicates that rates of depression are modestly higher for this population. For the current study, conducted from 2001-2004, we sought to examine rates and types of depressive symptoms in a cohort of patients receiving HIV care at two urban medical centers. These patients were participants in an intervention study examining adherence and mental health in persons triply diagnosed with psychiatric disorders, substance use disorders, and HIV/AIDS. Nearly three quarters of these participants were people of color, two thirds described their sexual orientation as heterosexual, and the vast majority were unemployed. We sought to examine the relationship of depression to patients' adherence to antiretroviral medication regimens (highly active antiretroviral therapy [HAART]). Results obtained from structured clinical interviews and self-report questionnaires indicated that study participants experienced high rates of depressive symptoms, and that 72.9% of participants met criteria for major depressive disorder (MDD). The results of this study offer a detailed view of the incidence and nature of MDDs and depressive symptoms for an urban sample of substance-abusing adults with HIV/AIDS. Given the degree to which depressive symptoms and MDD appear to be prevalent for this group, as well as the observation that these symptoms are amenable to treatment, future research should focus on identifying helpful strategies and interventions for treating these symptoms, effective ways of providing linkages to care, and ways in which standardized assessment and treatment protocols might be adapted to better suit this population.

A group of 660 undergraduates and 596 clinical and counseling psychologists completed a battery of questionnaires about AIDS. Both groups knew moderate amounts of AIDS general information and prevention information and reported moderately positive attitudes toward AIDS patients. Also, both groups felt fairly invulnerable to HIV infection; neither group had much direct experience with HIVinfected patients. For both samples, degree of homophobia was the best predictor of stigmatizing attitudes toward persons with AIDS. Implications for program development and professional practice are discussed.College students represent a young adult population often experimenting with sexual and drug use behaviors for the first time, and constitute a large population that may be comparatively easily accessed by social science interventions. Psychologists, trained to foster behavioral and attitudinal change, are in a pivotal position to design HIV risk-reduction programs targeted for these sexually active young adults. Before psychologists can design and test risk-reduction programs that enhance the ability and motivation of college students to change their behaviors, however, they must first assess the knowledge base of this population to make sure that these young adults possess accurate HIV knowledge, a necessary but not sufficient condition for HIV risk reduction (Calsyn, Saxon, Freeman, & Whittaker, 1992;Crawford, 1990;Fisher & Fisher, 1992;McCusker et al., 1992). The first goal of the current study was to assess college student knowledge about HIV in a large sample to determine what knowledge gaps interveners must fill to set the stage for behavior change.Extant studies on student knowledge have suggested that students have knowledge gaps about HIV and that they may not translate accurate knowledge into risk reduction (Bell, Feraios,

Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

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