To examine the influence of racial-ethnic and sexual identity development on the psychosocial functioning of African-American gay and bisexual men (AAGBM), 174 AAGBM completed questionnaire packets designed to assess their levels of racial-ethnic and sexual identity development, self-esteem, social support, male gender role stress, HIV prevention self-efficacy, psychological distress, and life satisfaction. The results indicate that AAGBM who possess more positive (i.e., integrated) self-identification as being African American and gay reported higher levels of self-esteem, HIV prevention self-efficacy, stronger social support networks, greater levels of life satisfaction, and lower levels of male gender role and psychological distress than their counterparts who reported less positive (i.e., less well integrated) African American and gay identity development. Although higher levels of racial-ethnic identity development were associated with greater levels of life satisfaction, sexual identity development was not.

With a significant proportion of HIV-infected patients now presenting with co-occurring substance abuse disorders and mental disorders, interest in integrated HIV care is growing. However, no review of integrated HIV care has been conducted. Using relevant key word searches of the Medline and Psychlit databases, the authors identified about 450 publications. The few evaluations of integrated models tended to focus on measurements of engagement and retention in medical care, and their findings indicated an association between integrated HIV care and increased service utilization. No random assignment controlled studies were identified, except in the peripheral area of integrated care (without HIV primary care) for persons with co-occurring substance abuse disorders and mental disorders. The majority of reviewed articles described integrated models operating in the field and various aspects of implementation and sustainability. Overall, they supported use of a wide range of primary and ancillary services delivered by a multidisciplinary team that employs a 'biopsychosocial' approach. Despite the lack of scientific knowledge regarding the effects of integrated HIV care, those wanting to optimize treatment for patients with multiple interacting disorders can gain useful and practical knowledge from this literature.

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In the Southeast, mental health and substance abuse services are sparse and stigma is high; thus, innovative treatment strategies are needed to address the high levels of co-occurring mental illness and substance abuse. Antiretroviral therapies will not reach their potential for slowing the HIV/AIDS epidemic and prolonging survival if comorbidities that influence patient behavior are not addressed.

Objectives There is a dearth of information on the experience of pain in persons living with HIV and co-occurring psychological and substance use problems. This study examined the prevalence and correlates of pain in 162 HIV+ persons diagnosed with mood and/or anxiety disorders as well as substance use disorders. Methods Bodily pain scores in the current sample were compared to pain scores in the United States (US) general population and HIV+ persons who screened negative for psychological and substance use problems. Bivariate analyses were used to identify significant correlates of pain scores in the current sample which were then subjected to multiple regression analysis. Results Pain scores in the current sample were significantly lower (indicating more pain) than the general population and HIV+ persons who screened negative for psychological and substance use problems. Multivariate analysis indicated that the presence of mood disorder, older age and lower CD4 cell counts (below 200) were associated with increased pain. Presence of mood disorder accounted for the largest amount of unique variance in pain scores. Discussion HIV+ persons with diagnosed mood/anxiety and substance use disorders reported substantially higher levels of pain than the general population and HIV+ persons without these comorbid conditions. The presence of mood disorder emerged as an important marker for pain in the current sample. Given that individuals living with HIV and comorbid psychological and substance use disorders are at increased risk for pain, concerted efforts should be directed at identifying and treating pain in this population.