Previous research has linked poor mental health among people living with HIV to a greater likelihood of participating in risky behaviors. “Untreated mental illnesses can be detrimental to the health and well-being of younger patients with HIV and may place others at risk for being infected with the virus,” says Laura B. Whiteley, MD.
Few studies have explored disparities in the receipt of mental healthcare among adolescents and young adults living with HIV. To address this issue, Dr. Whiteley and colleagues had a study published in the Journal of the International Association of Providers of AIDS Care. The researchers conducted a cross-sectional survey of 1,706 HIV-infected adolescents and young adults aged 13 to 26 who were engaged in care.
According to findings, there was a significant disparity in mental healthcare utilization for psychiatrically symptomatic African-American adolescents and young adults living with HIV. “African-American youth with psychiatric symptoms were significantly less likely than non-African Americans to have received mental healthcare and psychiatric medications,” says Dr. Whiteley. Conversely, Latinos were more likely than non-Latinos to report receiving mental healthcare. The lack of disparity also extended to sexual minorities and impoverished or homeless youth and young adults.
Information from the study may help clinicians target efforts to overcome barriers for managing this specific patient population. “More initiatives to engage African-American youth and young adults who are receiving medical care could be needed,” Dr. Whiteley says. She adds that efforts should be made within all HIV treatment sites to reduce disparities for minority patients. The focus of these efforts should be toward educating parents, patients, and providers about common mental health conditions among HIV-positive patients and their treatment options.
Dr. Whiteley also stresses that HIV care environments should be culturally appropriate and inviting to the diverse people living with the virus. “Recruiting diverse individuals to work in these sites is an approach worthy of consideration,” she says. Addressing the physical structure and presentation of clinical care facilities may help. In addition, peer initiatives may enable minority youth and young adults to serve as supportive role models and mentors. This may foster better communication with healthcare providers about mental health concerns.
“Care providers should be aware of these disparities and the many barriers to mental healthcare that youth and young adults with HIV can experience,” says Dr. Whiteley. “We hope that future research examines cultural and structural factors that may shape patients’ use of mental healthcare as well as provider characteristics that could contribute to disparate care.”
Whiteley LB, Brown LK, Swenson R, Kapogiannis BG, Harper GW. Disparities in mental health care among HIV-infected youth: disparities and equalities. J Int Assoc Provid AIDS Care. 2014;13:29-34. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883958/.
Mellins CA, Havens JF, McDonnell C, et al. Adherence to antiretroviral medications and medical care in HIV-infected adults diagnosed with mental and substance abuse disorders. AIDS Care. 2009;21:168–177.
Mellins CA, Smith R, O’Driscoll P, et al. High rates of behavioral problems in perinatally HIV-infected children are not linked to HIV disease. Pediatrics. 2003;111:384–393.
Kataoka SH, Zhang L, Wells KB. Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status. Am J Psychiatry. 2002;159:1548–1555.
Kennamer JD, Honnold J, Bradford J, Hendricks M. Differences in disclosure of sexuality among African American and White gay/bisexual men: Implications for HIV/ AIDS prevention. AIDS Educ Prev. 2000;12:519–531.
Horberg MA, Silverberg MJ, Hurley LB, et al. Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy and on clinical outcomes in HIV-infected patients. J Acquir Immune Defic Syndr. 2008;47:384–390.