Mental Health Needs of HIV Sufferers Up as Medications Help Physical Symptoms

Thanks to improved HIV drug therapy, there is a burgeoning demand to treat the mental health needs of those living longer with the disease. And psychiatrists gathering in Banff, Alberta, for the Canadian Psychiatric Association meeting Thursday are being urged to prepare for this need.

"We can't assume there are enough specialists to handle it," said Ken Citron, who runs the HIV psychiatric clinic at Mount Sinai Hospital in Toronto. Citron says general psychiatrists are going to have to develop a working knowledge of how to treat HIV patients. He says psychiatric residency training should include some exposure to HIV/AIDS issues -- often not the case outside large Canadian centers.

People with HIV have a higher incidence of mental health problems than the general population. HIV attacks the brain, causing inflammation and tissue deterioration. The illness also causes several neuro-cognitive disorders that can lead to clinical depression. Many people with HIV also have mild or moderate thinking problems, process more slowly, and have trouble with memory and focus. Citron notes that treatment requires a certain amount of specialized knowledge because of the interaction between psychiatric and HIV drugs.

As HIV becomes more of a chronic illness, the mental strain of living with the disease creates other needs. "We have to help them find meaning and develop relationships that will enable them to live with the illness," said Citron. "Even if you treat that person's major depression, there's still a human being there with all sorts of needs and concerns," he said. "Work-related issues: 'Do I go back to work and risk losing disability benefits and then getting fired?' And then what happens if the illness flares up?"

A US study has estimated that 1 percent of all psychiatric in-patients are HIV-positive. It is not clear whether that percentage is reflected in Canada. About 50,000 people in Canada have tested HIV-positive since testing began in 1985. Health Canada estimates another 15,000 HIV-infected Canadians do not know it since they have never been tested. Since 1997, about 2,200 Canadians a year are added to the national HIV figure.

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