• Barbara J Turner and John A Fleishman.
• Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA. bturner@mail.med.upenn.edu
• J Gen Intern Med. 2006 Dec 1; 21 (12): 123512411235-41.

BackgroundReceipt of highly active antiretroviral therapy (HAART) differs by gender and racial/ethnic group and may reflect an effect of mood disorders.ObjectiveWe examined the effects of dysthymia and major depression on HAART use by 6 groups defined by gender and race/ethnicity (white, black, Hispanic).Main Outcome MeasureSelf-reported HAART use in the past 6 months.Data SourceInterview data from the HIV Cost and Services Utilization Study (HCSUS). Independent variables measured in or before the first half of 1997, and HAART use measured in the second half of 1997.AnalysesMultivariate logistic regression of depression and dysthymia on HAART use by 6 patient groups.ParticipantsOne thousand nine hundred and eighty-two HIV-infected adults in HIV care in 1996 and with a CD4 count <500 in 1997.ResultsHighly active antiretroviral therapy receipt was the highest for white men (68.6%) and the lowest for Hispanic women (52.7%) and black women (55.4%). Dysthymia was more prevalent in women (Hispanic, 46%; black, 27%; white, 31%) than men (Hispanic, 23%; black, 18%; white, 15%). The prevalence of major depression was greater in whites (women, 35%; men, 31%) than minorities (women, 26%; men, 21%). Compared with white men without dysthymia, the adjusted odds ratios (AORs) of HAART were significantly lower for black women (0.50 [95% confidence interval [95% CI] 0.29 to 0.87]) and Hispanic women (0.45 [95% CI 0.25, 0.79]). Among patients with depression and no dysthymia, minority women had HAART use (AOR=1.28 [95% CI 0.48 to 3.43]) similar to white men.LimitationsSelf-report data from the early era of HAART use; causation cannot be proven; mental health diagnoses may not meet full DSM IV criteria.ConclusionsDysthymia is highly prevalent in minority women and associated with a 50% reduction in the odds of receiving HAART. This underrecognized condition may contribute more than depression to the "gender disparity" in HAART use.

34 keywords...

hide…