HIV & Depression FAQ

How common is depression among people living with HIV/AIDS?
People living with HIV are experiencing very high rates of depression. According to research in the U.S., about 30 to 40% of men with HIV and 40 to 60% of women with HIV experience significant depression. A recent study of 360 people living with HIV or AIDS (PHAs) conducted for the Ontario AIDS Network (OAN) revealed that 57% had a major depressive disorder. In addition, a significant proportion of community support workers estimate that depression affects their clients.

Does every person living with HIV/AIDS experience depression?
No. Depression is a serious issue among PHAs, but the extent to which people suffer from depression and its severity varies, depending on many factors including life situation and coping skills. In fact, some PHAs will suffer little or no depression; most will have mild to moderate depression; and some will experience severe depression.

How does depression impact the lives of PHAs?
If not diagnosed and/or treated, depression has a debilitating effect on people living with HIV/AIDS. It affects their daily functioning, their ability to manage their illness, their immune system and their survival rates. For example: depression is associated with faster disease progression. It also increases the risk of suicide and may be the underlying cause of alcohol and drug use.

Who treats depression?
There is a range of providers who can help people with depression, according to the severity of their illness. They include: family physicians, psychiatrists, psychologists, social workers, therapists/counselors, and AIDS Service Organizations (ASOs). Recent OAN survey data found that almost all community support workers (CSWs) have received some training in mental health issues, and that a significant number have formal education in either psychology or social work, which suggests that many CSWs have valuable skills for helping clients deal with depression.

What roles can community-based organizations like ASOs play?
Community-based organizations are ideally placed to provide many effective interventions for depression. They already have well-established relationships and services that are provided in a trusting, empathetic, confidential environment. Screening, prevention and programs and support services are areas in which ASO can - and already do - help PHAs suffering from depression. Community-based organizations can also provide information and education about depression and coping skills, and support services such as counseling, support groups and practical assistance (e.g. with food, housing, income).

How does stigma affect PHAs with depression?
The stigma associated with mental health problems like depression can cause the public to be uncomfortable around people who have mental health problems and discriminate against them. This externalized stigma can make ASO staff uncomfortable talking about depression or providing services for people who are depressed. Stigma can also take the form of self-loathing, in which people who are depressed internalize negative public attitudes towards mental illness. This internalized stigma can prevent PHAs from acknowledging their depression or seeking help for fear of being labeled mentally ill. It also compounds the stigma that many members of marginalized groups already experience having HIV.

How can stigma be reduced?
Some progress is being made in this area. People talk more openly about depression and mental health organizations work hard to destigmatize it. ASOs can help reduce stigma and increase access to care by increasing mental health literacy in PHAs and staff, by talking about depression as a normal response to HIV, and by integrating information about depression into other programs.

What are the benefits of early screening for depression for PHAs?
Screening is an objective way of identifying whether someone may be depressed, and assessing how severe that depression may be. It can help identify depression very early. For PHAs, the benefits include better adherence to medications, better management of HIV, less stress, greater capacity to manage life events and longer survival.

Are there other ways in which ASOs can distinguish between mild/moderate and severe depression?
ASOs can watch clients for changes in behaviour, such as: a chance in adherence to treatment (missing appointments or medication); an inability to make life choices, including those related to medical care; a preoccupation with a particular, usually minor problem; a change in functioning; substance use; self-imposed isolation.

What therapies are used to treat depression?
Traditional expert-based treatments for depression include pharmacological treatments, psychotherapy (particularly cognitive-behaviour therapy), interpersonal therapy, electroconvulsive therapy, or a combination of these various forms of treatment.

Are there interventions that can be delivered by ASOs?
Just as ASOs are well placed to provide screening and assistance for PHAs with depression, they are equally well situated to provide a wide range of interventions to help PHAs - especially those with mild/moderate depression - prevent and manage their illness. These include education, social support, practical assistance, peer support, self efficacy, stress management and solution-focused therapy.

How can PHAs help themselves?
ASOs can deliver a message to PHAs about their own individual strengths and resources, and encourage them to use them to manage their depression. By making healthy lifestyle choices in the areas of diet and exercise, by working through a treatment plan described in a book, by focusing on self-care and thus making their own health a priority, PHAs can reduce their symptoms of depression and improve their quality of life.

How can ASOs work with different community-based organizations to better serve clients with depression?
Partnering with other community organizations, such as local branches of the Canadian Mental Health Association, hospitals and community care clinics, builds a support network for ASOs. For example, ASOs can identify community health services, psychiatrists, psychologists and physicians who are willing to take referrals of clients with signs of severe depression, or to provide advice to ASO staff. Mental health professionals can give workshops for ASO staff on identifying and managing depression. ASOs can give workshops for mental health professionals on HIV and the complex issues faced by PHAs.