title: Culturally Sensitive Approaches to Identification and Treatment of Depression among HIV Infected African American Adults: A Qualitative Study of Primary Care Providers' Perspectives.
abstract: BACKGROUND
  Major depressive disorder (MDD) is highly prevalent among HIV-infected (HIV+) individuals, and is associated with non-adherence to antiretroviral therapy (ART), and accelerated disease progression. MDD is underdiagnosed and undertreated among low-income African Americans, who are disproportionately impacted by the HIV epidemic. To improve detection and treatment of depression among African Americans living with HIV/AIDS, it is important to understand culturally and contextually relevant aspects of MDD and attitudes about mental health treatment.
  
  
  METHODS
  A focus group session was conducted with seven providers and staff at a primary care center that serves a largely African-American community heavily impacted by the HIV epidemic in Washington, DC. Data were analyzed using an inductive approach to distill prominent themes, perspectives, and experiences among participating providers.
  
  
  RESULTS
  Five themes emerged to characterize the lived experiences of HIV+ African-American patients: (a) Changes in perceptions of HIV over time; (b) HIV is comorbid with mental illness, particularly depression and substance abuse; (c) Stigma is associated with both HIV and depression; (d) Existing mental health services vary and are insufficient and (e) Suggestions for optimal treatment for comorbid HIV and depression.
  
  
  CONCLUSIONS
  This study reflects the views of providers from one clinic in this community.
  
  
  CONCLUSIONS
  Substantial economic disadvantage, pervasive childhood adversity, limited education and limited resources jointly put members of this community at risk for acquisition of HIV and for development of depression and addictions. These contextual factors provide an important reminder that any patient-level depression identification or intervention in this community will have to be mindful of such circumstances.
authors.affiliation: Department of Psychology, George Washington University, Washington, D.C., USA.
authors.forename: Huynh-Nhu
authors.initials: HN
authors.lastname: Le
authors.affiliation: Translational Neuroscience Laboratory, Department of Psychiatry, Howard University, Washington, D.C., USA.
authors.forename: Maria Mananita S
authors.initials: MM
authors.lastname: Hipolito
authors.affiliation: Department of Psychology, George Washington University, Washington, D.C., USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Lambert
authors.affiliation: Family and Medical Counseling Service, Inc. Washington, D.C. USA.
authors.forename: Flora
authors.initials: F
authors.lastname: Terrell-Hamilton
authors.affiliation: Translational Neuroscience Laboratory, Department of Psychiatry, Howard University, Washington, D.C., USA.
authors.forename: Narayan
authors.initials: N
authors.lastname: Rai
authors.affiliation: Translational Neuroscience Laboratory, Department of Psychiatry, Howard University, Washington, D.C., USA.
authors.forename: Charlee
authors.initials: C
authors.lastname: McLean
authors.affiliation: University of Southern California, Los Angeles, California, USA.
authors.forename: Suad
authors.initials: S
authors.lastname: Kapetanovic
authors.affiliation: Translational Neuroscience Laboratory, Department of Psychiatry, Howard University, Washington, D.C., USA.
authors.forename: Evaristus
authors.initials: E
authors.lastname: Nwulia
keywords: African-Americans; Cross-cultural psychiatry; Depression; HIV