Psychiatric Disorders and Substance Use Among African American Women in HIV Care
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ORIGINAL PAPER
Psychiatric Disorders and Substance Use Among African American Women in HIV Care Heidi E. Hutton1 · Noa Cardin2 · Keemi Ereme3 · Geetanjali Chander4 · Xiaoqiang Xu1 · Mary E. McCaul1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract African-American (AA) women are overrepresented among women with HIV (WWH). In the United States, psychiatric disorders are prevalent among WWH and associated with adverse outcomes. However, little research has examined psychiatric disorders among AA WWH. 315 AA women who were hazardous/heavy drinkers (HD) or moderate/non-drinkers (ND) were recruited from an HIV clinic in a study on alcohol use disorders. We compared sample prevalence of Axis-1 psychiatric diagnoses using the Structured Clinical Interview for DSM-IV with those from general population AA women in the National Comorbidity Survey-Replication (NCS-R). While 29.9% of general population AA women had any lifetime disorder, 66.9% of HD and 62.4% of ND WWH met criteria for a lifetime Axis-1 disorder. Specifically, lifetime PTSD and lifetime MDD were over threefold higher; current PTSD and current MDD respectively were 11-fold and threefold higher. PTSD was the most frequent comorbid diagnosis. HD and ND WWH did not differ in prevalence of psychiatric diagnoses despite significantly higher rates of substance use among HD women. Diagnostic evaluation and intervention for psychiatric disorders should be a priority in HIV medical care settings to improve health outcomes. Interventions should be tailored to address the particular stressors, challenges, and resiliencies among AA WWH. Keywords Major depressive disorder · PTSD · HIV · African-American women · Hazardous alcohol use · Alcohol use disorder
Introduction African American (AA) women comprise just 13% of the United States (US) population of women yet they represent 59% of all HIV cases. The rate of new diagnoses among AA women (24.9%) is nearly 15 times the rate among white women and nearly 5 times the rate among Latinas [1]. Compared with other ethnic/racial groups of women, AA women with HIV (WWH) have longer delays to HIV diagnosis, are * Heidi E. Hutton [email protected] 1
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
2
Department of Health Science, Towson University, Towson, MD, USA
3
Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA
4
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
less likely to be on antiretroviral therapy and to be virally suppressed, and have the highest morbidity and mortality from HIV [2–5]. Importantly, although incident HIV infections have declined among AA women in the last decade, significant disparities continue to exist [6]. Using the population attributable proportion (PAP) measure, the CDC calculated that an estimated 93% of incident HIV infections among AA women in 2016 would not have occurred if the i
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