The relationship between depression and coping among black and Latino men living with HIV/AIDS

African Americans and Latinos bear a disproportionate burden of health problems with respect to HIV/AIDS when compared to the general population. HIV (human immunodeficiency virus) is the virus that causes Acquired Immunodeficiency Syndrome (AIDS). This disease has been reported to be highest among the African Americ an and Latino community in the United States. There are research studies on the rela tionship between HIV and depression as well as a growing interest in the coping pattern s of people infected with HIV disease. In this study, African American and Lati no men who are HIV-positive were recruited from two HIV agencies. The Concern and Coping wi th HIV and Beck Depression Inventory were administered to measure levels of coping and depression among the participants. According to the findings from multivariate a n lysis of Variance (MANOVA), there was no significant difference in the levels of depression or coping among African American and Latino HIV-positive men. Spearman bivariat e correlation also indicated a significant relationship between depression and copi g among African American and Latino HIV-positive men. There was no significant re la ionship between mode of HIV transmission and coping or mode of HIV transmission and depression. These results are discussed in terms of their clinical implicati ons, highlighting the implication for policy, research, and practice. Depression and Coping with HIV 11 CHAPTER ONE INTRODUCTION This chapter presents the background of the problem, HIV/AIDS, in the general population and specifically among Blacks and Latinos. This chapter also presents the theoretical foundation of this study, significance of the study, statement of t he problem, research questions, and operational definitions. Background of the Problem African Americans and Latinos bear a disproportionate burden of health problems with respect to HIV/AIDS when compared to the general population (U.S. Department of Health and Human Services, 2001). According to the Centers for Disease Control (CD C) (2005) approximately 40,000 persons in the United States become infected with HIV each year. The latest U.S. Centers for Disease Control report (2007) on the U.S. epi demic found that in 2007, African Americans (51%) and Latinos (18%) represented 69% of the estimated number of HIV/AIDS diagnoses in 2007 (CDC, 2009). White people constituted 29% of the estimated number of HIV/AIDS cases diagnosed in 2007. Meanwhile, African Americans and Latino constituted only 26% of the United Sta tes population. Mortality rates until age 85 are higher for blacks than for whites. Acc ording to the CDC (2009), at the end of 2007, the estimated number of persons living with HIV/AIDS between 2003–2007 in 50 states and the District of Columbia was 455,636 (CDC, 2009). The HIV/AIDS rate of people of color is more than seven times that of whites. In the past decade, death due to HIV/AIDS has increased dramatically in the African American population, and this disease is now one of the top five causes of death for this group (U.S. Department of Health and Human Services, 2001). In the United Depression and Coping with HIV 12 States, the HIV/AIDS epidemic is a health crisis for African Americans . Over the last two decades there has been abundant research on depression and coping within the HIV/AID S population (Folkman & Moskowitz, 2000; Jenkins & Guarnaccia, 2003; Penedo et al., 2001; Simoni & Ng, 2000). An estimated one in three persons with HIV infection may experience depressive symptoms (Orlando et al., 2002). The lifetime prevalence of depression in HIV-infected patients has been es timat d at 22–45% (Penzak, Reddy, & Grimsley, 2000). HIV-infected patients have been observed to have an increased risk of depression when there is a history of substance use, recent medical hospitalization, and homosexual risk behaviors (Fairfield et al., 2001). The increasing relationship between depression and HIV has prompted this author’ s desire to look into the relationship between depression and HIV among Blacks and Latinos living with HIV in the U.S. Another factor that is of importance among Blac ks and Latinos living with HIV is the way they cope. Coping processes are better under stoo by looking at how people cope with specific stressors, rather than treating coping as a stable personality trait (Lazarus & Folkman, 1984). A stressor-specific appr oach is especially useful for studies of coping with health problems. HIV disease-r lat d stressors include not only fatality, specific symptoms, treatments, side e ffects, and other physical features, but also secondary social concerns, such as lifestyle st igma, impoverishment, and relational implications of getting and passing on the infection. These stressors may prompt appraisal and coping patterns that differ from othe r conditions. Coping patterns in response to HIV-related stressors may differ from coping required for stressors that are not life threatening. Depression and Coping with HIV 13 Purpose of the study The purpose of this study is to identify the relationship between depression and coping strategies that urban-based Black and Latino HIV-positive men empl oy in the management of their infection. It is widely accepted that HIV infection is a s tressful life event, and individuals with HIV infection are highly vulnerable to stress (Jia, Uphold, & Faan, 2005). Hopefully, this study will complement the existing work related to coping with HIV/AIDS among Blacks and Latinos as well as the general population of Americans with HIV/AIDS. Statement of the Problem Although there are high numbers of Blacks and Latinos living with HIV, little is known about the levels of depression and coping with an HIV-positive status among Blacks and Latinos who often contend with poverty, inadequate access to health care , racism, and poor health outcomes in comparison to Whites. This specific information on coping strategies adopted by Black and Latino men living with HIV may help foc us intervention strategies designed specifically for HIV-positive men of color . A person infected with HIV is viewed with stigma, unlike a person who has a disease like ca nc r. Such stigma could impact the resources available to the individual who has HIV (in term s of his/her levels of depression and coping). Being HIV-positive may mean the loss of health, friends, employment, financial independence, physical intimacy, and the s upport of one’s family members (Friedland, Renwick, & McColl, 1996). An estimated one in three persons with HIV infection also may experience depressive symptoms (O rlando et al., 2002). Depression and Coping with HIV 14 Research addressing the specific coping strategies of Blacks and Lat i os living with HIV/AIDS is limited. It is anticipated that social support, religion, an d family values contribute to coping with HIV/AIDS among people of color. This study highlights and critically evaluates the specific coping strategies that this populat ion uses. This will inform clinicians in adapting their treatment plans to address the special needs of African-American and Latino men living with HIV/AIDS. HIV/AIDS in the General Population According to the CDC, in 2006, 50% of all adults and adolescents who were diagnosed with HIV/AIDS in the United States were men who have sex with men (MSM), followed by 33% of adults and adolescents infected through heterosexual contac t (CDC HIV/AIDS Surveillance Report, 2006). Among men who were diagnosed with HIV/AIDS in 2006, 67% were infected through male-to-male sexual contact. Sixte en percent of the men contracted HIV through heterosexual contact, and 12% were infec ted through injection drug use. Among all females who were diagnosed with HIV/AIDS in 2006, 80% were infected through heterosexual contact, while 19% were infected throug h injection drug use. With regards to gender, 73% of all adults and adolescents who wer e diagnosed with HIV/AIDS were male, while 26% were female adolescents and adults (CDC HIV/AIDS Surveillance Report, 2006). From 2001 through 2005, the estimated number of persons in the United States living with AIDS increased from 331,512 to 425,910—an increase of 28% (CDC, 2005). Table 1 presents the estimated number of Blacks and Latinos living with HIV at the end of 2007. Depression and Coping with HIV 15