Depression as a barrier to appropriate HIV care among women of color

Background. Women of color (WOC) are disproportionately affected by the HIV epidemic, in terms of infection, mortality, and risk of being lost to care. We explore the role of depression, trauma, and ongoing partner psychological abuse as possible barriers to retention of WOC in HIV care.

Methods. Baseline data were collected from 179 unique (335 total interviews) HIV+ WOC at a large university's infectious diseases clinic (April-December, 2010). Interviewers asked validated questions related to depression, trauma, psychological abuse and demographics (age, education, employment, insurance status), among others. Linear regression models generated beta coefficients and 95% confidence intervals for the correlates of depression.

Results. WOC were approximately equally distributed across education categories (less than, high school, more than high school) and 65 percent (%) were under 50 years old. Ten (10%) were in non-permanent housing and the vast majority (70%) was unemployed. Correlations between depression and the abuse scales were moderate (r=0.3). In models containing sociodemographic variables only, unemployment and low education were significantly associated with increased depression scores. In models including trauma, both child and adult trauma were associated with increased depression and the sociodemographics were reduced to statistical non-significance. Ongoing partner psychological abuse was also associated with higher depression scores.

Conclusion. Depression is a barrier preventing HIV(+) people from adhering to medical care. Experiences with past trauma and current psychological abuse by WOC are associated with increased levels of depression. Identifying the determinants and co-conditions for depression may be important in caring for this population.