HAART: no help for the head.

Despite the effectiveness of highly active antiretroviral therapy (HAART), the mental health of New York City women with HIV is no better now than it was in pre-HAART years, according to a study comparing two matched samples of infected women, one interviewed in 1994-1996, before the therapy became available, and another in 2000-2002, after its use had become widespread. (1) Mean scores on standard scales measuring depression, self-esteem and mental health were statistically indistinguishable between samples. Likewise, the groups averaged comparable scores on six of seven measures of psychosocial adjustment to chronic illness; the exception was that women in the later sample scored higher than those interviewed in the mid-1990s on a measure related to family life, indicating greater distress. Why the lack of improvement? According to the researchers, women with HIV may experience "multiple chronic stressors" that outweigh any psychological benefit of effective treatments, or they may become demoralized if HAART's effects do not meet their expectations. The researchers urge continued attention to interventions to improve HIV-infected women's mental health and quality of life.

(1.) Siegel K, Karus D and Dean L, Psychosocial characteristics of New York City HIV-infected women before and after the advent of HAART, American Journal of Public Health, 2004, 94(7): 1127-1132.