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Objectives. We examined associations between depressive symptoms and AIDS-related mortality after controlling for antiretroviral therapy use, mental health treatment, medication adherence, substance abuse, clinical indicators, and demographic factors. Methods. One thousand seven hundred sixteen HIV-seropositive women completed semiannual visits from 1994 through 2001 to clinics at 6 sites. Multivariate Cox and logistic regression analyses estimated time to AIDS-related death and depressive symptom severity. Results. After we controlled for all other factors, AIDS-related deaths were more likely among women with chronic depressive symptoms, and symptoms were more severe among women in the terminal phase of their illness. Mental health service use was associated with reduced mortality. Conclusions. Treatment for depression is a critically important component of comprehensive care for HIV-seropositive women, especially those with end-stage disease.

Objectives. We examined racial/ethnic disparities in highly active antiretroviral therapy (HAART) use and whether differences are moderated by substance use or insurance status, using data from the Women's Interagency HIV Study (WIHS). Methods. Logistic regression examined HAART use in a longitudinal cohort of women for whom HAART was clinically indicated in 2005 (N = 1354). Results. Approximately 3 of every 10 eligible women reported not taking HAART. African American and Hispanic women were less likely than were White women to use HAART. After we adjusted for potential confounders, the higher likelihood of not using HAART persisted for African American but not for Hispanic women. Uninsured and privately insured women, regardless of race/ethnicity, were less likely than were Medicaid enrollees to use HAART. Although alcohol use was related to HAART nonuse, illicit drug use was not. Conclusions. These findings suggest that expanding and improving insurance coverage should increase access to antiretroviral therapy across racial/ethnic groups, but it is not likely to eliminate the disparity in use of HAART between African American and White women with HIV/AIDS.

Objectives. We used longitudinal data to examine the roles of 4 dimensions of patient satisfaction as both predictors and outcomes of use of highly active antiretroviral therapy (HAART) among women in the United States with HIV/AIDS. Methods. Generalized estimating equations were used to analyze time-lagged satisfaction–HAART relationships over 8 years in the Women’s Interagency HIV Study. Results. Multivariate models showed that, over time, HAART use was associated with higher patient satisfaction with care in general, with providers, and with access/convenience of care; however, patient satisfaction was not associated with subsequent HAART use. Symptoms of depression and poor health-related quality of life were associated with less satisfaction with care on all 4 dimensions assessed, whereas African American race/ethnicity, illegal drug use, and fewer primary care visits were associated with less HAART use. Conclusions. Our findings suggest that dissatisfaction with care is not a reason for underuse of HAART among women with HIV and that providers should not be discouraged from recommending HAART to dissatisfied patients. Rather, increasing women’s access to primary care could result in both increased HAART use and greater patient satisfaction.

Seroconversion for HIV antibody occurred in two homosexual men who reported no anal intercourse for greater than or equal to 5 years and multiple episodes of receptive oral intercourse with ejaculation. Neither man reported intravenous drug use or receipt of blood products. The last antibody-negative specimen was also negative by the polymerase chain reaction and p24 antigen assays. All sexually active persons should be clearly counselled that receptive oral intercourse with ejaculation carries a potential risk of HIV transmission.

To assess the impact of HIV infection on mortality and the accuracy of AIDS reporting on death certificates, we analyzed data from 6704 homosexual and bisexual men in the San Francisco City Clinic cohort. Identification of AIDS cases and deaths in the cohort was determined through multiple sources, including the national AIDS surveillance registry and the National Death Index. Through 1990, 1518 deaths had been reported in the cohort and 1292 death certificates obtained. Of the 1292 death certificates, 1162 were for known AIDS cases, but 9% of the AIDS cases did not have HIV infection or AIDS noted on the death certificate. Only 0.7% of the decedents had AIDS listed as a cause of death and had not been reported to AIDS surveillance. AIDS and HIV infection was the leading cause of death in the cohort, with the highest proportionate mortality ratio (85%) and standardized mortality ratio (153 in 1987), and the largest number of years of potential life lost (32,008 years). The devastating impact of HIV infection on mortality is increasing and will require continued efforts to prevent and treat HIV infection.