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Dysthymia may contribute to the disparity in use of antiretroviral therapy between men and women

Dysthymia, a chronic low-level daily depression that lasts at least 2 years and is relatively prevalent among women and minorities, may be a barrier to minority women's use of highly active antiretroviral therapy (HAART). In particular, the feelings of hopelessness, indecision, and mental inflexibility that commonly occur in persons with dysthymia could prevent these patients from either being offered or accepting HAART, notes Barbara J. Turner, M.D., M.S.Ed., of the University of Pennsylvania, and John A. Fleishman, Ph.D., of the Agency for Healthcare Research and Quality (AHRQ).

They analyzed data on the use of HAART in 1997 among 1,982 HIV-infected adult patients in the national HIV Cost and Services Utilization Study, which is supported by AHRQ (HS08578). Overall, 63 percent of patients received HAART. However, treatment varied significantly by gender and race. White men were the most likely to receive HAART (69 percent), while Hispanic women (53 percent) and black women (55 percent) were least likely.

Compared with white men without dysthymia, black and Hispanic women with dysthymia were less likely to receive HAART. Among patients with depression and no dysthymia, minority women had HAART use similar to white men. Thus, dysthymia, an underrecognized condition, may contribute more than depression to the gender disparity in HAART use, conclude the researchers. They found that dysthymia was more prevalent among women than men, and that major depression was greater among whites than minorities.

See "Effect of dysthymia on receipt of HAART by minority HIV-infected women," by Drs. Turner and Fleishman, in the December 2006 Journal of General Internal Medicine 21, pp. 1235-1241. Reprints (AHRQ Publication No. 07-R021) are available from the AHRQ Publications Clearinghouse.

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