Five years ago, when he was 44, Ellsworth Bishop suffered two strokes in two weeks. He was admitted to a nursing home; for months, he couldn’t talk or walk.

Although he’d known he was HIV positive since 1987, he hadn’t started treatment. He was, however, taking psych meds. “My problem was depression,” he says. “I went through a divorce, my father died, my mother died, and I had the virus—all at one time, it just hit me.”

In the nursing home at St. Elizabeth Ann’s Health Care & Rehabilitation Center in Staten Island, New York, Bishop spent two years recovering from his strokes. He also began taking HIV meds. Other people at this comprehensive HIV care program could relate to his problems with depression—almost all have suffered from various mental health issues, says Linda Dianto, MS, program director for St. Elizabeth Ann’s Adult Day Health Care Program. The program helps people bridge the chasm between serious illness and daily life.

Mental illness is often associated with HIV. Joe Losowski, director of chronic care at the New York State Department of Health AIDS Institute, estimates that rates of mental illness among people with HIV/AIDS range from 10 to 25 percent on the low end to as high as 50 percent. Rates are higher in some day programs, he says, because “day programs target clients with multiple service needs.”

Research suggests a number of reasons for the correlation. Mental illness may impede a person’s ability to negotiate safer sex and control impulses. And prevention messages don’t necessarily target the mentally ill, which adds to their HIV risk, says St. Elizabeth Ann’s medical director Nanette Thomas, MD. Because the virus enters the brain, it may also encourage mental health problems—especially in advanced stages of HIV disease. Even with HIV under control, the realities of living with the virus might cause anxiety or depression or disrupt emotional and mental health in other ways.

“It’s a chicken and egg situation,” Dianto says. “Our clients were in an unsafe world to start with; they could have entered that world through their mental health issues.” Dianto’s program treats more than the physical aspects of HIV. “It’s a combo program: mental health programs and medication,” she says. “Mental health is as important as physical health.”

At St. Elizabeth Ann’s, a variety of therapies aim to stabilize mental health. Groups meet to discuss anger management, aging, substance abuse, medication adherence, family relationships and feelings of loss. Holistic therapies include Reiki (a Japanese stress-reduction and healing technique), acupuncture and massage. Recreational therapy encourages healthy leisure activities; poetry and art workshops promote self-expression; a chaplain offers spiritual support.  

The final piece, Dianto says, is how to be happy. “Everyone thought they were going to die when they got their [HIV] diagnosis. Nobody talks about happiness.”

Enter Happier Horizons, a workshop created by Adrian McInman. The group teaches participants to improve their self-esteem and sense of control. “I’m giving them simple things they can hang onto,” McInman says (see sidebar for examples). “Most people won’t meditate for 30 minutes, but they can try diaphragmatic breathing for 60 seconds.” Dianto adds, “The program helps them think about being happy.”

Bishop says McInman’s course, which he took after leaving the nursing home in 2006, worked. “It gave me a different perspective,” Bishop says, “I [was able to] stop taking psych meds.” He’s still off those meds—and stable without them. In addition, he has stuck to his HIV regimen, and his virus is now undetectable.

But many clients simply deny their mental health problems and refuse needed psych meds, as Daryl Lewis, who entered the day program in 2004, once did. “I’d been diagnosed as manic depressive, but I was in denial. I knew better, but I stopped taking my psych meds,” recalls Lewis, who was diagnosed with AIDS in 1989. “That led me to relapse. A group called Double Trouble taught me to accept my dual diagnosis.”

Double Trouble was a peer-run group that disbanded last year because clients didn’t keep it going. Its replacement, a staff-run Dual Diagnosis group, was less effective, and Lewis is helping restart Double Trouble this summer.

“Peer-run support groups are effective in helping people face their mental health diagnosis,” Dianto says. Constantly receiving help from staff can make people feel helpless. A peer-run group derives its power from allowing everyone the chance to be the helper.

Ultimately, the St. Elizabeth Ann’s day program encourages people to accept their conditions—all of them—learn to treat them and keep going. Both Lewis and Bishop see themselves eventually returning to work. The day program, they say, helps them envision that future.

“People here gave me insight on my virus,” Bishop says. “I can live with this virus as long as I take my meds, do my prayers and meditation and stay focused. It’s not a death sentence. It’s like a celebration of life.”

Six tips from Adrian McInman’s Happier Horizons workshop  

Chosen Values Write down the words you’d like people to use to describe you. How can you change your life to better reflect those values?

Diaphragm Breaths Inhale through your nose, letting your stomach—not your chest—and your diaphragm expand. Exhale through your mouth. Go as slowly as possible without holding your breath. Do this for 60 seconds.

Positive Meditation After diaphragm breathing, spend 60 seconds concentrating on a color, a pleasant place, a person you admire or something you’d like to do.

Thought Stoppage When you have a negative thought, snap your fingers and tell yourself, “Stop!” Do a diaphragm breath and think of the positive values you’ve identified.

Mental Imagery Picture yourself remaining cool and calm while dealing with a difficult situation. Think of the words people would use to describe you in that situation.

Pointed questions Ask yourself what makes you happy. List your answers, then note how many minutes you spent doing those things yesterday. Do you set aside time to do what makes you happy?       

96% of positive people have had psychological problems since their HIV diagnoses.
Source: Joint survey of 2,052 people with HIV by AIDSmeds, POZ, the National Association of People with AIDS and the American Psychological Association. For more on the survey, search “mental health services” at