Claudia Medina, whose family is from Colombia, says that when she tested positive, in 1994, “things seemed so hopeless.” Medina’s primary support system—her family—managed to accept her HIV diagnosis. They had a harder time, however, addressing the health condition that followed: crippling clinical depression. Their advice: You just need to be stronger.

As many as one in three people with HIV may suffer from clinical depression—feeling bleak, exhausted and unable to manage everyday challenges. Depression affects more women than men, and Latinas most of all (see sidebar). The brain chemistry imbalance is often caused by traumatic events, such as a positive diagnosis.

With no outward signs of illness, asymptomatic positive people like Medina may choose not to disclose their HIV status. But depression is harder to hide. Medina, who was working full-time while raising a 1-year-old son, says, “I couldn’t deal with work any longer. I was missing shifts; I’d end up crying at the front desk.” Her employer, a social services agency, helped arrange for leave. Her family remained in denial. “According to the Hispanic community,” Medina says, “depression just doesn’t exist. My aunt told me, ‘A strong woman does not need to go to some counselor or take pills to cope with life.’ My grandmother, who raised 12 children, said, ‘Do you think that any of us have not gone through hard times? You don’t need medications; you just need to be tough.’”

Many cultures, Medina says, interpret any shift from this thinking as a betrayal: “Viewing depression as an illness, talking openly about HIV, saying that it’s OK to be gay—if you buy into these things,” she says, “you’re seen as a traitor to your culture.”

Medina’s turning point came on her darkest day. Locked in the bathroom and ready to cut her wrists, she heard her son’s voice calling for her. “I was reminded of why I’m on this planet,” she says. “Everyone has that anchor, that reason for being here. They just need to be reminded of it sometimes.” With that reminder, Medina stopped listening to the naysayers and started listening to herself—getting the counseling and treatment that have brought her back to health. Now a case manager at an AIDS service organization, she says, “People hear that I’ve been positive for 14 years and I’ve dealt with depression, and all of a sudden there’s a light for them.”

Shine on.      


REGAINING HOPE


Half of the positive women in the Women’s Interagency HIV Study (WIHS)—and even more of its Latina women—experienced serious depression at some point over a two-year period. WIHS researcher Judith Cook, PhD, of the University of Illinois, Chicago, says that for depressed positive people—no matter what sex or nationality—the messages are clear:


• Acknowledge it
“The first thing I do with depressed clients,” says Claudia Medina (main story, below), “is normalize it. Once you acknowledge that it’s real, you can start to address it.”

• Get help
Those who seek mental health treatment are more likely to take their HIV meds, remain healthy and live longer. Cook advises, “Talk to your doctor; get a referral for mental health counseling and, if appropriate, medication. Look for someone who speaks your language and see them regularly.”

• Find your own community
According to Cook, the social and self-imposed stigmas of depression can isolate women from vital social supports. Most local AIDS organizations or clinics offer support services.