Impact of alcohol and drug use on diagnosis and management of depression in gay men attending general practice

This study explores the role of alcohol and drug use on the diagnosis and management of depression among gay men attending Australian general practice clinics. The study was conducted with the goal of assisting GPs to address alcohol, drug use and depression in gay men and to add to the knowledge of these issues in the general practice setting. Three research analyses were made from the study relating to patterns of alcohol- and other drug-use associated with depression, comparison of doctor and patient beliefs about drug use and depression, and the impact of alcohol and other drug use on the agreement between doctors’ assessments of major depression and patients’ scores in depression screening tools

Primary health care project on HIV and depression

Commencing in April 2006 this three-year-project adopted a comprehensive and multi-method approach to investigate the prevalence, nature, clinical management and self-management of depression among men, particularly homosexually active men, attending HIV-caseload general practice clinics

Human rights and universal access for men who have sex with men and people who inject drugs: a critical reflection on 2010 UNGASS narrative country progress reports

All UN member states have endorsed a commitment to protect human rights in the global fight against HIV and to ensure universal access to HIV prevention, treatment, care, and support. To assess progress towards fulfilling this commitment, countries submit reports to UNAIDS biennially, known as UNGASS reports. Our quantitative analyses show that core indicators relating to most-at-risk populations, particularly men who have sex with men (MSM) and people who inject drugs (PWID) are limited or absent from many UNGASS reports, particularly those submitted by countries in developing regions. We conducted a qualitative thematic analysis of the narrative part of the 2010 UNGASS country progress reports, an important yet under-explored part of the reporting process, to consider how signatory countries in developing regions address the issue of MSM and PWID in a written form. Our analysis identified a repertoire of narrative approaches to MSM and PWID which revealed fault lines between countries’ endorsement of the Declaration of Commitment on HIV/AIDS and programmatic responses to MSM and PWID. Our findings raise questions about the relationship between “universal” human rights and “local” cultures, and about the UNGASS reporting process itself. Through critical engagement with these questions, our article aims to contribute to international dialogues on how to better recognise and respond to shortcomings in the global commitment to human rights and universal access for people vulnerable to HIV

Discourses of depression of Australian general practitioners working with gay men

The data for this article are from a primary health care project on HIV and depression, in which the prevalence, nature, clinical management, and self-management of depression among homosexually active men attending high-HIV-caseload general practice clinics were investigated. One of the qualitative arms consisted of in-depth interviews with general practitioners (GPs) with high caseloads of gay men. The approach to discourse analysis was informed by Halliday’s systemic functional linguistics. GPs constructed three discourses of depression: engaging with psychiatric discourse, engaging with the patient’s world, and engaging with social structures. When GPs drew on the discourse of psychiatry, this discourse was positioned as only one possible construction of depression. This discourse was also contextualized in the social lives of gay men, and it was explicitly challenged and rejected. Engaging with their patients’ social world was considered vital for recognizing depression in gay men. Finally, the GPs’ construction of depression was inextricably linked to social disadvantage and marginalization. Depression is highly heterogeneous and constructed in terms of social relationships rather than as an independent entity that resides in the individual. There is a synergy between GPs’ constructions of depression and men’s experiences of depression, which differs from conventional medical views, and which enables GPs to be highly effective in dealing with the mental health issues of their gay patients

Does drug and alcohol use undermine concordance between doctors' assessments of major depression and patients' scores on a screening tool for depression among gay men attending general practice?

General practitioners (GPs) identify that depression can be difficult to diagnose in populations with high rates of alcohol and other drug (AOD) use. This is a particular concern with gay men who are a population known to engage in high rates of AOD use and who are vulnerable to depression. This paper uses data from 563 gay men and their GPs to describe concordance between assessments of major depression and, in particular, whether AOD use undermines concordance. Data were collected as part of a larger study of male patients and GPs at high HIV-caseload general practices in Australia. Concordance was measured by comparing patients’ scores on the PHQ-9 screening tool, which is based on DSM-IV criteria, and GPs’ ratings of the likelihood of depression for each participant. We observed high concordance between GPs’ assessments of major depression and patients’ scores on the PHQ-9 (79% agreement), although our analysis also suggests that concordance was better when it related to cases in which there was no depression. The high concordance observed in our study did not appear to be undermined by gay male patients’ AOD use, with the exception of frequent use of crystal methamphetamine. Here, men who reported frequent use of methamphetamine were significantly less likely to have concordant assessments (AOR 0.3, 95% CI 0.1-0.8). Overall, GPs appear to identify depression among many of their gay male patients. While GPs should be aware of the potential complications presented by frequent crystal methamphetamine use, other AOD use may have less impact on the diagnosis of depression

'We just don't know': Ambivalence about treatment strategies in the Australian community-based HIV media

The community-based HIV media in Australia provide a unique arena for the negotiation of competing models of medicine between activists, clinicians, government and people living with HIV/AIDS. This article examines how these media have interpreted developments in HIV treatment strategies since the introduction of new treatments in 1996, and identifies the discursive elements employed in journalistic constructions of the temporality and character of HIV medicine. A discourse of ambivalence recurs throughout this journalism, framing the negotiated shifts in treatment strategies as evidence of the uncertainty and unpredictability of HIV medicine. Associated with this discourse are metaphors of medical ambivalence that employ provocative imagery such as fashion, rollercoaster, obstacle course and guessing game to shore up a notion of the volatility of HIV medicine. This article participates in ongoing engagements between the communities and clinicians affected by HIV/AIDS and, more broadly, in the production of knowledge around medicine and the media

Management of HIV and depression in general practice: the Primary Health Care Project on HIV and Depression

The Primary Health Care Project on HIV and Depression is a study that was conducted over three years to look at issues surrounding HIV and depression in Gay men. The study investigated the prevalence, nature, clinical management and self-management of depression among men, particularly homosexually active men, attending high HIV-caseload general practice clinics in Sydney, Adelaide and a rural-coastal town in New South Wales.The study had three broad aims. The first was to describe, measure and compare depression among HIV-positive and HIV-negative gay men. The second was to describe the ways in which depression is managed by general practitioners (GPs) and gay men themselves; and the third was to develop the research capacity and skills of GPs to assess and manage depression among gay men

Experiences in managing problematic crystal methamphetamine use and associated depression in gay men and HIV positive men: in-depth interviews with general practitioners in Sydney, Australia

Background: This paper describes the experiences of Australian general practitioners (GPs) in managing problematic crystal methamphetamine (crystal meth) use among two groups of male patients: gay men and HIV positive men. Methods: Semi-structured qualitative interviews with GPs with HIV medication prescribing rights were conducted in Sydney, Adelaide and a rural-coastal town in New South Wales between August and October 2006. Participants were recruited from practices with high caseloads of gay and HIV positive men. Results: Sixteen GPs were recruited from seven practices to take part in interviews. Participants included 14 male GPs and two female GPs, and the number of years each had been working in HIV medicine ranged from two to 24. Eleven of the GPs who were based in Sydney raised the issue of problematic crystal meth use in these two patient populations. Five key themes were identified: an increasing problem; associations with depression; treatment challenges; health services and health care; workforce issues. Conclusion: Despite study limitations, key implications can be identified. Health practitioners may benefit from broadening their understandings of how to anticipate and respond to problematic levels of crystal meth use in their patients. Early intervention can mitigate the impact of crystal meth use on co-morbid mental illness and other health issues. Management of the complex relationships between drug use, depression, sexuality and HIV can be addressed following a `stepped care` approach. General practice guidelines for the management of crystal meth use problems should address specific issues associated with gay men and HIV positive men. GPs and other health practitioners must appreciate drug use as a social practice in order to build trust with gay men to encourage full disclosure of drug use. Education programs should train health practitioners in these issues, and increased resourcing provided to support the often difficult task of caring for peo

Self-reported sexual difficulties and their association with depression and other factors among gay men attending high HIV-caseload general practices in Australia

Introduction. Sexual expression affects physical, mental and social well-being. There is a lack of understanding of male sexual dysfunction in homosexually active men. Aim. We investigated gay men's self-report of a number of sexual problems. Methods. The survey data were from a sample of 542 self-identified gay men, 40% of whom were HIV positive, recruited from six high HIV-caseload general practices in Australia. Main Outcome Measures. The reporting of experiencing three or more sexual problems over a period of at least 1 month in the 12 months prior to a survey was defined here as having "multiple" sexual problems. We explored a number of factors, including HIV status, depression, alcohol and other drug use, and sexual risk-taking with casual male partners, in association with multiple sexual problems