On AIDS Psychiatry

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Earlier today, Mary Ann Cohen, co-editor of the Comprehensive Textbook of AIDS Psychiatry helped us better understand the AIDS epidemic in young American men. Cohen’s book (with Jack M. Gorman), navigates the ample evidence supporting the fact that psychiatric treatment can decrease transmission, diminish suffering, improve adherence, and decrease morbidity and mortality in AIDS patients. In the excerpt below, Jimmie Holland, MD the Wayne E. Chapman Chair in Psychiatric Oncology at Memorial Sloan Kettering Cancer Center and a Professor of Psychiatry at the Weill Medical College of Cornell University provides a Forward which puts the Comprehensive Textbook of AIDS Psychiatry into historical perspective.

The publication of the Comprehensive Textbook of AIDS Psychiatry, edited by two psychiatrists who have ‘‘been there’’ since the beginning of the epidemic, is a benchmark for the field —it has come of age.

The book begins with an important history of the disease. In the early 1980s, we were sure that infectious diseases were on their way to being eradicated. Then the first cases of a strange ‘‘wasting disease’’ appeared in New York and San Francisco. Frightening, mysterious, without known cause or cure, and without knowledge of the route of transmission, this disease instilled near-panic levels of fear among the public. The same fears existed in health care personnel. Society quickly stigmatized AIDS as it had done with all prior epidemics—from the plague, to tuberculosis, to cancer. The short course of three decades has resulted in the panic dissipating as information about cause and treatment emerged.

However, the stigma took another direction as we learned more about this disease. It appeared disproportionately in populations that carried their own complex and negative social connotations, gay men and substance abusers. Research was slowed by these 9780195304350.jpgbiases, yet in three decades, treatment has turned a devastating disease into one with a chronic course in the industrialized world. The tragedy of our current world condition is that the places where most of these cases are occurring have little access to the known preventive measures and effective treatments that are now accepted practice in the United States. It will be a blot on the Western world when the history of this era is written on this pandemic, for the fiber of life was allowed to be destroyed in Africa while the resource-rich countries looked on.

It is crucial that the psychiatric and psychosocial manifestations of HIV/AIDS be widely understood by physicians and their teams who provide care for persons with HIV. The care of children is a critical component, especially in the developing world. The central nervous system sequelae of delirium and dementia are serious effects requiring management by those with a good knowledge of the psychiatry of medical illness. The psychological issues of sadness, depression, anxiety, and coping with a disease that has no cure require thoughtful management. All the problems of a chronic illness, with its need for adherence to treatment and for social support, make this one of the chronic diseases of the twenty-first century that will require continued allocation of resources as the challenges of patients change as the disease evolves. The thoughtful explication of symptoms and signs of the common psychiatric disorders is a contribution to the literature on AIDS, written by our best authorities…

Attention to the means of transmission of HIV by sexual contact and substance abuse related behavior has made prevention as important as the treatment. Application of what we know today in the developing world will begin to change the devastation that has occurred in Africa….

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