More Than Just Blue

BY Benjamin Ryan

September 22 2010 3:00 PM ET

 Johnny Guaylupo was only 17 years old when he found out he was HIV-positive. While he’d struggled with depression throughout much of his life, after his diagnosis he saw his emotions take a dangerous turn.

“Me and my friends would say, ‘I’m going down. Everything’s just going down,’ ” he recalls about those volatile younger days.

In this case, Guaylupo says, “going down” meant thoughts of suicide.

“I started getting depressed about my diagnosis,” he says, “what to do about telling my family, my friends. I thought my life was over.”

After an argument with the older man with whom he was in a “bad so-called relationship,” he tried to kill himself.

Mental health professionals have long cried for the public to acknowledge depression as an illness akin to any serious physical ailment: one with defined symptoms, with prescribed treatment, and that can ultimately prove fatal. In the case of HIVers, this recognition is of vital importance because depression is the number 1 obstacle to antiretroviral adherence, professionals note, and is strongly associated with faster disease progression.

Over the years since the low point that almost led him to take his own life, Guaylupo has turned things around. While he says he still suffers from bouts of depression, none have been as severe as the one that nearly ended his life—thanks in part, he says, to a steady and fruitful relationship with his therapist.

“I know for a fact that it’s not easy, but it’s something that’s treatable, that you can work through,” he says. “It’s not really that hard. I mean, it may seem the worst. It may seem like everything is happening at one time. And everything at one time is hard for me, and I just want to grieve. But it’s not that serious—if you seek help.”

Today, he tries to help other struggling HIVers through his work in an adult day health care program at Housing Works, a New York City AIDS service organization, a job that the 27-year-old Brooklynite says provides him with a sense of purpose and structure he lacked as a teenager.

Yes, It’s Real

Some researchers state that as much as 40% to 60% of the HIV-positive population will suffer from depression at some point in their lives. Using a more rigid set of criteria than most, Glenn J. Treisman, MD, Ph.D., who is director of the AIDS Psychiatry Service at Johns Hopkins Hospital in Baltimore, estimates that at any given time about one in five HIVers is suffering from major depression and requires psychiatric treatment. Regardless of how they define a diagnosis of depression, most scientists agree that HIVers suffer from the condition at a rate four to five times greater than the general population.

Robert H. Remien, Ph.D., who studies the psychology of HIV at Columbia University in New York City, cautions against concluding that rates are so high simply because HIVers have every reason to be depressed. Rather, he says, depression and HIV engage in a complex, interweaving dance—each potentially influencing and exacerbating the other.

“Think about who is vulnerable to getting HIV,” Remien says. “They are often disen­franchised people because of their sexual identity, substance abuse, etc.”

These populations, he explains, are already primed for experiencing depression and might also have a family history of mental illness. Their depression could then cause a sense of apathy about their own well-being that leads them to take the sorts of risks that expose them to the virus.

Furthermore, Remien points out, people who are facing a new HIV diagnosis should not see the onset of major depression or thoughts of suicide as a natural and expected reaction to the news.



























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