If you're like most HIVers, you see your primary care doctor three or four times a year to discuss your meds, CD4-cell count, and viral load. But when was the last time you used one of these appointments to talk about your mental health?

There's little doubt that living with the tricks that HIV plays on an immune system can also affect mental and spiritual well-being. But this side of the disease isn't always discussed. As Steven M. Harlow, clinical director of New Leaf counseling center in San Francisco, notes, "As HIV has come to be more of a manageable illness, people have forgotten that there is still an emotional impact to having this disease."

Yet the stigma and discrimination that still accompany having HIV can take a toll. A study led by Susan Cochran, an epidemiologist at the University of California, Los Angeles's School of Public Health, has found that gay HIV-positive men are up to eight times as likely as heterosexual men to report having mental health problems. Similar studies conducted around the world show that HIVers, regardless of gender, age, or sexual orientation, commonly suffer from depression.

The findings underscore the importance of HIVers discussing their mental heath with their doctors. "Getting mental health care is important in its own right, because it affects people's lives," says Brian Wells Pence, an epidemiologist at Duke University who studies mental health issues in HIVers. "But it's also important because it can affect how well a person engages in their medical care."

There is no mental health equivalent to a CD4 count or a viral load, but there are screening tools doctors can regularly-and easily-use.

Harlow says that HIV specialists and primary care docs can and should conduct mini assessments to identify problems their HIV-positive patients might be having with depression or anxiety. In addition, he says, they should be regularly assessing whether a patient is experiencing any emotional problems because of life changes or if their substance use or sexual behaviors have changed in ways that need to be addressed.

And if the doctor doesn't bring the subject up, says Harlow, then the patient definitely should feel free to start the conversation. "Nobody," he insists, "should suffer the impact of depression or anxiety and the loneliness and isolation that can accompany them without getting help."