HIV in Specific Populations

The HIV pandemic has affected different communities in varying ways. This chapter will discuss some of the unique considerations related to HIV and mental health in several specific populations and communities. Some topics that seem to be universal with all the populations discussed include stigma, trauma, barriers to care, and healthcare disparities. Important factors involved in work with children and adolescents include issues around HIV disclosure, neurodevelopmental considerations, decreased adherence, and the transition to adult care. Some particular issues for women to be reviewed involve psychosocial issues causing barriers to care, gender-based violence, and issues relating to pregnancy and conception, as well as menopause. Racist policies driving HIV health disparities for Black Americans, especially Black men who have sex with men (MSM) and Black women, will be presented along with the concept of medical mistrust, as well as the complex role of the Black church, religion, and spirituality in the lives of Black Americans dealing with HIV. The disproportionate rates of HIV in men who have sex with men (MSM) will be reviewed, including the potential role of homophobia/anti-gay bias, substance use, and, for older men, the issues of ageism and loss of social networks. The chapter will provide a list of definitions related to gender identity; it will discuss HIV in the transgender population, review data on transphobia and discrimination negatively impacting interactions with the healthcare system, and provide an overview on transgender healthcare, including the intersection with HIV care.