Addressing Psychosocial Comorbidities among HIV-Infected Youth
Cultural Diversity & Mental Health
In a multicultural patient population, it is often difficult to achieve patient compliance with referrals to mental health services. Beliefs concerning treatment of mental health conditions vary among members of different cultural groups, many of which reject conventional Western methods of treating mental health disorders. For mental health concerns, in communities where there is a strong sense of spirituality, families may consult spiritual leaders for help. Some may comply with the conventional medical treatment recommendations while incorporating interventions grounded in their own cultural traditions.464748
According to the 2000 U.S. Census, Hispanics of all races represent 13.3 percent of the U.S. population, about 37.4 million individuals. 49 The use of spiritualism, Santeria, and other religious approaches to health and mental health conditions in this group is common. Community storefronts that offer spiritual readings or the neighborhood curandero that promotes the use of herbal treatments, special diets, and spiritual prescriptions can influence the patient to reject the clinician's recommendations for psychotropic medications and psychotherapy. 50 Of special concern to the clinician would be adverse effects and contraindications between certain holistic treatments and conventional medications. Patients should be encouraged to give detailed information regarding all current "medications," including herbs and vitamins.
Regarding the AI/AN population, the 2000 U.S. Census reported that 4.3 million people (1.5% of the U.S. population) identified themselves as being of members of this demographic. There are approximately 700 AI tribes and AN villages in the United States, with 569 tribes having a special trust relationship with the U.S. government. The degree of access to and use of traditional AI/AN medicine varies from group to group. Traditional practices can include ceremonies specifically for the community or for the individual and family. Traditional medicine represents vast systems of prevention and treatment that operate at several levels, culminating with practitioners who dedicate a substantial portion of their lives to healing. 51
As a result of the trauma of colonization and subsequent abuse perpetuated by policies of assimilation, AI/AN people have been put at risk of behavioral, emotional, and mental health problems. With the recent strengthening of tribal culture, there has been an increase in the availability of tribal services and culturally sensitive mainstream mental health services. Consequently, a clinician has a higher probability of ensuring culturally sensitive services for an AI/AN adolescent patient, particularly when working in conjunction with the family and, possibly, members of the extended family.
The expression of distress through somatic complaints has been documented across many cultural groups. A mild to serious anxiety disorder will be described as suffering that ranges from "nerves" to "demonic possession." 52 Familiarity with the wide scope of beliefs among the many cultures, and a nonjudgmental approach to these beliefs, will provide the clinician with the tools and skills to develop and implement a viable treatment strategy that is agreeable to both the patient and the physician. 53
- Szapocznik J, Lopez B, Prado G, et al. Outpatient drug abuse treatment for Hispanic adolescents. Drug Alcohol Depend. 2006 Sep;84 Suppl 1:S54-63.
- Suarez M, Raffaelli M, O'Leary A. Use of folk healing practices by HIV-infected Hispanics living in the United States. AIDS Care. 1996 Dec;8(6):683-90.
- Trotter RT. Curanderismo: a picture of Mexican-American folk healing. J Altern Complement Med. 2001 Apr;7(2):129-31.
- Delgado M. Therapy Latino style: implications for psychiatric care. Perspect Psychiatr Care. 1979 May-Jun;17(3):107-13.
- Alonso L, Jeffrey WD. Mental illness complicated by the santeria belief in spirit possession. Hosp Community Psychiatry. 1988 Nov;39(11):1188-91.
- Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978 Feb;88(2):251-8.
- Baez A, Hernandez D. Complementary spiritual beliefs in the Latino community: the interface with psychotherapy. Am J Orthopsychiatry. 2001 Oct;71(4):408-15.
- Starn JR. Family Culture and Chronic Conditions. In: Jackson PL, Vessey JA, eds. Primary Care of the Child with a Chronic Condition. St. Louis: Mosby; 1996:58-71.