While doing some reading recently, I stumbled on a startling statistic. An estimated 35% to 60% of HIVers become clinically depressed; the national average is somewhere between 5% and 10%. While statistics can often be used in misleading ways, these numbers, I found, are generally agreed upon as accurate.
Years ago when I first heard that HIVers were more likely to have depression than people without the virus, my first thought was that it made sense. People contract a virus that's ultimately deadly and often a source of societal stigma, so of course they'll be depressed. And the illness itself--with its symptoms (the chronic infections, exotic illnesses, body sweats, fatigue) as well as numerous trips to the doctor or hospital--generates its own feelings of sadness and loss. In short, it brings enormous challenges and can lend itself quite easily to depression.
However, does HIV actually cause depression? Just because there's a correlation between depression and HIV disease doesn't mean the virus actually causes it. If HIV causes depression, why doesn't every HIVer have it? What about the opposite? Is it possible that people who are depressed are more likely to contract HIV? After all, there are stressors that people who contract HIV have in common. For example, it remains true that the hardest hit populations are men who have sex with men and minority women--populations who encounter stress and challenges that people in the majority do not have to face.
The truth is that there are many reasons HIVers become depressed. What matters more than the 'why,' however, is the 'what'--namely, that more of us do become depressed. And then the next pressing questions are, What do we do about it? How do we care for ourselves? How do we live in hope instead of fear? How do we survive?
The first follow-up question--What do we do about it?--is crucial because study after study confirms that depression affects the progression of HIV disease, not only in how it damages T cells but also in how it affects memory and concentration in ways that compromise medication adherence. It's a double whammy.
So what do we do? Two words: Take action. Call a therapist. Talk to your doctor about depression. Take medication if recommended. Exercise, even if it's walking around the block. Pay attention to your diet, even if it's eating one more fresh vegetable a week. Talk about what you're struggling with, even if only with one person. Clean your apartment, even if that means washing one dish. Open your mail, even if it's one piece. Call someone, even if only one person. All of these can create momentum around which we can generate hope, and with hope comes the possibility of change. It also breaks down life's tasks into small, manageable steps. The feeling of accomplishment you get from such actions creates incentive for more change.
Something is always better than nothing when it comes to the backbreaking, paralyzing, and oppressive weight of depression.
There is no question that we who have HIV wrestle with issues most people do not have to face. Between being sick more often, facing mortality sooner, and living with stigma more consistently, we live with some obstacles and are bound to have painful emotions that can be difficult to feel or express. However, while feelings of sadness, anger, and loss are inevitable, depression isn't. To do nothing about depression is to cave in to it, giving up hope that things can change. And giving up hope, especially for someone with HIV, is deadly.
Fransen is a licensed clinical social worker and is in private therapy practice in Chicago.