Jason Kaplan
NOT ONLY IS PORTLANDER Doug Sanders a slender 35-year-old battling AIDS, he is struggling to control a pre-existing mental illness. In this fight, Sanders is not alone. Although formal documentation is scarce, health providers are reporting an alarming number of AIDS patients who also suffer from mental illnesses.

At first blush, such connections may seem highly coincidental; however, health providers say that over the past few years a clear picture of the poisonous nexus between mental illnesses and AIDS has begun to emerge.

In hindsight, Sanders clearly sees the link from his manic depression to his contraction of AIDS: depression, loneliness and, as Sanders put it, "drinking everything that wasn't nailed down" led him through a whirlwind of casual, sexual encounters. Now, Sanders' on-going battle with mental illness complicates his treatment of AIDS in a way that physicians only are beginning to comprehend.

Although large-scale studies are scarce, health providers are reporting an alarming number of patients with the devastating dual diagnosis of HIV/AIDS and mental illness. Here in Portland, the Partnership Project has begun to collect data on HIV/AIDS and mental illness. The Partnership Project provides case management and helps AIDS and HIV-positive sufferers deal with the tedium of managing their sickness--handling appointments at clinics, providing food assistance, and dealing with housing. From July 1998 to June 1999, a bleak 56 percent of Partnership's clients had at least one mental-health diagnosis.

One of the primary reasons this epidemic snuck up on researchers is because of AIDS reputation as a "gay disease." In an attempt to de-stigmatize the disease, there was a measured movement away from systematic tracking of patients' social factors, like sexual orientation and mental-health status. Only in the past few years have researchers begun to link the connections between HIV and mental illness. In 1997, Clinical Psychology Review devoted an entire issue to HIV and AIDS among the mentally ill. One article showed an HIV-positive rate of nearly 8 percent among the mentally ill, compared with about one-half of a percent among the general U.S. population.

More than just a contributing factor, though, mental illness--and its own bouquet of meds--intensifies and dangerously complicates treatment of AIDS. Like combining any medication, the perils are acute.

Since Sanders tested positive for HIV in 1994, he has had two doctors--one to treat his HIV, another to treat his manic depression. But he notes that any coordination of care has come at his own initiative.

In 1997, Sanders suffered a psychotic episode when his HIV cocktail was being adjusted. "You have two very powerful medications being prescribed by different doctors," he said. "You get some very bizarre side effects--in my opinion, that could be what triggered that psychotic episode."

Dr. Mark Loveless, HIV program director at the Oregon Health Division, concurs with Sanders' concerns. "The medicines used for schizophrenia or bipolar disorder or even for severe depression," he explains, "have to be managed very carefully when people are also taking antiviral medications, particularly protease inhibitors."