Introduction
There is no gainsaying that HIV infection has assumed a pandemic nature the world over. In addition to its contribution to morbidity and mortality, possible relationship of outcome of treatment with psychiatric morbidity and substance use presents another dimension to the disease. In one study, about 50% of patients with HIV infection had substance use problems; 18.5% were frequent users of alcohol while half of the patients had psychiatric morbidity (Bing et al., 2001). Earlier studies however reported a smaller percentage (Ferrando, Evans, Goggin, Sewell, Fishman, & Fiabkin, 1998; Maj et al., 1994). In yet other studies prevalence of 22% to 32% (Evans, Ferrando, Sewell, Goggin, Fishman, & Rabkin, 1998; Rabkin, Goetz, Remien, Williams, Todak, & Gorman, 1997) was reported which is two to three times higher than the prevalence of psychiatric disorders in general community population (Blazer, Kessler, McGonagle, & Swartz, 1994).
Lower prevalence of 9% of major depression and 2% of anxiety disorder were reported among the patients after 6-months follow up (Perkins, Stern, Golden, Murphy, Naftolowitz, & Evans, 1994). It was observed that while depression had substantial impact on quality of life, anxiety has negative impact on social role and mental functioning. In addition, where substance use problem is present but not treated, there is non-adherence to antiretroviral drugs (Ironson et al., 2005). The overall consequence of substance use and psychiatric morbidity among patients with HIV infection is poor physical health, rapid progression to AIDS and death, particularly non AIDS related death (Ironson et al.. 2005). in addition, Ironson et al. (2005) reported that psychosocial factors contribute significantly to the variance in disease progression.