Shared services.

In their study of women living with or at risk of human immunodeficiency virus (HIV) infection, Schuman et al found that one-third of women reported needing mental health care, but that only two-thirds of those in need had that need met. This article describes an approach to providing mental health services to women with HIV used in our Chicago clinic. What we call the "ambiance of caring" creates an atmosphere in which mental health support can be provided and received. A continuing respectful primary care relationship and a supportive non-judgmental environment are the keys to success. Good communication, sensitive history taking, appropriate assessment tools, and direct questioning in a safe setting will let the patient know that you really care about what she is experiencing. Real-time referrals with a team of social workers, psychologists, and psychiatrists allow the best beginning to the therapeutic relationship. The next decade will provide an opportunity to address the mental health concerns of women with HIV--some of our society's most complex patients.

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