Background. There is little agreement on whether the prevalence of psychiatric disorder is elevated in HIV-seropositive (HIV +) populations compared with uninfected persons. However, evaluation of this issue has been limited by difficulties of sampling, study design and failure to control for other risk factors for disorder.

Methods. Prevalence and clinical characteristics of DSM-III-R major depressive disorder (MDD), generalized anxiety disorder, adjustment disorder, and alcohol and substance abuse/dependence were evaluated in a representative sample of HIV + men attending primary care physicians' offices in a defined geographical area. Lifetime prevalence at baseline and 1-year rates during longitudinal follow-up were determined for the 113 HIV + men, as well as 57 HIV – men, via standardized interview. Multivariate analyses considered unique and combined effects of HIV serostatus and other risk factors on likelihood of disorder.

Results. Although there were no differences in lifetime rates prior to baseline, HIV + men were at greater risk for disorders during the prospective study period. For MDD, this effect was maintained even after controlling for other risk factors. Several of these other factors bore their own effects: regardless of HIV serostatus, men were susceptible to psychopathology if at baseline they were younger, had a lifetime psychiatric history, or had poor social supports or a low sense of personal mastery.

Conclusions. The risk of certain psychiatric disorders appears uniquely elevated in HIV + men. Since other factors also influence risk, interventions designed to minimize psychopathology during HIV infection should attend to both HIV-related and non-HIV-related risk factors.