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An elderly uncircumcised male presented with thick scaly lesions over his glans penis of one year duration. Histology showed acanthosis, papillomatosis, and elongated rete ridges into the dermis suggestive of pseudoepitheliomatous, keratotic, and micaceous balanitis. Topical therapy was advised and followed up closely for malignant transformation.

Background: Diagnosis of HIV infection creates an overwhelming stress and leads to symptoms like guilt, fear, anxiety, sad mood, grief and suicidal ideation. Though the rate of suicide has decreased after the introduction of highly active anti-retroviral therapy (HAART), it still remains high. Indian studies assessing suicidal ideation in people living with HIV (PLHIV) are scarce. Psychiatric evaluation and treatment improves the quality of life in PLHIV. Aim of the study was to assess the prevalence and patterns of psychiatric morbidity including suicidal ideation in PLHIV attending Integrated Counselling and Testing Centre (ICTC), prior to initiation of ART.Methods: A cross sectional study design was used. 11476 persons attending ICTC of IRT Perundurai Medical College, Erode, Tamil Nadu, India were tested for their HIV status over a period of two years. 211 persons were found to be positive, 143 persons gave consent and met inclusion criteria. Every patient underwent a semi-structured clinical interview and their psychiatric morbidity was assessed based on ICD 10. Current suicidal behavior, hopelessness and depression were measured by appropriate rating scales. Data was analyzed by using the SPSS 16.Results: Psychiatric diagnosis was present in 36.4% of the sample. Depression was the commonest diagnosis followed by adjustment disorder, alcohol related problems and anxiety disorder. 26 persons (18.2%) had current suicidal ideation. 3 out of 143 persons had attempted suicide within 6 months following notification of their HIV status.Conclusions: Nearly 1/3rd of PLHIV require psychiatric referral and 1/5th of PLHIV have suicidal ideation. It will be highly beneficial to integrate psychiatric services into daily care of PLHIV.