Psychological distress states have been related to rate of disease progression among HIV-positive individuals. However, the measures that have been used in this research as well as the treatment context of the populations studied are highly variable, making it challenging for clinicians to incorporate such measures into screening batteries. The present study examined the association of two summary scales of the Millon Behavioral Medicine Diagnostic (MBMD; Millon et al., Millon Behavioral Medicine Diagnostic. NCS Assessments, Minneapolis, 2001), with markers of HIV disease status (CD4 and CD8 cell counts, viral load) among an ethnically diverse sample of 147 HIV-positive individuals (52 men who have sex with men, 34 men who have sex with women, and 51 women) who had recently initiated Highly Active Antiretroviral Therapy (HAART). After controlling for age and months since HIV diagnosis, we found that higher scores on the overall MBMD Psych Referral Summary Scale, reflecting a need for mental health treatment, were related to greater HIV viral load but did not relate to CD4 or CD8 cell counts. Subgroup analyses revealed that Psych Referral scores were related to greater HIV viral load only for the men who have sex with men (MSM) subgroup. These results suggest that the MBMD may help in identifying psychosocial characteristics associated with some markers of disease status in persons with HIV and perhaps may also be useful in identifying individual differences in response to treatment and eventual disease outcome.

Introduction Over the last decade the number of children with life-limiting conditions surviving into adulthood has increased dramatically and is likely to continue to increase. Engaging the Adult Specialist Palliative Care (SPC) services in the care of these young adults (YA) is essential. The YA concerned commonly have complex needs, rare conditions and a mixture of cognitive and physical disabilities. For many adult SPC teams this is new territory, and there are many potential barriers to care. Provision of SPC services for these YA needs to be appropriate, available and equitable- and in practice this is often a challenge. With this in mind, we endeavoured to identify and explore the barriers to care. Methodology We conducted a telephone survey using a semistructured questionnaire. All adult SPC in-patient units in Wales were invited to participate. The Clinical Lead was interviewed and we explored their experiences, views and concerns regarding proving a service to these YA. Results 13/14 units participated. Five of the units had had experience in caring for YA with complex needs but none had looked after more than 2. There was enthusiasm for providing service to YA but this was tempered by some important concerns. Including Education/training of staff, adequate staffing levels and funding. There were several practical issues including management of non-invasive ventilation and ventricular-peritoneal shunts that reduced general confidence. Interestingly, there was a shift in attitudes over the course of the interview, resulting in 12 of the units feeling confident to admit the hypothetical patients (with Cerebral Palsy and Duchenne Muscular Dystrophy). Conclusion The attitudes among the adult SPC units towards the care of YA with complex needs are generally positive. There are, however, specific issues and concerns that need to be addressed in order to safely progress in developing an appropriate service for this patient group.

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