It’s easy to imagine that having an incurable illness could make you depressed.Having an incurable illness which carries a stigma, like AIDS and HIV, could make you even more depressed at least that’s what you might think.There are no local statistics but US psychiatrist Andrew Angelino says anywhere between 20 and 30 percent of HIV patients in America suffer from depression.That’s two to three times higher than the depression rates seen elsewhere in the general population.In the majority of cases, contracting the HIV virus is not the reason the person is depressed.According to Dr Angelino, depression is actually the reason the person contracted HIV.Dr Angelino is director of the General Psychiatry Unit at Johns Hopkins’ Bayview Medical Center.“A lot of people think the depression is a result of the illness. It's actually the other way round,” he said in an interview with Body & Soul.“Most people with depression who are in the HIV clinic, had their depression first.“Because they were depressed, they were unable to feel pleasures from things. And because they were unable to feel pleasure, they engaged in higher risk behaviors to try to get some sort of excitement or pleasure in their life.” He said that numerous studies show that people with depression are more inclined to engage in risky behaviours.“Studies show that there’s a higher rate of drug use when they are depressed than when they are not depressed,” he said.“So they wind up with HIV as an outcome of an illness rather than a cause of the illness.”Dr Angelino said he had a male patient who contracted HIV through having unprotected sex with prostitutes. The man had been married for 15 years but told the psychiatrist that he became bored having sex with his wife. He shared his lack of interest in his wife with a male friend. The friend suggested they have sex with prostitutes when they were at a convention in Las Vegas.The patient enjoyed the experience and so when he returned home, he continued to use prostitutes for sex, eventually contracting HIV.Dr Angelino eventually discovered the man was disinterested with life generally sex with his wife wasn’t the problem.“It turns out he was suffering with major depression,” said Dr Angelino.He was able to treat the man which enabled him to enjoy life, despite having HIV.He even enjoyed sex with his [HIV-free] wife again.HIV can cause depression in some cases, Dr Angelino noted.“You can have brain problems from HIV infection, including dementia, delirium; you can develop bipolar disorder as a result of infection of the brain we think,” he said. “But the majority of patients that I see are not depressed because they have HIV. They have HIV because they are depressed.”Dr Angelino conducted continuing education lectures for staff of the Bermuda Hospitals Board last week. He spoke to physicians on depression in patients with HIV.