No abstract

Background: The increasing health problem of hepatitis C virus (HCV) infection has only recently attracted the attention of psychosocial research, especially among subjects at higher risk (e.g. intravenous drug users; IDUs). The aim of the present study was to compare emotional stress symptoms, psychosocial variables (i.e. social support, external locus of control and emotional repression) and coping strategies in HCV-seropositive, human immunodeficiency virus (HIV)-seropositive and HCV/HIV-noninfected IDUs. Methods: IDUs followed by the Infectious Diseases Outpatient clinic were enrolled in the study over a period of 1 year. HCV-positive (n = 62) and HIV-positive (n = 76) IDUs and HCV/HIV-seronegative IDUs (n = 152) completed the Brief Symptom Inventory, the Social Provision Scale, the Locus of Control scale and the affective inhibition scale of the Illness Behavior Questionnaire. Coping with illness among HCV-positive and HIV-positive subjects was assessed through a modified version of the Mental Adjustment to Cancer Scale. Results: No significant differences were found between the samples with respect to individual and interpersonal variables. HCV-positive subjects showed higher scores on several psychological stress dimensions (i.e. obsessive-compulsive, phobic anxiety, paranoid ideation, psychoticism) and lower scores on fighting spirit, hopelessness and anxious preoccupation towards illness than HIV-positive patients. HCV-positive and HCV/HIV-seronegative IDUs reported comparable scores on most of the psychological measures. Conclusions: The findings indicate that routine assessment of psychosocial variables and coping mechanisms should be integrated into all HCV and HIV services, especially those dedicated to treatment of patients with substance abuse, as a vulnerable segment of the population at risk for life-threatening physical illness such as HCV and HIV infections.

Directors of 471 outpatient mental health settings in New York State (82.1 percent of 574 settings located in counties with intermediate to high AIDS case rates) completed a survey about HIV and AIDS services, training needs, and barriers to care. Most of the sites served one to ten persons with HIV infection annually and had staff members who were trained in providing at least one HIV-related service. Nonetheless, 84 percent of the respondents reported unmet needs for training. The likelihood of providing certain services was significantly increased in sites that were in urban locations, primarily served clients with comorbid alcohol or other drug use disorders, lacked funds for providing condoms, had staff members who were trained in HIV and AIDS services, identified particular HIV training needs, believed clients needed condoms, and viewed HIV-related services as very important.

People with severe mental illness evidence significantly higher rates of HIV infection than the general population in the United States. Frequently, the only access to health care for this population is through their outpatient mental health care providers. In order to determine how these providers were dealing with the increased risk of HIV infection among this group, a survey of all licensed and certified outpatient mental health care centers in New York State was conducted. The data were compared to a similar previous survey conducted in 1997.

Despite experts' tendency to emphasize individual rights, public reluctance to mandate testing is unlikely to extend to people with serious mental illness. No argument for mandatory testing can be persuasive if improved voluntary testing can achieve adequate detection rates. Voluntary testing protocols should be studied to determine which successfully identify infected individuals.

Semistructured interviews including (questions about practices related to HIV risk assessment were conducted on 53 psychiatric units of general hospitals in New York State in 1992 and 1993. Few units have adopted practices across the board. Assessment of risk for many or almost all patients was reported by 25 units (47 percent). On three units (6 percent) all patients received information about HIV, and on 13 (25 percent) many patients did. Twenty units (38 percent) reported counseling only a few patients about risk, and eight (15 percent) counseled almost none. Twenty-eight (53 percent) urged only a few patients to get an HIV test, and nine (17 percent) urged almost none.

This article describes a multidisciplinary, multiagency approach to improve access to mental health services in individuals incarcerated within the New York State Department of Correctional Services (DOCS). An interagency work group convened focus groups with staff to assess needs and created a brief screening tool for serious mental illnesses. The NYS Brief Screening Tool (NYS BST) was pilot tested at two DOCS maximum security facilities. Results indicate that the NYS BST is easily administered by staff and well tolerated by inmates. Preliminary measures of sensitivity were within acceptable limits. The routine use of the NYS BST during intake at DOCS reception centers is under discussion. It also will be considered for use throughout the system whenever an inmate needs to be screened for potential mental health service needs.

It appears that clinics with large numbers of known HIV infected patients have mobilized to deal with the unique needs of these patients by providing specialty services and training staff in HIV service provision. However, the majority of clinics have failed to realize that severe mental illness is associated with behaviors that place individuals at risk of HIV infection or else routine HIV risk assessment would be more common.