Untitled

Abstract

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.

Preventing HIV Among U.S. Women of Color With Severe Mental Illness: Perceptions of Mental Health Care Providers Working in Urban Community Clinics

“…In a survey of New York State outpatient mental health care program directors, 84 percent of participants reported unmet needs for staff training in HIV/AIDS service provision (McKinnon et al, 1999). In a similar study, Satriano and colleagues (1999) found that some staff members had been trained to provide pre- and post-HIV test counseling in less than half (45 percent) of the sites. Of note, researchers showed that mental health professionals’ lack of training in these areas hindered HIV prevention efforts in the clinic (Herman et al, 1994), whereas training staff in HIV-related issues significantly increased providers’ likelihood of conducting routine HIV risk assessments (McKinnon et al, 1999).…”

“…Together, these findings underscore the importance of undertaking HIV prevention activities with women with SMI at multiple levels (e.g., individual, interpersonal, societal) and in multiple domains (e.g., psychiatric illness, interpersonal skills, abuse, discrimination, economic security) (Coates, Richter, & Caceres, 2008; Meade & Sikkema, 2005). Despite this need, mental health care settings often lack routine HIV risk assessment and comprehensive HIV prevention activities (McKinnon, Wainberg, & Cournos, 2001; Satriano, Rothschild, Steiner, & Oldham, 1999; Solomon, Tennille, Lipsitt, Plumb, Metzger, & Blank, 2007; Walkup, Satriano, Hansell, & Olfson, 1998). …”

“…However, clinicians may face a number of societal-, institutional-, and individual-level barriers to addressing HIV-related issues with their patients (Collins, 2006; Cort, Attenborough, & Watson 2001; Herman, Kaplan, Satriano, Cournos, & McKinnon, 1994; Higgins, Barker, & Begley, 2008; McKinnon et al, 1999; Satriano et al, 1999; Solomon et al, 2007; Sullivan, Koegel, Kanouse, Cournos, McKinnon, Young, & Bean, 1999; Wright & Martin, 2003). Societal barriers pertain to social norms and attitudes about sexuality in the context of mental illness (Collins, 2006), including those acquired during MHCPs’ professional socialization and education (Higgins et al, 2008).…”

“…Societal barriers pertain to social norms and attitudes about sexuality in the context of mental illness (Collins, 2006), including those acquired during MHCPs’ professional socialization and education (Higgins et al, 2008). Institutional barriers center on the structure of service delivery (Collins, 2006), institutional values and practices related to sexuality in mental health care clinics (Herman et al, 1994; Higgins et al, 2008;), limited funding for HIV services in mental health settings, and a lack of provider training related to HIV and other sexual health concerns (Herman et al, 1994; Higgins et al, 2008; McKinnon et al, 1999; Satriano et al, 1999; Solomon et al, 2007). At the individual level, providers’ attitudes, views, and beliefs pertaining to sex, sexuality, and HIV among persons with mental illness, as well as a lack of knowledge and skills regarding HIV/AIDS, may affect their ability to engage severely mentally ill individuals in HIV prevention (Collins, 2006; Cort et al, 2001; Herman et al, 1994; Solomon et al, 2007).…”

Psychiatric response to the AIDS epidemic in the United States

“…A study of the HIV Medicaid database in New Jersey revealed that over 12% of that population had a major mental illness (Walkup et al , 1999). Two studies among psychiatric out-patients in New York State revealed that less than one-third of the programmes were conducting routine HIV risk assessment (McKinnon et al , 1999; Satriano et al , 1999). A preliminary look at the cost of providing HIV-related medical care to the New York State Medicaid population indicated that it was significantly more costly to provide such care to persons who had a concurrent diagnosis of a major mental illness (Mental Health, Drug Use and HIV Medicaid Data Workgroup, 1999).…”