HIV and Serious Mental Illness

Persons with severe mental health conditions should be included as a key population in HIV programmes – a case study of South Africa

“…Persons with severe mental health conditions SMHC refer to a wide range of diagnoses that have common psychiatric symptoms, which persist over time and are functionally disabling. Schizophrenia, schizoaffective disorder, other psychotic disorders, bipolar disorder, and major depressive disorder with psychotic features are usually classified as severe [6]. Amongst numerous reasons to focus on this group as a key population, three stand out:…”

“…Risk and vulnerability Many people with SMHC engage in behaviours that increase their risk of infection, including unprotected sex with multiple partners, sex work and intravenous drug use; engage in hypersexuality during acute phases; have co-occurring substance misuse problems that can lead to sexual risks; live in shared accommodation and in institutions [6] (often same gender) where sexual activity is often not accepted and protection is not provided. Mental health conditions are also associated with lower adherence to HIV treatment [9].…”

“…Testing for and treating HIV Routine HIV testing of people with SMHC is generally low [6], though essential [7]. Some practitioners and even family members hold the erroneous belief that people with SMHC are not sexually active and hence do not need HIV testing.…”

“…In actual numbers, they not only meet the criteria for inclusion but also place a greater risk for the spread of HIV than certain groups already identified as key populations (see Table 1 ). Due to their mental health status, they also usually receive less HIV prevention and treatment [ 6 ].…”

“…Targeted preexposure prophylaxis (PrEP) needs to be expanded for SMHC [ 6 ]. Given concerns about adherence in this group, long-acting injectable PrEP may prove highly appropriate to this population.…”