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

Agénor, Madina; Collins, Pamela Y.

doi:10.1080/07399332.2012.755983

Cited by 5 publications

(2 citation statements)

References 46 publications

(99 reference statements)

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“…Lastly, people with SMI experience specific challenges related to living with symptoms that can be disabling, in addition to social, economic and gender-specific vulnerabilities [22][23][24][25][26][27]. These increase their risk of coercive sexual encounters, transactional sex, and sex with partners at high risk of HIV and unsafe drug use [28][29][30].…”

Section: Introductionmentioning

confidence: 99%

Intervening for HIV prevention and mental health: a review of global literature

et al. 2021

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Introduction Numerous effective HIV prevention options exist, including behaviour change interventions, condom promotion and biomedical interventions, like voluntary medical male circumcision and pre‐exposure prophylaxis. However, populations at risk of HIV also face overlapping vulnerabilities to common mental disorders and severe mental illness. Mental health status can affect engagement in HIV risk behaviours and HIV prevention programmes. We conducted a narrative review of the literature on HIV prevention among key populations and other groups vulnerable to HIV infection to understand the relationship between mental health conditions and HIV prevention outcomes and summarize existing evidence on integrated approaches to HIV prevention and mental healthcare. Methods We searched five databases for studies published from January 2015 to August 2020, focused on HIV prevention and mental health conditions among key populations and individuals with serious mental illness. Studies were included if they evaluated an HIV prevention intervention or assessed correlates of HIV risk reduction and included assessment of mental health conditions or a mental health intervention. Results and discussion We identified 50 studies meeting our inclusion criteria, of which 26 were randomized controlled trials or other experimental designs of an HIV prevention intervention with or without a mental health component. Behaviour change interventions were the most common HIV prevention approach. A majority of studies recruited men who have sex with men and adolescents. Two studies provided distinct approaches to integrated HIV prevention and mental health service delivery. Overall, a majority of included studies showed that symptoms of mental disorder or distress are associated with HIV prevention outcomes (e.g. increased risky sexual behaviour, poor engagement in HIV prevention behaviours). In addition, several studies conducted among groups at high risk of poor mental health found that integrating a mental health component into a behaviour change intervention or linking mental health services to combination prevention activities significantly reduced risk behaviour and mental distress and improved access to mental healthcare. Conclusions Evidence suggests that mental health conditions are associated with poorer HIV prevention outcomes, and tailored integrated approaches are urgently needed to address overlapping vulnerabilities among key populations and other individuals at risk.

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Section: Introductionmentioning

confidence: 99%

Intervening for HIV prevention and mental health: a review of global literature

et al. 2021

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“…People with schizophrenia also experience unique barriers to routine HIV testing. 9 Efforts to create systemlevel changes to advance routine (versus risk-based) HIV testing for people with schizophrenia and other SMI have stalled in many cases, or have been unevenly implemented within particular health care settings across the US, such as emergency departments, substance use treatment facilities, and state-run psychiatric hospitals. [10][11][12] This complexity is further compounded by the fragmented US health care delivery system.…”

Section: Introductionmentioning

confidence: 99%

Examining the Impact of State-Level Factors on HIV Testing for Medicaid Enrollees With Schizophrenia

Thomas

Vittinghoff

Koester

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: People with schizophrenia experience unique barriers to routine HIV testing, despite increased risk of HIV compared with the general US population. Little is known about how health care delivery system factors affect testing rates or whether there are testing differences for people with schizophrenia. Setting: Nationally representative sample of Medicaid enrollees with and without schizophrenia. Methods: Using retrospective longitudinal data, we examined whether state-level factors were associated with differences in HIV testing among Medicaid enrollees with schizophrenia compared with frequency-matched controls during 2002–2012. Multivariable logistic regression estimated testing rate differences between and within cohorts. Results: Higher HIV testing rates for enrollees with schizophrenia were associated with higher state-level Medicaid spending per enrollee, efforts to reduce Medicaid fragmentation, and higher federal prevention funding. State-level AIDS epidemiology predicted more frequent HIV testing for enrollees with schizophrenia versus controls. Living in rural settings predicted lower HIV testing, especially for people with schizophrenia. Conclusion: Overall, state-level predictors of HIV testing rates varied among Medicaid enrollees, although rates were generally higher for those with schizophrenia than controls. Increased HIV testing for people with schizophrenia was associated with coverage of HIV testing when medically necessary, higher Centers for Disease Control and Prevention prevention funding, and higher AIDS incidence, prevalence, and mortality when compared with controls. This analysis suggests that state policymaking has an important role to play in advancing that effort. Overcoming fragmented care systems, sustaining robust prevention funding, and consolidating funding streams in innovative and flexible ways to support more comprehensive systems of care delivery deserve attention.

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