Primary and Secondary HIV Prevention Among Persons with Severe Mental Illness: Recent Findings

Abstract

Persons with severe mental illness (SMI) have been disproportionately affected by the HIV epidemic, with higher rates of HIV prevalence and morbidity than the general population. Recent research has advanced our understanding of the complex factors that influence primary and secondary HIV prevention for those with SMI. Sex risk in this population is associated with socioeconomic factors (e.g., low income, history of verbal violence) and other health risk behaviors (e.g., substance use, no prior HIV testing). Several interventions are effective at reducing risk behavior, and reviews highlight the need for more well-controlled studies that assess long-term outcomes. Recent research has elucidated barriers that interfere with HIV treatment for SMI populations, including individual (e.g., apathy, substance use), social (e.g., stigma), and system factors (e.g., transportation, clinic wait times). Interventions that coordinate HIV care for individuals with SMI show promise as cost-effective methods for improving medication adherence and quality of life.

Mental health and HIV/AIDS

“…Mental health disorders play a critical role in HIV acquisition across populations, increasing the risk of HIV acquisition by 4–10-fold [14,15]. In the United States, the prevalence of HIV is substantially higher among adults with serious mental illness (SMI; e.g.…”

Condomless Sex and Psychiatric Comorbidity in the Context of Constrained Survival Choices: A Longitudinal Study Among Homeless and Unstably Housed Women

“…People with severe mental illness (SMI) are disproportionally affected by and at risk for HIV and other STIs (17)(18)(19)(20)(21)(22) and prevalence of HIV is significantly higher among individuals with SMI (23). SMI includes chronic recurring psychiatric disorders such as major depressive disorder, post-traumatic stress disorder (PTSD), schizophrenia, substance use disorders, and other conditions that result in substantial functional and cognitive impairment.…”

“…With regard to sexual risk behaviors that transmit STIs (namely unprotected or condomless sex), some studies find lower rates of sexual activity among those with SMI, but higher rates of risk behaviors among those who are sexually active (17,18). However, other studies show that, rather than psychiatric symptoms alone, it is intimate partner violence, substance use, and constrained survival choices in the context of lower socioeconomic status that drive sexual risk behavior (18,23). Nevertheless, few studies have examined these issues exclusively among low-income women, which would facilitate a better understanding of issues that are gender-specific and germane in low-income populations but rare in the general population.…”

Increasing HIV Testing in Inpatient Psychiatry

“…Since the early years of the HIV epidemic, people diagnosed with serious mental illness (SMI) have experienced an increased risk of HIV infection. [1] Currently, in the United States (US), the prevalence of HIV among people with SMI (6%) is ten times the prevalence in the general population (0.6%). [2] Rigorous analyses suggest that mental illness is not an independent risk factor for HIV infection, but that people with SMI are disproportionately impacted by well-established HIV risk factors, such as substance abuse, risky sexual behavior, homelessness, and lower socioeconomic status.…”

“…[2] Rigorous analyses suggest that mental illness is not an independent risk factor for HIV infection, but that people with SMI are disproportionately impacted by well-established HIV risk factors, such as substance abuse, risky sexual behavior, homelessness, and lower socioeconomic status. [1,2,3] Recent outbreaks of HIV associated with injection of prescription opioids [4] have the potential to further increase risk of HIV infection among people with SMI because mental illness is associated with use, and misuse, of opioid medications. [5,6]…”