Voluntary HIV Testing Among Adults with Severe Mental Illness: Frequency and Associated Factors

Abstract

Adults with severe mental illness (SMI) are disproportionately affected by HIV/AIDS. This study describes the frequency and associated factors of HIV testing among psychiatric outpatients (N = 150) in a small Northeastern city. A structured clinical interview assessed demographic, psychosocial, behavioral, and psychiatric factors. In the past year, 41% of participants were HIV tested. A hierarchical linear regression model revealed the following multivariate correlates: lower educational attainment, HIV risk behavior, greater social support, homelessness, non-psychotic disorder, borderline personality disorder, and greater treatment utilization. Psychiatric factors remained significant correlates of HIV testing after accounting for psychosocial and behavioral factors. Although HIV testing occurred among a substantial proportion of participants, 45% of individuals who engaged in HIV risk behavior were not tested in the past year. Adults with SMI are in need of interventions promoting routine HIV testing and risk-reduction counseling.

HIV risk behaviors among outpatients with severe mental illness in Rio de Janeiro, Brazil

“…As with SMI samples elsewhere 2 and other populations 7, these findings suggest that patients most at risk for HIV are aware of the problem/disease. HIV testing in the prior year was reported by 42% of participants, comparable to the rate of voluntary testing reported in the US 18, but the average HIV knowledge score in our Brazil sample was lower than the range found in prior studies of psychiatric populations 3–6, despite the fact that one in five of our subjects had participated in some type of HIV prevention program and all of them had access to ongoing sexual health drop‐in groups. Patients who had attended prior HIV prevention programs did not have better HIV knowledge than those who had not received these services.…”

HIV testing among individuals with a severe mental illness: review, suggestions for research, and clinical implications

“…However, in another study, women with schizophrenia or schizoaffective disorders were less likely than women without a SMI to ever be tested for HIV (11% vs. 67%; Miller and Finnerty, 1996). Most adults with a SMI who report ever being tested for HIV were tested for HIV more than once, with 30% reporting two lifetime tests, 21% reporting three tests, and 35% reporting ≥ four HIV tests (Meade and Sikkema, 2005b). …”

HIV Testing Among Adults with Mental Illness in the United States

“…Implementing routine HIV testing in mental health settings (where screening is low due to: limited availability of on-site testing, clinician discomfort providing risk reduction counseling and administering HIV tests, and provider concerns that HIV testing may detract from the delivery of mental health care) and targeting outreach and testing campaigns towards those with mental illness may help improve testing rates in this at-risk population. [37][38][39][40] In addition, mentally ill persons who use illicit drugs should be screened for HIV when initiating treatment for substance abuse. 41 Lastly, linkage to and retention in HIV care are necessary, given poorer HIV outcomes for persons with versus those without psychiatric disorders.…”