HIV is a Common Problem in the Mental Health Community

HIV risk elevated in patients with serious mental illness

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) HIV and mental illness are two chronic conditions that can carry similar health and economic burdens. However, treatment and care for both are rarely integrated.

A recent study found that people with serious mental illness were at a significantly increased risk for HIV compared to the general population.

The researchers strongly believe that routine HIV testing in mental healthcare facilities is needed, and is recommended by the Centers for Disease Control and Prevention and the Institute of Medicine.

"Get tested for HIV."

The lead author of this study was Michael B. Blank, PhD, from the Department of Psychiatry at the University of Pennsylvania Perelman School of Medicine in Philadelphia, Pennsylvania.

The study included 1,061 patients with a serious mental illness who received care in Philadelphia and Baltimore, Maryland between January 2009 and August 2011.

A total of 287 participants were in university-based inpatient psychiatric units, 273 participants were in intensive case-management programs and 501 were in community mental health centers. Of these participants, 59 percent were men and 66 percent were black. All participants were at least 18 years old.

The researchers tested all the participants for HIV.

Data on the participants' demographics (age, race, sex, etc.), drug and alcohol history, sexual practices, history of sexually transmitted diseases, history of hepatitis C and overall health status were collected as well.

The findings showed that 51 participants (about 5 percent) tested positive for HIV. 

"These findings paint a recent picture of HIV infection rates in the community, and reinforce how important it is to identify patients and get them into appropriate infectious disease care in a timely manner while being treated for mental illness," said Dr. Blank.

"With such a high-risk group, it's imperative to be routinely testing patients to improve care and reduce transmissions to others. Historically, though, HIV testing is often not implemented in mental health care."

Black race, older age, homosexual or bisexual orientation, homelessness and hepatitis C were all significantly associated with increased odds of testing positive for HIV.

Compared to the white participants, the black participants were 5.79 times more likely to test positive for HIV.

The researchers found that participants 50 years old and older were 2.11 times more likely than 18- to 29-year-olds to test positive for HIV, and the participants aged 40 to 49 years old were 2.24 times more likely to test positive for HIV than the participants between the ages of 18 and 29 years old.

Homosexual or bisexual participants were 2.21 times more likely than heterosexual participants to test positive for HIV.

The findings revealed that current homelessness was associated with 50 percent increased odds of testing positive for HIV compared to not being homeless.

Compared to the participants who never had hepatitis C, those who were diagnosed with the virus at least once in their life were 2.24 times more likely to test positive for HIV.

Overall, the researchers discovered a positive association between the severity of participants' symptoms and the odds of testing positive for HIV. Dr. Blank and team believe that appropriate mental health treatment for patients with severe mental illness may play a key part in HIV prevention among this population.

The authors mentioned a few limitations of their study. First, the type of data collection did not allow the researchers to conclude that serious mental illness and HIV were directly related. Second, participants were pulled from a small number of care centers, so the findings may not be applicable to the general population. Third, the researchers did not consider data on the viral and treatment status of individual participants.

This study was published on February 13 in the American Journal of Public Health.

The Penn Center for AIDS Research and the Penn Mental Health AIDS Research Center provided funding.

Review Date: 
February 13, 2014
Last Updated:
February 19, 2014