HIV in the mentally ill

Epidemiology and Social Research Unit, Macfarlane Burnet Centre for Medical Research, Fairfield, Victoria, Australia.
Australian and New Zealand Journal of Psychiatry (Impact Factor: 3.41). 05/1996; 30(2):184-94. DOI: 10.3109/00048679609076094
Source: PubMed


To review the published literature in relation to prevalence of HIV infection and risk behaviours for HIV among the mentally ill to assist in the development of appropriate strategies for public health policy, surveillance and clinical management of HIV and HIV risk in these groups.
A search of published literature was carried out using 'Medline', in association with following up appropriate papers cited in the references of journals identified.
The North American literature shows an increased risk of HIV infection in psychiatric patients receiving treatment in both inpatient or community settings. HIV infection is associated with a number of risk behaviours, particularly male homosexual sex and injecting drug use, and being the sexual partner of a person with a history of these. Impulsivity, high levels of sexual activity during acute exacerbations of psychiatric illness, poor skills at negotiating safe sex, homelessness and drug abuse are all risk behaviours common among those affected by some mental illnesses. The mentally ill also have a comparatively poorer knowledge of HIV/AIDS. There is a dearth of published Australian data addressing the question of HIV seroprevalence or risk in the mentally ill. Although there has been development and implementation of HIV risk-reduction programs overseas, the development and evaluation of any programs in Australia has not been published.
Arguably, Australia has developed a comprehensive program of national surveillance for HIV infection and has been relatively successful in its response to the HIV epidemic, with the high rates of infection in the early to mid-1980s substantially reduced to around 600 new diagnoses per year. However, while risk behaviours which exposed those infected with the virus are recorded, underlying conditions which predispose them to these behaviours are not. Nevertheless, there is HIV infection amongst mentally ill and intellectually disabled people in Australia. Examination of the North American experience reveals opportunities to prevent a high rate of HIV infection in those with mental illness in Australia. Such a program would require adequate risk behaviour assessment, appropriate diagnostic testing and management, and development of specific educational interventions which are properly evaluated to ensure their effectiveness.

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    • "ttesman & Groome 1997). Furthermore, HIV seroprevalence rates have been shown to be significantly higher in those with serious mental illness compared to the general population (Susser et al . 1993, Volvka et al . 1991). Grassi (1996) suggests that people with mental illness have been neglected as potential 'victims of HIV infection'. According to Checkley et al . (1996), by far the greatest risk of infection would appear to be illicit drug use and unprotected sexual activity. Perhaps not surprising, as these are important risk factors within the general population also. According to Buckley et al . (1996), the closure of psychiatric hospitals and the drive towards community living may increase the vuln"
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