"Prevalence rates of HIV in persons with SMI are as high as 23% when co-occurring drug use and homelessness are concomitantly present (Cournos and McKinnon 1997; Blank et al. 2002; Meade and Sikkema 2005; Satriano et al. 2007; Walkup et al. 2008) and researchers continue to amass a growing list of barriers that impede case manager led HIV interventions for SMI adults. These barriers include case manager's concerns regarding confidentiality (Sullivan et al. 1999), antiquated beliefs that many SMI persons are asexual, lack of knowledge and skills related to HIV interventions, discomfort with discussions of sexuality, lack of designated funding and lower prioritization of HIV prevention activities as compared to other case management work (Arruffo et al. 1996; Brunette et al. 2000; Carmen and Brady 1990; Grassi 1996; Knox 1989; Sullivan et al. 1999; McKinnon et al. 1999; Shernoff 1988; Solomon et al. 2007) along with institutional cultures that discourage the systematic addressing of sexual behavior, sexual health, or HIV sexual risk for persons with SMI (Wainberg et al. 2007; Blank et al. 2008). Case managers often lack the recovery orientation which would allow them to overcome these barriers as outlined by the early leaders of the consumer recovery movement (Deegan 1988; Fisher 1994; Davidson and Strauss 1992; Ridgeway 2001) and more contemporarily promoted by the Substance Abuse and Mental Health Services Administration's (SAMHSA) 2006 consensus statement on mental health recovery. "
[Show abstract][Hide abstract] ABSTRACT: Following a randomized trial of case manager delivered HIV prevention intervention to persons with severe mental illness (SMI), this study sought to document changes within the service environment and with case managers themselves as a result of their experience and skills training. Utilizing qualitative methods, researchers conducted focus groups and in-depth interviews with 22 case managers and 3 administrators at an urban community mental health center. Beyond confirming previously established barriers to case manager delivery of HIV prevention interventions for persons with SMI, most noteworthy was the finding that case managers were generally unskilled in conducting assessments and tended to focus on "spoiled identity" and illness parts of their consumers. Experimental case managers revealed that they had been transformed by the training experience in a manner permitting them to both understand and work from a recovery model. Implications and directions for further study are discussed.
Community Mental Health Journal 10/2010; 46(5):486-93. DOI:10.1007/s10597-010-9326-0 · 1.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this study, we use the Colorado Symptom Index, a measure of psychiatric symptomatology, to identify vulnerable subgroups within the severely mentally ill population at elevated risk for HIV infection. Baseline data on 228 HIV positive and 281 HIV negative participants from two clinical trials were used. With years to HIV diagnosis as our primary endpoint, Kaplan-Meier estimates were calculated to find a CSI cut-off score, and a Cox proportional hazards model was used to obtain relative risks of infection for the two CSI categories created by the cut point. We found that a CSI score ≥ 30 was associated with a 47% increased risk for HIV infection (P < 0.01). While this study establishes the foundation for using CSI scores to identify a vulnerable subgroup within the SMI community, further studies should develop effective approaches to mitigate psychiatric symptomatology in order to examine the impact on HIV transmission risky behaviors.
Community Mental Health Journal 04/2011; 47(6):672-8. DOI:10.1007/s10597-011-9402-0 · 1.03 Impact Factor
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