Article

Responding to the threat of HIV among persons with mental illness and substance abuse.

Alcohol and Drug Abuse Research Unit, Medical Research Council, Tygerberg, South Africa.
Current Opinion in Psychiatry (Impact Factor: 3.55). 06/2007; 20(3):235-41. DOI: 10.1097/YCO.0b013e3280ebb5f0
Source: PubMed

ABSTRACT This article discusses current knowledge regarding the threat of HIV among persons with mental illness and substance abuse, and strategies for reducing this threat. It contains a review of the prevalence and consequences of dual/triple diagnosis, HIV risk behaviour and current HIV risk-reduction interventions among persons with dual diagnosis and interventions for triply diagnosed individuals.
Many persons with dual diagnosis remain undetected and there is a high prevalence of sexual risk behaviours among persons with dual diagnosis. Case management and supportive housing programmes are feasible options for the delivery of HIV risk-reduction interventions among such patients, and the adaptation of integrated behavioural treatment interventions can improve behavioural and healthcare utilization outcomes.
The developing world continues to see an escalation in HIV incidence. A more complete understanding of mental health, substance use and HIV serostatus interactions is needed to serve vulnerable populations. Mental health status not only mediates HIV risk behaviours, but positive serostatus has various effects on mental health. Co-morbid substance abuse is common among HIV-positive individuals with mental illness, resulting in serious adverse effects. Separate services for individuals with co-occurring substance abuse are less effective than integrated treatment programmes.

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    • "Risk for HIV infection among people with SMI has been associated with psychiatric symptom profile (McKinnon et al. 2001; Meade 2006) and cognitive impairment (McKinnon et al. 2002; Meade and Sikkema 2005); co-morbid substance use (McKinnon et al. 2001; Meade 2006; Meade and Sikkema 2007; Parry et al. 2007; Rosenberg et al. 2001b); history of childhood physical and sexual abuse (Devieux et al. 2007; Meade et al. 2009; Meade and Sikkema 2007); history of infection with a sexually transmitted disease (Vanable et al. 2006); relationship status (Meade 2006); type of treatment setting (Wright and Gayman 2005); inadequate assessment of personal risk (Kloos et al. 2005); multiple sexual partners, unprotected sex, and transactional sex (McKinnon et al. 2002; Meade and Sikkema 2005) and interactions among these factors. Questions remain regarding the epidemiology of HIV infection among people with SMI who live outside the epicenters of the epidemic; prevalence differences among diagnostic subgroups; as well as the intersecting social networks of people with SMI, injection drug users, and other high prevalence groups (Walkup et al. 2008). "
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    • "These rates are much higher than the 0.43% HIV prevalence rate found in the general population (McQuillan et al., 2006). The high rates of HIV in individuals with SMI may be, in part, driven by individuals who are dually diagnosed with a substance use disorder (Himelhoch et al., 2007; Parry et al., 2007). Among the dually diagnosed, HIV prevalence ranged from 6% to 23% (Meade and Weiss, 2007). "
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