Responding to the threat of HIV among persons with mental illness and substance abuse.
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.
Chapter: Navigating the worlds of information[Show abstract] [Hide abstract]
ABSTRACT: This chapter presents how best to navigate the systematized body of knowledge that constitutes women’s mental health services. The authors integrate the disparate disciplines involved in women’s mental health into a working framework focused on information-seeking behaviors.A public health perspective of women's mental health, Edited by Marion A. Becker, Bruce Lubotsky Levin, 01/2010: chapter Navigating the worlds of information: pages 373-390; Springer., ISBN: 978-1-4419-1525-2
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ABSTRACT: Although the co-occurrence of mental health and substance use disorders (SUDs) is well documented among correctional populations, less explored are the actual patterns that exist between specific SUDs and additional mental health disorders in combination. This study examines prevalence and correlates of psychiatric comorbidity in incarcerated men who screened positive for a SUD and the ability of a practical structured interview to document diagnostic indications of SUDs and co-occurring disorders. Comprehensive Addictions and Psychological Evaluation (CAAPE) interview data from 176 substance-dependent male inmates incarcerated in a local jail facility were analyzed. The most common substance dependence diagnoses were for alcohol (81%) and cocaine (35%). Posttraumatic stress disorder (PTSD) was the most common co-occurring mental health condition (55%), followed by antisocial personality disorder and major depressive episodes (51% each). Patterns related to the presence of PTSD and major depressive episodes accounted for a vast majority of inmates with both two and three diagnostic indications. Cronbach's alphas for the individual CAAPE diagnostic subscales ranged from 0.74 to 0.97. The design and implementation of treatment programs for substance-dependent inmates must consider co-occurring mental health issues. Several of the diagnostic categories evinced a bimodal pattern of responses in terms of severity. Negative correlations among many of the SUDs suggest that those with a greater level of severity involving some substances are less likely to manifest dependence and high severity for other substances. The observed Cronbach's alphas for the various subscales demonstrated acceptable preliminary support for the use of the CAAPE as a practical instrument in indentifying co-occurring disorders in a jail setting.Addiction Research and Theory 11/2012; 20(6). DOI:10.3109/16066359.2012.667853 · 1.03 Impact Factor
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ABSTRACT: The heightened risk of persons with serious mental illness (SMI) to contract and transmit human immunodeficiency virus (HIV) is a public health problem. Our objective was test the effectiveness of a community-based advanced practice nurse intervention to promote adherence to HIV and psychiatric treatment regimens call Preventing AIDS Through Health for Positives (PATH+). We enrolled 238 HIV-positive subjects with SMI who were in treatment at community HIV provider agencies from 2004 to 2009. Participants in the intervention group were assigned an advanced practice nurse who provided community-based care management at a minimum of one visit/week and coordinated their medical and mental healthcare for 12 months. A parallel process latent growth curve model using three data points for biomarkers (baseline, 12 and 24 months) and five data points for health related quality of life (baseline, 3, 6, 12, and 24 months) showed moderate to excellent fit for modeling changes in CD4, viral load, and mental and physical SF-12 subscales. Results suggest that positive effects for PATH+ persisted at 24 months; 12 months after the intervention ended. This project demonstrates the effectiveness of a nurse-led, community-based, individually tailored adherence intervention. We demonstrated improved outcomes in individuals with HIV/SMI and regarding health-related quality of life and reductions in disease burden.AIDS and Behavior 09/2013; 18(4). DOI:10.1007/s10461-013-0606-x · 3.49 Impact Factor