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: 3.94). 06/2007; 20(3):235-41. DOI: 10.1097/YCO.0b013e3280ebb5f0
Source: PubMed


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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    ABSTRACT: We evaluated the efficacy of a gender-specific intervention to reduce sexual risk behaviors by introducing female-initiated methods to urban women with severe mental illness. Seventy-nine women received 10 sessions of an HIV prevention intervention or a control intervention. The primary outcome was unprotected oral, anal, or vaginal intercourse, expressed using the Vaginal Episode Equivalent (VEE) score. Knowledge and use of the female condom were also assessed. Women in the HIV prevention intervention showed a three-fold reduction in the VEE score at the 3-month follow-up compared to the control group, but the difference was not significant. These women were significantly more likely to know about female condoms, have inserted one and used it with a sexual partner at the 3-month follow-up and to have inserted it at 6 months compared to controls. The female condom may be a useful addition, for a subset of women with SMI, to comprehensive HIV prevention programs.
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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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    ABSTRACT: The prevalence of human immunodeficiency virus (HIV) is elevated among individuals with a severe mental illness (SMI). Because of the benefits of HIV testing, it is important for individuals with SMI to have routine access to testing. The goals of this review are: to summarize knowledge about HIV testing prevalence, correlates, and interventions among individuals with an SMI; to identify research needs; and to discuss clinical implications of the studies reviewed.Method Literature searches were conducted using PsycINFO, PubMed, and Medline. Additional articles were obtained from reference lists of relevant articles. Fewer than one-half of individuals with an SMI have been tested for HIV in the past year. Engaging in sex or drug risk behavior was the only consistent correlate of HIV testing. Interventions for promoting HIV testing among individuals with an SMI have not been well developed or evaluated. Research on HIV testing among individuals with an SMI is needed. Mental health settings may be opportune venues for HIV testing, even though providers face ethical challenges when implementing testing programs in these settings.
    Psychological Medicine 08/2008; 39(3):355-63. DOI:10.1017/S0033291708003930 · 5.94 Impact Factor
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    ABSTRACT: Integrating substance use disorder (SUD) services with primary care (PC) can improve access to SUD services for the 20.9 million Americans who need SUD treatment but do not receive it, and help prevent the onset of SUDs among the 68 million Americans who use psychoactive substances in a risky manner. We lay out the reasons for integrating SUD and PC services and then explore the models used and the experiences of providers as they have begun SUD/PC integration in California.
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