HIV in Mental Health Facilities Sometimes Gets too Little Attention

Individuals receiving treatment for mental disorders are significantly more likely to be infected with HIV than is the general population.

This is a key finding from to a study published February 13 in the American Journal of Public Health led by Michael Blank, Ph.D., an associate professor of psychiatry at the University of Pennsylvania Perelman School of Medicine and a co-director of the Penn Mental Health AIDS Research Center. Blank spearheaded a multisite study with researchers from the University of Maryland and the Centers for Disease Control and Prevention (CDC) to evaluate the prevalence of HIV among patients receiving care at mental health facilities.

In an interview with Psychiatric News, Blank stated that it was as a graduate student, more than 20 years ago, when he observed the lack of psychiatric disorders being diagnosed in primary care settings, as well as the dearth of primary health care services available in facilities specializing in mental health care. “Since that time, we haven’t made much progress in care for people with complex co-occurring conditions such as HIV and mental illness.”

According to Blank, previous studies have evaluated the prevalence of HIV infections among those with mental illness, but they reported wide variations in incidence rates, ranging from 1 percent to 23 percent.

“Most studies of HIV prevalence among persons with mental illness were limited by the use of a single convenience sample, which caused the prevalence estimates from those studies to vary widely,” Blank explained. “While our study also used samples of convenience, we were systematic in including a large number of treatment sites and feel as though we were rigorous in representing a significant amount people receiving mental health care across multiple facilities.”

In the current study, Blank and colleagues administered HIV tests to more than 1,000 patients who were being treated for symptoms of depression, psychosis, or substance abuse at 10 inpatient psychiatry units, community mental health centers, and community management programs throughout Baltimore and Philadelphia from January 2009 to August 2011. Psychiatric symptoms were measured by the 24-itiem Behavior and Symptom Identification Scale (BASIS-24). Mental illness diagnoses were based on DSM-IV criteria.

Results revealed that 51 of the patients (4.8 percent) receiving treatment for mental illness were infected with HIV, approximately four times the rate for the general public in each city and 16 times the rate for the general U.S. population. In addition, 13 of the 51 individuals reported they were unaware of their HIV status. Rates were higher in those who reported homelessness and in those who reported co-infection with hepatitis C.

“These findings paint a recent picture of HIV infection rates in the community and reinforce how important it is to identify patients. . .in a timely manner while they are being treated for mental illness,” commented Blank.

Francine Cournos, M.D., a professor of clinical psychiatry at Columbia University and an expert in HIV disease, agreed. Cournos told Psychiatric News that the current findings expose the lack of HIV testing being provided to individuals by mental health professionals, despite recommendations from the CDC to offer voluntary HIV testing in all health care facilities—including those providing mental illness treatment.

“Psychiatrists should ensure that patients who test positive for HIV are linked to adequate HIV care, retained in care, and begin needed treatment,” Cournos emphasized.

As for Blank, he told Psychiatric News that he and his colleagues have recently developed an intervention program, Preventing AIDS Through Health (PATH), that is individually tailored for people with comorbid HIV infection and mental illness.

“The observation that the current health care system is fragmented, costly, and ineffective has been voiced far too often over many decades. It is time to integrate health care such that health and mental health services are more commonly available to everyone,” Blank stated.

The current study was funded by the CDC, National Institute of Mental Health, and National Institute of Allergy and Infectious Diseases. ■