Abstract
Background: While widely acknowledged to be an important clinical and public health issue, HIV assessment, counseling, and testing for the seriously mentally ill has not been well studied. Objective: To determine what proportion and which inpatients with schizophrenia have been recently tested for HIV. Method: A sample of 300 inpatients with schizophrenia were recruited from four general hospitals in New York City over a one year period. After confirmation of diagnosis with a structured interview, and elicitation of sociodemographic and drug use information, medical record review identified recent HIV testing. Bivariate and multivariate analyses were used to identify subgroups more likely to be tested. Findings: Recent HIV testing had been performed for 17% of the sample and was concentrated among those with higher documented risks. The majority of patients remain untested even in groups with direct risks, such as injection drug use, and indirect risks, such as frequent cocaine use in last year. Some evidence was found that white patients at risk may be less likely to be tested than Hispanic or African American patients. Conclusions: Aggressive efforts are needed to improve knowledge of HIV status among acutely ill patients with schizophrenia.
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REFERENCES
Ostrow D: HIV counseling and testing of psychiatric patients: time to reexamine policy and practices. General Hospital Psychiatry 14:1–2, 1992.
Grassi L: Risk of HIV infection in psychiatrically ill patients. AIDS Care 8:103–106, 1996.
American Psychiatric Association Commission on AIDS: Guidelines for HIV antibody testing. American Journal of Psychiatry 155:1648, 1998.
Richardson L: Waves of laws aimed at people with HIV. New York Times A1, 25 September 1998.
Rotheram-Borus MJ: AIDS and People with Severe Mental Illness: A Handbook for Mental Health Professionals (Book Review). New England Journal of Medicine 336:1332–1333, 1997.
Stewart D, Zuckerman C, Ingle J: HIV seroprevalence in a chronically mentally ill population. Journal of the National Medical Association 86:519–523, 1994.
Weinrich M, Curtis J, Carline J, et al: HIV risk screening in the primary care setting: Assessment of physicians skills. Journal of General Internal Medicine 12:107–113, 1997.
Mahler J, Yi D, Sacks M, et al: Undetected HIV infection among patients admitted to an alcohol rehabilitation unit. American Journal of Psychiatry 151:439–440, 1994.
Cournos F, Empfield M, Horwath E, et al: HIV seroprevalence among patients admitted to two psychiatric hospitals. American Journal of Psychiatry 148:1225–1230, 1991.
Empfield M, Cournos F, Meyer I, et al: HIV seroprevalence among homeless patients admitted to a psychiatric inpatient unit. American Journal of Psychiatry 130:47–52, 1993.
Sacks M, Dermatis H, Looser-Ott S, et al: Undetected HIV infection among acutely ill psychiatric inpatients. American Journal of Psychiatry 149:544–45, 1992.
Health Systems Agency of New York City, Inc: Quantitative Service Gap Analysis: Mental Health Services for People Living with HIV/AIDS. New York City Department of Health and The Mayor's HIV Health and Human Services Planning Council, 1996.
Carey M, Carey K, Kalichman S: Risk for human immunodeficiency virus (HIV) infection among persons with severe mental illness. Clinical Psychology Review 17:271–291, 1997.
Kalichman S, Kelly J, Johnson J, et al: Factors associated with risk for HIV infection among chronic mentally ill adults. American Journal of Psychiatry 151:221–227, 1994.
Kelly J, Murphy D, Sikkema K, et al: Predictors of high and low levels of HIV risk behavior among adults with chronic mental illness. Psychiatric Services 46:813–818, 1995.
Kelly J, Murphy D, Bahr G, et al: AIDS/HIV risk behavior among the chronic mentally ill. American Journal of Psychiatry 149:886–889, 1992.
Kessler R, Berglund P, Zhao S, et al: The 12-month prevalence and correlates of serious mental illness (SMI). Mental Health, United States, 1996. Edited by Manderscheid R, Sonnenschein M. Rockville, Md. U.S. Dept. of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Division of Biometry and Epidemiology, 1996:59–70.
Menon A, Pomerantz S: Substance use during sex and unsafe sexual behaviors among acute psychiatric inpatients. Psychiatric Services 48:1070–1072, 1997.
Cournos F, McKinnon K: HIV seroprevalence among persons with severe mental illness in the United States: A critical review. Clinical Psychology Review 17:259–269, 1997.
Meyer I, McKinnon K, Cournos F, et al: HIV seroprevalence among longstay psychiatric inpatients. Hospital and Community Psychiatry 44:282–284, 1993.
Silberstein C, Galanter M, Marmor M, et al: HIV-1 among inner city dually diagnosed inpatients. American Journal of Drug and Alcohol Abuse 20:101–131, 1994.
Volavka J, Convit P, Dwyer R, et al: HIV seroprevalence and risk behaviors in psychiatric inpatients. Psychiatry Research 39:109–114, 1991.
Sacks M, Dermatis H, Looser-Ott S, et al: Seroprevalence of HIV and risk factors for AIDS virus in psychiatric inpatients. Hospital and Community Psychiatry 43:736–737, 1992.
Lee H, Travin S, Bluestone H: HIV-1 in inpatients. Hospital and Community Psychiatry 43:181–182, 1992.
Meyer I, Cournos F, Empfield M, et al: HIV seroprevalence and clinical characteristics of the mentally ill homeless. Journal of Social Distress and the Homeless 2:103–116, 1993.
Susser E, Valencia F, Conover S: Prevalence of HIV infection among psychiatric patients in a New York City men's shelter. American Journal of Public Health 83:568–570, 1993.
Krakow D, Galanter M, Dermatis H, et al: HIV risk factors in dually diagnosed patients. American Journal of Addictions 7:74–80, 1998.
Valdiserri R, Weber J, Frey R: Trends in seropositivity in publicly funded HIV counseling and testing programs: Implications for prevention and policy. American Journal of Preventive Medicine 14:31–42, 1998.
Weber J, Frey R, Horsley R, et al: Publicly funded HIV counseling and testing in the United States, 1992-1995. AIDS Education and Prevention 9(suppl. B):79–91, 1997.
Anderson J, Hardy A, Cahill K, et al: HIV antibody testing and posttest counseling in the United States: data from the 1989 National Health Interview Survey. American Journal of Public Health 82:1533–1535, 1992.
Wolitski R, Radziszewska B: Morbidity and Mortality Weekly Report 42:786–789, 1993.
Miller K, Hennessy M, Wendell D, et al: Behavioral risks for HIV infection associated with HIV-testing decisions. AIDS Education and Prevention 8:394–402, 1996.
Asch S, London A, Barnes P, et al: Testing for human immunodeficiency virus infection among tuberculosis patients in Los Angeles. American Journal of Respiratory and Critical Care Medicine 155:378–381, 1997.
Silbersiepe K, Hardy A: AIDS knowledge and risk perception of cocaine and crack users in a national household survey. AIDS Education and Prevention 9:460–471, 1997.
Berrios D, Hearst N, Coates T, et al: HIV antibody testing among those at risk for infection. Journal of the American Medical Association 270:1576–1580, 1993.
Centers for Disease Control and Prevention: HIV testing among women aged 18-44 - United States, 1991-1993. Mortality and Morbidity Weekly 45:733–737, 1996.
Davis W, Deren S, Beardsly M, et al: Gender differences and other factors associated with HIV testing in a national sample of active drug injectors. AIDS Education and Prevention 9:342–358, 1997.
Shuter J, Alpert P, DeShaw M, et al: Rates of and factors associated with self-reported prior HIV testing among adult medical patients in an inner city emergency department in the Bronx, New York City. Journal Accuired Immune Deficiency Syndromes and Human Retrovirology 14:61–66, 1997.
Berrios D, Hearst N, Perkins L, et al: HIV antibody testing in young, urban adults. Archives of Internal Medicine 152:397–402, 1992.
Boyer C, Olfson M, Kellermann S, et al: Studying inpatient treatment practices in schizophrenia: an integrated methodology. Psychiatric Quarterly 66:293–320, 1995.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC, American Psychiatric Association, 1994.
Sheehan D, Lecrubier Y, Sheehan K, et al: Comparison of the Mini International Neuropsychiatric Interview with the SCID-P and CIDI: A validity study. Psychopharmacological Bulletin 31:616, 1995.
Schwartz-Watts D, Montgomery L, Morgan D: Seroprevalence of human immunodeficiency virus among inpatient pretrial detainees. Bulletin of the American Academy of Psychiatry and the Law 23:285–288, 1995.
Cournos F, Empfield M, Horwath E, et al: The management of HIV infection in state psychiatric hospitals. Hospital and Community Psychiatry 40:153–157, 1989.
Hellerstein D, Prager M: Assessing HIV risk in the general hospital psychiatric clinic. General Hospital Psychiatry 14:3–6, 1992.
Satriano J, Rothschild R, Steiner J, et al: HIV service provision and trainingneeds in outpatient mental health settings. Psychiatric Quarterly 70:63–74, 1999.
Walkup J, Satriano J, Hansell S, et al: Practices related to HIV/AIDS in a sample of general hospital units in New York State. Psychiatric Services 49:529–530, 1998.
McKinnon K, Cournos F, Herman R, et al: AIDS-Related Services and Training in Outpatient Mental Health Care Agencies in New York. Psychiatric Quarterly 50(9):1225–1228, 1999.
Allen D, Onorate I, Green T, et al: HIV infection in intravenous drug users entering drug treatment, United States, 1988 to 1989. American Journal of Public Health 82:541–546, 1992.
Blumberg M, Langston D: Mandatory HIV testing in criminal justice setting. Crime and Delinquency 37:5–18, 1991.
Ayuso-Mateos J, Montanes F, Lastra I, et al: HIV infection in psychiatric patients: an unlinked anonymous study. British Journal of Psychiatry 170:181–185, 1997.
Naber G, Pajonk F, Perro C, et al: Human immunodeficiency virus antibody test and seroprevalence in psychiatric inpatients. Acta Psychiatrica Scandinavic 89:358–361, 1994.
Kassler W: Advances in HIV testing technology and their potential impact on prevention. AIDS Education and Prevention 9(suppl B):27–40, 1997.
Bayer, R: Private acts, social consequences. New Brunswick, NJ, Rutgers University Press, 1989.
Perez-Pena R: Albany passes bill requiring HIV tracking. New York Times A1, B5-B6, 19 June 1998.
Cournos F, Bakalar N: Mandatory HIV testing for the mentally ill (letter). New England Journal of Medicine 337:1014–1015, 1997.
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Walkup, J., McAlpine, D.D., Olfson, M. et al. Recent HIV Testing Among General Hospital Inpatients with Schizophrenia: Findings from Four New York City Sites. Psychiatr Q 71, 177–193 (2000). https://doi.org/10.1023/A:1004632620890
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DOI: https://doi.org/10.1023/A:1004632620890