Abstract
Rates of HIV infection, STDs, and sexual and drug-use risk behaviors are high among people with severe mental illness. Clinicians often are in the best position to connect psychiatric patients to the particular HIV-related services they need. These may include prevention interventions, risk assessment, antibody test counseling, and medical care. This review article describes the AIDS epidemic and its underpinnings in this population in an effort to help clinicians to recognize when their patients are at risk for acquiring or transmitting the virus and to intervene appropriately and effectively with an array of relevant services. The importance of training to enhance clinicians' skills and comfort in delivering these services is emphasized. The lives and well-being of psychiatric patients are threatened by the AIDS epidemic, and there is much clinicians can do to minimize the devastating impact of HIV and AIDS on clients in hospitals, clinics, and other psychiatric treatment settings.
Similar content being viewed by others
REFERENCES
Cournos F, McKinnon K: HIV seroprevalence among people with severe mental illness in the United States: A critical review. Clinical Psychology Review 17:259-269, 1997.
Krakow DS, Galanter M, Dermatis H, et al.: HIV risk factors in dually diagnosed patients. American Journal of Addiction 7:74-80, 1998.
Rosenberg SD, Goodman LA, Osher FC, et al.: Prevalence of HIV, Hepatitis B, and Hepatitis C in people with severe mental illness. American Journal of Public Health 91:31-7, 2001.
Susser E, Colson P, Jandorf L, et al.: HIV infection among young adults with psychotic disorders. American Journal of Psychiatry 154:864-866, 1997.
Cournos F, Herman R, Kaplan M et al.: AIDS prevention for people with severe mental illness. Journal of Practical Psychiatry and Behavioral Health 3:285-292, 1997.
Steele FR: A moving target: CDC still trying to estimate HIV-1 prevalence. Journal of NIH Research 6:25-26, 1994.
Wortley PM, Fleming PL: AIDS in women in the United States: Recent trends. Journal of the American Medical Association 278:911-916, 1997.
Carey MP, Carey KB, Kalichman SC: Risk for Human Immunodeficiency Virus (HIV) infection among persons with severe mental illnesses. Clinical Psychology Review 17:271-291, 1997.
Susser E, Miller M, Valencia E, et al.: Injection drug use and risk of HIV transmission among homeless men with mental illness. American Journal of Psychiatry 153:794-798, 1996.
van Ameijden EJC, van den Hoek JAR, Jartgers C, et al.: Risk factors for the transition from noninjection to injection drug use and accompanying AIDS risk behavior in a cohort of drug users. American Journal of Epidemiology 139:1153-1163, 1994.
McKinnon K, Cournos F: HIV infection linked to substance use among hospitalized patients with severe mental illness. Psychiatric Services 49:1269, 1998.
Horwath E, Cournos F, McKinnon JR, et al.: Illicit-drug injection among psychiatric patients without a primary substance use disorder. Psychiatric Services 47:181-185, 1996.
Laumann EO, Gagnon JH, Michael RT, et al.: The Social Organization of Sexuality. Chicago, IL, University of Chicago Press, 1994.
McDermott BE, Sautter FJ, Winstead DK, et al.: Diagnosis, health beliefs, and risk of HIV infection in psychiatric patients. Hospital and Community Psychiatry 45:580-585, 1994.
Menon AS, Pomerantz S: Substance use during sex and unsafe sexual behaviors among acute psychiatric inpatients. Psychiatric Services 48:1070-1072, 1997.
Cournos F, Guido JR, Coomaraswamy S, et al.: Sexual activity and risk of HIV infection among patients with schizophrenia. American Journal of Psychiatry 151:228-232, 1994.
Kalichman SC, Kelly JA, Johnson JR, et al.: Factors associated with risk for HIV infection among chronic mentally ill adults. American Journal of Psychiatry 151: 221-227, 1994.
Stevenson LY, Murphy DA, Kelly JA, et al.: Risk characteristics for HIV infection among urban chronic mentally ill adults. In Abstracts (PO-C11-2857), 9th International Conference on AIDS. Berlin, Germany, 1993.
Hanson M, Kramer TH, Gross W, et al.: AIDS awareness and risk behaviors among dually disordered adults. AIDS Education and Prevention 4:41-51, 1992.
Cournos F, McKinnon K, Meyer-Bahlburg HFL, et al.: HIV risk activity among persons with severe mental illness: Preliminary findings. Hospital and Community Psychiatry 44:1104-1106, 1993.
Sacks MH, Perry S, Graver R, et al.: Self-reported HIV-related risk behaviors in acute psychiatric inpatients: A pilot study. Hospital and Community Psychiatry 41:1253-1255, 1990.
Katz RC, Watts C, Santman, J: AIDS knowledge and high risk behaviors in the chronic mentally ill. Community Mental Health Journal 30:395-402, 1994.
Morningstar P, Chitwood D: How women and men get cocaine: Sex-role stereotypes and acquisition patterns. Journal of Psychoactive Drugs 19:135-142, 1987.
Leigh CB: The relationship of substance use during sex to high-risk behavior. Journal of Sex Research 27:199-213, 1990.
Kim A, Galanter M, Castaneda R, et al.: Crack cocaine use and sexual behavior among psychiatric inpatients. American Journal of Drug and Alcohol Abuse 18:235-246, 1992.
McKinnon K, Cournos F, Sugden R, Guido JR, Herman R: The relative contributions of psychiatric symptoms and AIDS knowledge to HIV risk behaviors among people with severe mental illness. Journal of Clinical Psychiatry 57:506-513, 1996.
Gounis K, Conover S, Roche B: Homelessness in New York City: The institutional determinants of HIV risk behaviors. In Abstracts (S5.2), 2nd International Conference on AIDS' Impact: Biopsychosocial Aspects of HIV Infection. Brighton, England, 1994.
Akhtar S, Crocker E, Docleu N, et al.: Overt sexual behavior among psychiatric inpatients. Diseases of the Nervous System, 38:359-361, 1977.
Modestin J: Patterns of overt sexual interaction among acute psychiatric inpatients. Acta Psychiatrica Scandanavia 64:446-459, 1981.
Kelly JA, Murphy DA, Bahr GR, et al.: AIDS/HIV risk behavior among the chronic mentally ill. American Journal of Psychiatry 149:886-889, 1992.
Carmen E, Brady SM: AIDS risk and prevention for the chronic mentally ill. Hospital and Community Psychiatry 41:652-657, 1990.
Kalichman SC, Sikkema KJ, Kelly JA, et al.: Use of a brief behavioral skills intervention to prevent HIV infection among chronic mentally ill adults. Psychiatric Services 46:275-280, 1995.
Herbert B: Woman battering and HIV infection. In Abstracts (TP500), HIV Infection in Women: Setting a New Agenda. Washington, DC, Philadelphia Sciences Group, 1995.
Danovsky M, Brown L, Kessel S, et al.: Psychiatrically hospitalized adolescents: Sexual-abuse as a co-factor in HIV risk. In Abstracts (FE1-187), HIV Infection in Women: Setting a New Agenda. Washington, DC, Philadelphia Sciences Group, 1995.
Otto-Salaj LL, Heckman TG, Stevenson LY, et al.: Patterns, predictors and gender differences among severely mentally ill men and women. Community Mental Health Journal 34:175-190, 1998.
Hardy AM: National health interview survey data on adult knowledge of AIDS in the United States. Public Health Report 105:629-634, 1990.
Kelly JA: HIV risk reduction interventions for persons with severe mental illness. Clinical Psychology Review 17:293-309, 1997.
Knox MD, Boaz TL, Friedrich MA, et al.: HIV risk factors for persons with serious mental illness. Community Mental Health Journal 30:551-563, 1994.
McDermott BE, Sautter FJ, Winsread DK, et al.: Diagnosis, health beliefs, and risk of HIV infection in psychiatric patients. Hospital and Community Psychiatry 45:580-585, 1994.
Zafrani M, McLaughlin DG: Knowledge about AIDS. Hospital and Community Psychiatry 41:1261, 1990.
Otto-Salaj LL, Kelly JA, Stevenson LY, et al.: Outcomes of a randomized small-group HIV prevention intervention trial for people with serious mental illness. Community Mental Health Journal 37:123-144, 2001.
McKinnon K, Cournos F, Herman R, et al.: AIDS-related services and training in outpatient mental health care agencies in New York. Psychiatric Services 50:1225-1228, 1999.
Brunette MF, Mercer CC, Carlson CL, et al.: HIV-related services for persons with severe mental illness: policy and practice in New Hampshire community mental health. Journal of Behavioral Health Services Research 27:347-353, 2000.
McKinnon K, Wainberg ML, Cournos F: HIV/AIDS preparedness in mental health care agencies with high and low substance use disorder caseloads. Journal of Substance Abuse 13:127-135, 2001.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
McKinnon, K., Cournos, F. & Herman, R. HIV Among People with Chronic Mental Illness. Psychiatr Q 73, 17–31 (2002). https://doi.org/10.1023/A:1012888500896
Issue Date:
DOI: https://doi.org/10.1023/A:1012888500896