HIV/AIDS/STD/HCV, Coinfection, Seroprevalence and Education in Severe Mental Illness: Health Education Pilot

Abstract

HIV/AIDS among the severely mentally ill (SMI) population exceeds the held belief that man to man contact is the leading type of, rate of transmission and infection placing an emphasis on high risk behavior management, education and testing as key in reducing the epidemic in psychiatric facility inpatient/outpatient populations (Rothbard, Psychiatric Services 54(9):1240–1246, 2003). The Information-Motivation-Behavioral Skills Model (IMB) is an integrative framework to explain HIV risk reduction most often used and tested with the SMI population (Carey et al. Journal of Consulting and Clinical Psychology 72(2), 2004; Donenberg AIDS Education and Prevention 17(3):200–216, 2005; Meade and Sikkema Clinical Psychology Review 25(4):433–457, 2005; Rosenberg et al. Comprehensive Psychiatry 42(4):263–271, 2001). This education pilot program was developed for the Department of Texas State Health Services (DSHS) Austin State Hospital (ASH) Education and Rehabilitation Adult Psychiatric Services (APS) acute and forensic inpatient units.

Appendices

Appendix A

• Workshop 1

  • Objective 1: Participant will correctly identify 2 ways HIV/AIDS is transmitted.

• Workshop 2

  • Objective 2: Participant will correctly identify 4 out 6 common unsafe behaviors.

• Workshop 3

  • Objective 3: Participant will identify 3 high risk behaviors that s/he can control.

• Workshop 4

  • Objective 4: Participant will develop a risk continuum scale of sexual behaviors.

• Workshop 5

  • Objective 5: Using the risk continuum scale developed in the previous workshop, participant will assess the risk for a partner based on a scenario provided.

  • Goal 2: Create a personal reason to change (motivation) engaging in high risk behaviors in an effort to reduce the spread of the epidemic in SMI community.

• Workshop 6

  • Objective 1: Participant will correctly identify 4 out of 6 symptoms associated with HIV/AIDS.

Facilitator presents a brief discussion about the progression of symptoms beginning with HIV infection through late stage AIDS. Many people will not have any symptoms when first becoming infected with HIV. Other may have a flu-like illness within a month or two after exposure to the virus. This illness may include: fever, headache, tiredness, and/or enlarged lymph nodes (glands of the immune system easily felt in the neck and groin). These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, people are very infectious, and HIV is present in large quantities in genital fluids.

More persistent or severe symptoms may not appear for 10 years or more after HIV first enters the body in adults. This period of “asymptomatic” infection varies greatly in each individual. Some people may begin to have symptoms within a few months, while others may be symptom-free for more than 10 years. Even during the asymptomatic period, the virus is actively multiplying, infecting, and killing cells of the immune system. The virus can also hide within infected cells and lay dormant. The most obvious effect of HIV infection is a decline in the number of CD4 positive T (CD4+) cells found in the blood—the immune system’s key infection fighters. The virus slowly disables or destroys these cells without causing symptoms. As the immune system worsens, a variety of complications start to take over. For many people, the first signs of infection are large lymph nodes or “swollen glands” that may be enlarged for more than 3 months. Other symptoms often experienced months to years before the onset of AIDS include: lack of energy, weight loss, frequent fevers and sweats, persistent or frequent yeast infections (oral or vaginal), persistent skin rashes or flaky skin, pelvic inflammatory disease in women that does not respond to treatment, and/or short-term memory loss. Some people develop frequent and severe herpes infections that cause mouth, genital, or anal sores, or a painful nerve disease called shingles.

AIDS

Symptoms of opportunistic infections common in people with AIDS include: coughing and shortness of breath, seizures and lack of coordination, difficult or painful swallowing, mental symptoms such as confusion and forgetfulness, severe and persistent diarrhea, fever, vision loss, nausea, abdominal cramps and vomiting, weight loss and extreme fatigue, severe headaches, and coma (15 min).

Retrieved May 15, 2006 from http://www.niaid.nih.gov/factsheets/hivinf.htm

• Workshop 7

  • Objective 2: Participant will correctly identify 3 medical interventions used to treat HIV/AIDS.

Treatment

When AIDS first surfaced in the United States, there were no medicines to combat the underlying immune deficiency and few treatments existed for the opportunistic diseases that resulted. Researchers, however, have developed drugs to fight both HIV infection and its associated infections and cancers. The first group of drugs used to treat HIV infection, called nucleoside reverse transcriptase (RT) inhibitors, interrupts an early stage of the virus making copies of itself. These drugs may slow the spread of HIV in the body and delay the start of opportunistic infections. This class of drugs, called nucleoside analogs, include: AZT (Azidothymidine), ddC (zalcitabine), ddI (dideoxyinosine), d4T (stavudine), 3TC (lamivudine), Abacavir (ziagen), Tenofovir (viread), Emtriva (emtricitabine). Health care providers can prescribe non-nucleoside reverse transcriptase inhibitors (NNRTIs), such as: Delavridine (Rescriptor), Nevirapine (Viramune), and Efravirenz (Sustiva) (in combination with other antiretroviral drugs).

FDA also has approved a second class of drugs for treating HIV infection. These drugs, called protease inhibitors, interrupt the virus from making copies of itself at a later step in its life cycle. They include: Ritonavir (Norvir), Saquinivir (Invirase), Indinavir (Crixivan), Amprenivir (Agenerase), Nelfinavir (Viracept), Lopinavir (Kaletra), Atazanavir (Reyataz), and Fosamprenavir (Lexiva). FDA also has introduced a third new class of drugs, known at fusion inhibitors, to treat HIV infection. Fuzeon (enfuvirtide or T-20), the first approved fusion inhibitor, works by interfering with HIV-1’s ability to enter into cells by blocking the merging of the virus with the cell membranes. This inhibition blocks HIV’s ability to enter and infect the human immune cells. Fuzeon is designed for use in combination with other anti-HIV treatment. It reduces the level of HIV infection in the blood and may be active against HIV that has become resistant to current antiviral treatment schedules. Because HIV can become resistant to any of these drugs, health care providers must use a combination treatment to effectively suppress the virus. When multiple drugs (three or more) are used in combination, it is referred to as highly active antiretroviral therapy, or HAART, and can be used by people who are newly infected with HIV as well as people with AIDS. Researchers have credited HAART as being a major factor in significantly reducing the number of deaths from AIDS in this country. While HAART is not a cure for AIDS, it has greatly improved the health of many people with AIDS and it reduces the amount of virus circulating in the blood to nearly undetectable levels. Researchers, however, have shown that HIV remains present in hiding places, such as the lymph nodes, brain, testes, and retina of the eye, even in people who have been treated.

• Workshop 8

  • Objective 3: Participant will correctly identify 3 ways to safely engage in sexual activity or use IV drugs.

• Workshop 9

  • Objective 4: Participant will correctly identify 3 other sexually transmitted diseased that are also reduced by practicing safer sex practices.

• Workshop 10

  • Objective 5: Participant will demonstrate an understanding that there are at least two strains of HIV that can be introduced at different times adding to the disease process for already infected persons.

• Workshop 11

  • Goal 3: Develop skills to negotiate safer sex practice.

  • Objective 1: Participant will correctly identify 3 topics that need to be discussed prior to engaging in sexual activity with a partner.

• Workshop 12

  • Objective 2: Participant will develop 3 questions to ask a potential sexual partner prior to engaging in sexual activity.

• Workshop 13

  • Objective 3: Participant will develop a personal response for the questions s/he developed in the previous workshop.

• Workshop 14

  • Objective 4: Participant will demonstrate negotiation techniques in a role play situation using the questions and responses developed in the previous workshops.

• Workshop 15

  • Objective 5: Participant will develop a personal safety plan to reduce high risk behaviors using a minimum of 5 points covered during the workshop series.

Appendix B

• Workshop 1

  • Objective 1: Participant will correctly identify 2 ways HIV/AIDS is transmitted.

• Workshop 2

  • Objective 2: Participant will correctly identify 4 common unsafe behaviors.