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HIV and Serious Mental Illness

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HIV Psychiatry

Abstract

People with serious mental illness have higher rates of HIV infection than the general population in the United States. Serious mental illness refers to the following psychiatric disorders as they are described in DSM-5: schizophrenia, schizoaffective disorder, other psychotic disorders, bipolar disorder, and major depressive disorder with psychotic features. Since the beginning of the HIV epidemic, there have been many barriers to meeting the HIV prevention and care needs of people living with both HIV and serious mental illness. This chapter focuses on what psychiatrists and all care team members need to know about addressing the complex needs of persons living with HIV and serious mental illness, either through direct treatment and management or as a leader or member of a multidisciplinary care team. We describe rates of HIV infection and common risk behaviors among people with serious mental illness. We highlight how multiple intersecting stigmas may play a role in access to HIV prevention and care. We detail the array of HIV services that are typically needed by people with serious mental illness. We also discuss sexual side effects of psychotropic medications and how to address them in the context of HIV prevention and care as well as recovery. Finally, we discuss training needs specific to the roles of the psychiatrists, physicians, other clinicians, and members of a care team, and the importance of ongoing training to fill service gaps and enhance service delivery and care integration.

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Author information

Authors and Affiliations

  1. New York State Psychiatric Institute, New York, NY, USA

    Karen M. McKinnon

  2. Washington Heights Community Service, New York, NY, USA

    Karen M. McKinnon

  3. Department of Psychiatry, Columbia University, New York, NY, USA

    Karen M. McKinnon

  4. Northeast/Caribbean AIDS Education and Training Center, New York, NY, USA

    Karen M. McKinnon

  5. New York State Psychiatric Institute, New York, NY, USA

    Jean-Marie Alves-Bradford

  6. Washington Heights Community Service, New York, NY, USA

    Jean-Marie Alves-Bradford

  7. Mailman School of Public Health, New York, NY, USA

    Francine Cournos

  8. Northeast/Caribbean AIDS Education and Training Center, New York, NY, USA

    Francine Cournos

Authors
  1. Karen M. McKinnon
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  2. Jean-Marie Alves-Bradford
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  3. Francine Cournos
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Corresponding author

Correspondence to Karen M. McKinnon .

Editor information

Editors and Affiliations

  1. Baylor Scott & White Health, Texas A&M University, Temple, TX, USA

    James A. Bourgeois

  2. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Mary Ann Adler Cohen

  3. School of Medicine, Georgetown University, District of Columbia, Washington, DC, USA

    Getrude Makurumidze

Multiple Choice Questions

Multiple Choice Questions

  1. 1.

    Rates of HIV among people with serious mental illness are:

    1. (a)

      higher than those in the general population

    2. (b)

      the same as those in the general population but on the rise

    3. (c)

      lower than those in the general population

    4. (d)

      too understudied to know

    Answer: (a)

  2. 2.

    A recent survey of outpatient mental health programs in New York showed that HIV testing is offered by:

    1. (a)

      almost all programs in accordance with CDC guidelines

    2. (b)

      about half of programs

    3. (c)

      about one-third of programs

    4. (d)

      about one in five programs

    Answer: (c)

  3. 3.

    When carrying out HIV risk assessment, which of the following is not on the list of behaviors to assess periodically?

    1. (a)

      history of sexually transmitted infections

    2. (b)

      sniffing of drugs

    3. (c)

      trading sex for a place to stay

    4. (d)

      sexual orientation

    Answer: (d)

  4. 4.

    Which of the following is not essential for talking to patients about sex, sexual health, and sexual risk?

    1. (a)

      comfort with sexual language

    2. (b)

      formal training about sexual anatomy

    3. (c)

      understanding patients’ cultural frame of reference about sex

    4. (d)

      all of these are essential

    Answer: (b)

  5. 5.

    Any program caring for people with both SMI and HIV should receive training to provide which of the following services:

    1. (a)

      HIV genotyping

    2. (b)

      co-management of ART and psychotropic medications

    3. (c)

      differential diagnosis between schizophrenia and schizoaffective disorders

    4. (d)

      all of the above

    Answer: (b)

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McKinnon, K.M., Alves-Bradford, JM., Cournos, F. (2022). HIV and Serious Mental Illness. In: Bourgeois, J.A., Cohen, M.A.A., Makurumidze, G. (eds) HIV Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-030-80665-1_12

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  • DOI: https://doi.org/10.1007/978-3-030-80665-1_12

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-80664-4

  • Online ISBN: 978-3-030-80665-1

  • eBook Packages: MedicineMedicine (R0)

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