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HIV Testing and Prevention

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HIV Psychiatry

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Abstract

Psychiatric illness is associated with increased likelihood of infection with HIV, and thus patients living with psychiatric illness represent a population that is particularly vulnerable to new HIV infection. Clinicians who work with patients with psychiatric illness and other patients at high risk for HIV have the opportunity and responsibility to intervene with screening, prevention, and other measures to reduce the burden of HIV-related illness in these patients. In this chapter, we review concepts in HIV prevention that are relevant to patients with psychiatric illness. We first discuss some of the core strategies in public health approaches to HIV prevention, including treatment as prevention (TasP), pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP.) We then review some of the factors that place psychiatrically ill people at particularly high risk for HIV. Finally, we discuss specific recommendations for assessment, testing, and providing PrEP and PEP to patients with psychiatric illness.

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Author information

Authors and Affiliations

  1. Department of Psychiatry, NYU School of Medicine, New York, NY, USA

    Mark V. Bradley

  2. Consultation-Liaison Psychiatry Service, Columbia University Irving Medical Center, New York, NY, USA

    Luis F. Pereira

  3. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Mary Ann Adler Cohen

Authors
  1. Mark V. Bradley
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  2. Luis F. Pereira
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  3. Mary Ann Adler Cohen
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Corresponding author

Correspondence to Mark V. Bradley .

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.

    Post-exposure prophylaxis differs from pre-exposure prophylaxis in which of the following ways? (Please choose one only.)

    1. (a)

      It is helpful in reducing HIV transmission.

    2. (b)

      It is recommended for an HIV-negative sexual partner of a person with HIV and needs to be taken on a daily basis for the duration of the relationship, or it is not consistently efficacious in preventing HIV transmission.

    3. (c)

      The duration of post-exposure prophylaxis is the same as that of pre-exposure prophylaxis.

    4. (d)

      Post-exposure prophylaxis is indicated emergently following an accidental exposure of an HIV-negative person to the blood or body fluid of an HIV-positive person during a sexual encounter or injection drug use.

    5. (e)

      Post-exposure prophylaxis is a response to a medical emergency and but is not comprised of treatment with antiretroviral medications.

      (Correct answer is d.)

  2. 2.

    Post-exposure prophylaxis or PEP is indicated for which of the following clinical presentations?

    1. (a)

      An HIV-negative man who is in a long-term monogamous relationship with an HIV-positive man experiences condom failure during receptive anal sex.

    2. (b)

      A person with opioid use disorder in remission experiences a relapse and shares needles during an instance of injection drug use.

    3. (c)

      An HIV-negative person who was drugged and awakened after a sexual encounter while intoxicated with no recollection of the encounter.

    4. (d)

      An HIV-negative, non-pregnant woman who is of childbearing age and is in a long-term relationship with an HIV-positive man realizes that her partner “forgot” to put on a condom during vaginal intercourse.

    5. (e)

      All of the above.

      (Correct answer is e.)

  3. 3.

    Treatment as prevention (TasP) refers to which of the following HIV prevention strategies:

    1. (a)

      Incorporating evidence-based behavioral prevention interventions within the workflow of a primary care clinic

    2. (b)

      The collecting of detailed HIV risk behavior information by primary care clinicians during routine visits

    3. (c)

      The prescription of pre-exposure prophylaxis (PrEP) by psychiatrists to patients with mental illness and high-risk HIV behavior

    4. (d)

      The use of combined antiretroviral therapy to reduce the viral load of people living with HIV and thereby preventing their infection of others

    5. (e)

      The use of Medicaid funding to support HIV education efforts

      (Correct answer is d.)

  4. 4.

    Examples of structural factors that contribute to increased HIV risk include which of the following?

    1. (a)

      A 32-year-old woman who uses intravenous drugs is ambivalent about entering treatment for opioid use disorder.

    2. (b)

      A specific state law criminalizes programs which provide clean needles to people who inject drugs.

    3. (c)

      A 55-year-old man discontinues lithium carbonate due to concerns about interactions with his antiretroviral regimen and experiences subsequent mania leading to high-risk sexual behavior.

    4. (d)

      A primary care clinician, upon learning that her patient exchanges sex for money, feels embarrassed and uncomfortable discussing methods of reducing HIV transmission risk.

    5. (e)

      A 23-year-old man who has sex with men (MSM) does not believe that he is at risk for HIV as he does not identify as gay or bisexual.

      (Correct answer is b.)

  5. 5.

    Which of the following statements is correct regarding PrEP?

    1. (a)

      All patients taking TDF/FTC for PrEP should switch to TAF/FTC as the latter combination of antiretrovirals is associated with fewer renal side effects.

    2. (b)

      It is not necessary to rule out HIV infection prior to initiating PrEP.

    3. (c)

      PrEP can only be prescribed by infectious disease physicians.

    4. (d)

      The combination TAF/FTC is not recommended for use in cisgender women because its effectiveness in this population has not been well evaluated.

    5. (e)

      Individuals on PrEP only need to be reassessed every 12 months in order to repeat HIV testing and assess for adherence, risk behaviors, and side effects.

      (Correct answer is d.)

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Bradley, M.V., Pereira, L.F., Cohen, M.A.A. (2022). HIV Testing and Prevention. 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_2

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  • DOI: https://doi.org/10.1007/978-3-030-80665-1_2

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  • Online ISBN: 978-3-030-80665-1

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