HIV and people with serious mental illness: The public sector's role in reducing HIV risk and improving care

Objective: The paper discusses issues related to the detection, prevention of transmission, and treatment of human immunodefiency virus (HIV) infectio n among persons with serious mental illness and suggests ways public mental health systems can address these issues. Methods: MEDLINE was searched fro m 1980 through 1998, and all pertinent references were reviewed. Results: P ersons with severe mental illness are at greatly increased risk of HIV infe ction due to increased likelihood of high-risk sexual behaviors and injecti on drug use. The formidable barriers to detection and effective treatment o f HIV that exist in this population can be attributed to the unique charact eristics of this population, lack of knowledge and expertise among mental a nd physical health care providers, and fragmented mental and physical healt h care systems. Conclusions: In the last five years, treatments for HIV tha t are far more efficacious than earlier treatments have become available, : making it more important for HIV infection be detected and treated among p ersons with serious mental illness. Public mental health systems need to im plement active prevention policies and practices, educate both mental healt h and physical health care providers about key treatment issues, and develo p effective linkages between mental and physical health care providers and systems.