Clearinghouse: stimulants and HIV

A bibliography of recent articles on stimulant usage and its impact of sexual behavior is provided. The references include articles on the increased frequency of unprotected sex, social issues related to people who trade sex for drugs, and the use of condoms among injecting drug users. Contact information is given for two specialists in the area of stimulant abuse.     

HIV and chronic mental illness

The literature on HIV seroprevalence, risk, knowledge, and behavior is reviewed, and suggestions for treating seropositive people with chronic mental illness is outlined. In general, people with chronic mental illness have higher rates of HIV than people within the general population. Within this chronic mental illness population, seroprevalence is more prevalent among injection drug users and men who have sex with men. Homelessness is a risk factor for HIV infection and disease progression. Research indicates that mentally ill patients do not score well on assessments of their HIV-related knowledge, attitudes, and risk behavior. The provision of physical and mental health care for seropositive people with mental illness is a complex process that must take into account the full range of needs and obstacles faced by this high risk group.     

Clearinghouse: STDs and HIV

A list of 13 references on sexually transmitted diseases and HIV is provided. Journals referenced include Journal of Hepatology and European Journal of Medical Research. Contact information for three organizations where additional information can be obtained is provided.     

Clearinghouse: HIV and sleep

Articles, reviews and studies referring to investigations on sleep and HIV are listed in alphabetical order by author. A guide to sleep disorder clinics and professionals in the field of sleep disturbance is included.     

Clearinghouse: youth and HIV

References for information on adolescent transsexuals, young homosexual men, and college-aged women are provided. Reference papers on risk behavior in adolescent populations, condom use among adolescents, and HIV/AIDS prevention intervention are also provided. Contact numbers are offered.     

Clearinghouse: youth and HIV

This bibliography lists articles related to treating HIV in young patients. Topics include treatment of dissociation in young men who have been infected as a result of sexual abuse; development of youth-based treatment approaches; attitudes and risk behavior of young mothers with HIV; and specific prevention programs for adolescents with HIV. Contact information is included.     

Clearinghouse: HIV and couples

A bibliography of articles focusing on managing sexual relationships between HIV-discordant couples is provided. Papers included in the bibliography address counseling couples, family support issues in HIV-serodiscordant couples, patterns and predictors of high-risk sexual behavior, and reproductive issues. Contact information is included for several programs within the San Francisco area.     

Clearinghouse: older people and HIV

A list of 18 articles from professional magazines and journals are referenced on the subject of older people and HIV. Topics include research on aging, health care service delivery, and the problems associated with unrecognized HIV in older people. Contact information is included for the National Association on HIV Over Fifty (NAHOF) and the New Jersey School of Osteopathic Medicine.     

Clearinghouse: HIV drug adherence

A bibliography of articles focusing on drug adherence issues in HIV treatment is provided. Papers included in the bibliography address social problems associated with treating individuals who may not be able to follow their treatment regimens for a variety of reasons, and compliance issues. Contact information is included for several programs within the San Francisco area.     

HIV/AIDS患者合并精神障碍研究进展

艾滋病病毒(HIV)感染者/艾滋病(AIDS)患者(简称HIV/AIDS患者)合并精神障碍极大地加重了个人和社会的疾病负担,影响生活质量.而精神障碍与HIV感染之间的病理生理学和相互影响机制、依从性、共病模式、药物相互作用等尚不完全清楚,给干预、治疗及管理带来了巨大挑战.本文基于现有的最新证据,对HIV/AIDS患者合...     

Adherence to HIV antiretrovirals among persons with serious mental illness

Despite the absence of empirical evidence, serious mental illness is assumed to be a high risk factor for nonadherence to HIV antiretroviral regimens. To assess antiretroviral adherence among persons with serious mental illness, we conducted a study in which adherence was observed over a 2-week period with electronic monitoring bottle caps and self-report. Forty-seven participants enrolled, with all but two (96%) completing the study. Psychiatric diagnoses included bipolar depression (n = 24), schizophrenia (n = 12), schizoaffective disorder (n = 5), and major depression with psychotic features (n = 6). Mean adherence (proportion of prescribed doses taken) was 66% (standard deviation [SD] = 34), as measured by electronic monitoring; 40% demonstrated at least 90% adherence, but 31% had less than 50% adherence. Self-reported adherence to psychotropics was moderately correlated with self-reported (r = 0.45, p < 0.05) and electronically monitored (r = 0.39, p < 0.05) antiretroviral adherence. Viral load (log(10)) was negatively correlated with electronically monitored (r = -0.28, p < 0.10) and self-reported (r = -0.39, p < 0.05) antiretroviral adherence, after controlling for the length of time on treatment. These findings suggest that many patients with serious mental illness are able to adhere very well to antiretroviral regimens, yet a substantial proportion of our sample displayed poor adherence, indicating the need for research to further assess the factors that influence adherence to antiretrovirals in this population.     

Patterns of HIV care for patients with serious mental illness

Individuals with serious mental illness are at higher risk for HIV than are members of the general population. Although studies have shown that individuals with serious mental illness experience less adequate care and worse physical health outcomes than comparable patients without serious mental illness, little is known about HIV care among individuals with serious mental illness who become infected with HIV. In the present study, we describe patterns of highly active antiretroviral treatment (HAART) use and physician monitoring received by 154 patients with serious mental illness infected with HIV. Participants were recruited from mental health agencies in Los Angeles, California. Data from 762 HIV-only patients from a separate Western U.S. probability sample were used for comparison. High proportions of serious mental illness patients with HIV in our sample appeared to be receiving adequate HIV care. Fifty-one percent of all serious mental illness patients with serious mental illness with HIV were taking HAART, and the majority received close monitoring of their CD4 counts (84%) and viral loads (82%) throughout a 1-year period. HAART use and patterns of CD4 count and viral load monitoring did not differ significantly between patients with both serious mental illness and HIV, and patients with HIV only (all p > 0.05). Specialized programs providing assistance to serious mental illness populations with HIV may be helping to narrow health care disparities as a result of having serious mental illness.     

Correlates of HIV infection among patients with mental illness in Brazil

People living with mental illness are at increased risk for HIV. There are scarce data on correlates and prevalence of HIV infection, and none with a nationally representative sample. We report on correlates of HIV infection from a cross-sectional national sample of adults receiving care in 26 publicly funded mental health treatment settings throughout Brazil. Weighted prevalence rate ratios were obtained using multiple log-binomial regression modeling. History of homelessness, ever having an STD, early age of first sexual intercourse before 18 years old, having suffered sexual violence, previous HIV testing, self-perception of high risk of HIV infection and not knowing one's risk were statistically associated with HIV infection. Our study found an elevated HIV seroprevalence and correlates of infection were not found to include psychiatric diagnoses or hospitalizations but instead reflected marginalized living circumstances and HIV testing history. These adverse life circumstances (history of homelessness, having suffered sexual violence, reporting a sexually transmitted disease, and early sexual debut) may not be unique to people living with mental illness but nonetheless the mental health care system can serve as an important point of entry for HIV prevention in this population.     

Correlates of HIV antiretroviral adherence in persons with serious mental illness

Although several studies have examined the relationship between symptoms of depression or psychological distress and medication adherence, this is the first published study of HIV antiretroviral adherence and its correlates among persons diagnosed with serious mental illness. Forty-five of 47 (96%) participants completed a two-week study in which their adherence to antiretroviral medication was measured using electronic monitoring caps. Mean adherence (proportion of prescribed doses taken) was 66% (SD=34). There were several correlates (p<0.05) of adherence among background and medical characteristics, physical symptoms and side effects, cognitive and psychosocial functioning, and treatment-related attitudes and beliefs. However, in a forward stepwise regression, attendance at recent clinical appointments was the sole predictor that entered the model--accounting for 49% of the variance in adherence. Using attendance at recent clinic appointments as the criterion, adherence readiness (90+% adherence to antiretrovirals) was correctly determined for 72% of the sample. Although not sufficient to serve as the basis for treatment decision making, review of appointment-keeping records may provide clinicians with a simple, cost-effective method for predicting adherence to ongoing treatment, as well as for evaluating adherence readiness to inform the decision of whether to prescribe or defer treatment.     

HIV health care access issues for women living with HIV, mental illness, and substance abuse

Nurses at the Well-Being Institute, a community-based nursing outreach clinic in Detroit, Michigan, located 75 women living with HIV, mental illness, and substance abuse who were lost to follow-up at their HIV medical clinic as part of a nursing research study. Women who had been scheduled for an appointment in the last 4 months but who had missed that appointment were considered "lost to follow-up" in the HIV clinic. The purpose of the research was to study factors related to health care access in women not participating in regular health care for their HIV infection. Women were randomly assigned to two study groups. Women assigned to "care as usual" study group (n = 37) received no additional services beyond study interviews for 1 year. Women assigned to the "nursing intervention" group (n = 38) were provided with nursing services designed to facilitate their return to and continued connection with their HIV clinic. Findings showed that factors related to the women's vulnerability, such as mental illness and drug use, were more related to their use of expensive health care services such as hospital emergency departments or hospital inpatient admissions than was assignment to either the "nursing intervention" or "care as usual" study groups. Two case studies describing the cost of care for 2 of the multiply diagnosed women in the study is presented. The women differed on whether they had stable housing and were accessing care for their mental illness.     

The HIV epidemic among individuals with mental illness in the United States

People with depression and other mental illness comprise a growing proportion of individuals living with HIV in the United States; at the same time, the prevalence of HIV among mentally ill individuals is at least seven times higher than in the general population. Individuals with mental illness are particularly vulnerable to infection with HIV because of several factors, including the higher prevalence of poverty, homelessness, high-risk sexual activities, drug abuse, sexual abuse, and social marginalization found in this population. Nevertheless, mentally ill individuals are often not screened for HIV and may not be appropriately targeted in current HIV prevention efforts. Moreover, despite widespread access to antiretroviral treatment in the United States, HIV outcomes among mentally ill individuals continue to be poor. This disparity can be explained by several interrelated factors, including lower rates of highly active antiretroviral therapy (HAART) utilization, lower rates of adherence to HAART, and immunologic changes associated with mental illness itself. We need to improve our design of prevention, screening, and treatment programs to better reach individuals with comorbid HIV and mental illness.     

Clearinghouse: depression

Bibliographic references and contact persons for depression are provided. References are cited from medical journals and scientific bulletins.     

Clearinghouse: psychotherapy

A reference list is provided of journal articles related to psychotherapy and HIV. The topics include studies of psychotherapy and treatment of depression in HIV-infected persons. Contacts in psychotherapy services are provided.     

Clearinghouse: disclosure

Twelve published references are provided on the subject of HIV disclosure. Topics presented include negotiating safer sexual relationships after receiving a positive HIV test, and communicating with significant others or sexual partners about a positive test result. Contact information of three universities is provided.