Severe mental illness is a new risk marker for blood-borne viruses and sexually transmitted infections

OBJECTIVE: To determine whether severe mental illness (SMI) constitutes a risk for the acquisition of sexually transmissible infections (STIs) and blood-borne viruses (BBVs), including human immunodeficiency virus (HIV), both locally and globally. METHOD: Database searches revealed 51 eligible studies for the review. Studies with samples of patients with SMI were analysed and compared with population data. RESULTS: Most studies were conducted in the United States and the majority examined levels of risk behaviours. The review revealed that many countries, including Australia, had not had any prevalence studies for STIs or any BBVs among patients with SMI. STIs, HIV and other BBVs, as well as risk behaviours, were more prevalent in patients with SMI, compared with population rates. Overall, a weighted mean of 4% of patients with SMI had HIV infection and 10-20% had hepatitis C virus (HCV). CONCLUSIONS: Severe mental illness appears to be a risk marker for the presence of STIs, HIV and other BBVs. HIV and HCV prevalences were elevated for those with risk behaviour histories, but rates also seem elevated for patients with SMI lacking such histories when compared with the general population. IMPLICATIONS: Programs are needed, particularly in the United States, for screening all patients with SMI for STIs and BBVs to kerb this epidemic. Such strategies could also be applicable in Australia, but there is less conclusive evidence.