Public Financing and Delivery of HIV/AIDS Care Securing the Legacy of Ryan White (2005) / Chapter Skim
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Appendix C: Mental Illness and HIV Comorbidity: A Large and Vulnerable HIV Subpopulation
Appendix C: Mental Illness and HIV Comorbidity: A Large and Vulnerable HIV Subpopulation
Pages 250-267
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From page 250... ...
.2 Regardless of etiology, the comorbidity of MI-HIV poses special challenges for HIV care. Individuals with this comorbidity face even greater barriers to care than do those with HIV alone.
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. After controlling for SES, mental illness is as prevalent in African Americans and Hispanic Americans as whites.
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. The comorbidity of MI-HIV has been largely studied in two different ways -- in samples either receiving mental health care, or in samples receiving HIV care.
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or drug dependence (12.5 percent) , according to the nationally representative HIV Cost and Services Utilization Study (HCSUS)
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Mental Illness and HIV Acquisition or Transmission People with MI are considered at increased risk of acquiring or transmitting HIV for two reasons: (1) greater likelihood of high-risk sexual behavior or substance abuse and (2)
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. One causal pathway to HIV infection in adolescence or young adulthood is thought to begin with childhood sexual abuse, then development of SMI, a substance use disorder, and/or high risk sexual behavior, and culminating in HIV infection (Rosenberg et al., 2001)
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While comorbidity of MI and a substance use disorder is common, and lifetime rates of injection drug use are quite high among those with SMI, there is little information on whether injection drug practices are related to HIV transmission. For example, it is unknown whether persons with MI who engage in injection drug use participate in needle exchange programs or use bleach to clean needles (Sullivan et al., 1999)
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These findings, if confirmed, underscore the importance of recognizing and treating depression as a standard part of HIV care, considering that depression is the most prevalent mental disorder in those receiving HIV care (Bing et al., 2001)
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. While the HCSUS study of people in HIV care found relatively high rates of utilization of mental health services (61.4 percent used mental health services)
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. One study that directly focused on the barriers to receipt of HIV care for individuals whose SMI-HIV comorbidity is already known compared nearly 300 SMI-HIV patients in Los Angeles and New York City to patients from the HCSUS cohort from the same geographic region and with HIV alone.
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260 PUBLIC FINANCING AND DELIVERY OF HIV/AIDS CARE Withholding HIV Care and Discrimination Against Mental Illness Persons with mental illness or HIV are highly stigmatized. Though empirical research is limited, it would hardly be surprising if stigma were not compounded for individuals with MI-HIV comorbidity.
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APPENDIX C 261 TREATMENT ISSUES The treatment of MI-HIV comorbidity is more complex than the treatment of HIV alone or MI alone. Both MI and HIV treatment require a wide array of long-term services, including medication, counseling, patient education, risk reduction strategies, and other supports and services.
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From page 262... ...
One early indication was from a nationally representative study finding disparities in patterns of HIV care. While use of needed care was good for many HIV-infected patients, disadvantaged populations -- blacks, Latinos, women, the uninsured, and Medicaid-insured -- had the least favorable patterns of care (Shapiro et al., 1999)
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All indications are that coordinated or integrated care -- for the full range of comorbidities, including substance abuse treatment -- is critical for improving adherence with HIV care, controlling the HIV epidemic, and for providing patients with the most comprehensive and effective array of health services.
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2001. Use of mental health and substance abuse treatment services among adults with HIV in the United States.
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Rockville, MD: DHHS, Substance Abuse and Mental Health Ser vices Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.
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Journal of Substance Abuse 13(1-2)
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2000. Severely and persistently mentally ill substance abusers: clinical and policy issues.
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