Study: HIV incidence 4x higher in people with mental health diagnoses

A recent study took a look at the incidence of HIV in people who had mental health diagnoses, and found that they were four times more likely to be HIV positive than the general population.

There were people who were being treated either as inpatients on a psychiatric unit, who were outpatients at a psychiatric hospital, or were receiving mental health services in community mental health centers. The research was done at sites in Philadelphia, PA and Baltimore, MD. Over 1,000 patients were included in the study and were tested for HIV. All HIV screening tests were later confirmed with a Western blot analysis.

The incidence of HIV infections in the general populations of Philadelphia and Baltimore are both about 1.3%. Testing on the patients in this study showed that, overall, 4.9% of patients currently being treated for psychiatric illnesses were HIV positive. Patients in the inpatient psychiatric units averaged 5.9% positive. In the group of patients who were outpatients at the psychiatric hospitals, the rate of HIV infection was 5.1%. In the community mental health centers is was around 4%. Also, more than 12 patients who didn’t think that they were HIV positive when they agreed to participate in the trial, were found to be HIV positive after testing.

Mental health via Shutterstock

Mental health via Shutterstock

The researchers were surprised that so many patients were found to be HIV positive. These patients had all been in previous psychiatric treatment. The Centers for Disease Control (CDC) suggests that these patients get tested for HIV. Apparently some clinical sites were failing to do this.

Additionally, the researchers found that the more severe the psychiatric symptoms were, the higher the risk for infection with HIV.

Often, the patients with the most severe mental illnesses (e.g., psychosis) are hospitalized. In this study, those patients who were hospitalized had the highest rate of HIV infection (>5%). Those with less severe symptoms, treated in the community setting, had a lower (4%) rate of HIV infection. But even that rate was significantly higher than the rate in the general population (1.3%.)

This research also showed that there was a higher incidence of HIV infections in the psychiatric population for people who were African-American, gay or bisexual, and/or who were infected with Hepatitis C.

This study points out that those patients with mental illness may not be getting screened for HIV appropriately, and some may be inadequately treated or even not treated at all. The authors state: “These findings reinforce recommendations for routine HIV testing in all clinical settings to ensure that HIV-infected persons receiving mental health services are identified and referred to timely infectious disease care.”

There are a number of other groups that also seem to be falling through the cracks and not getting screened for HIV. Teens, African-American men, those who have limited access to health care, and the aging population, among others, have all been identified as groups where access to HIV testing is limited or underutilized. This study indicates that patients with mental illness need to be included with those groups, as well.


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Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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