Missed Opportunity to Test Patients With Severe Mental Illness for HIV

Despite being up to 15 times more likely to be HIV positive, people with bipolar disorder, schizophrenia, and major depression with psychosis aren’t much more likely than the general population to be tested for the virus, according to a new study headed by the University of California San Francisco (UCSF) and published in Psychiatric Services.

The gap found in the study represents a missed opportunity to treat HIV early on.

“People with severe mental illness have higher rates of unsafe behaviors that put them at risk for HIV infection,” first author Christina Mangurian, MD, MAS, of the UCSF Department of Psychiatry, said in a statement. “This includes engaging in unprotected sex with HIV-positive partners and partners of unknown HIV status, injecting drugs, using substances in the context of sexual activity and episodes of sexual violence.”

The researchers reviewed records for nearly 57,000 California residents on at least 1 antipsychotic medication from October 1, 2010, to September 30, 2011. Participants were enrolled in Medicaid and were aged between 18 and 67 years. They found that only 6.7% of people with severe mental illness received HIV testing. The general population has a self-reported testing rate of 5.2%.

Recent studies have identified the prevalence of HIV among people with severe mental illness as being up to 6%, which is far higher than the 0.4% among the general population.

During the 1 year studied, women were more likely to be tested than men (7.7% compared with 5.5%). In addition, 10.8% of black participants were tested compared with 6% of whites and 2.7% of Asians/Pacific Islanders. The authors also determined that people with comorbid drug or alcohol use disorders were more likely to be tested than those without them.

“This is a missed prevention opportunity to detect HIV early in the course of illness,” Mangurian said. “Effective treatments are widely available and people with severe mental illness appear to comply with antiretroviral therapies at rates similar to other groups. We believe that annual HIV testing should be strongly considered by public mental health administrators.”