Responding to the threat of HIV among persons with mental illness and substance abuse.
OBJECTIVE
This article discusses current knowledge regarding the threat of HIV among persons with mental illness and substance abuse, and strategies for reducing this threat. It contains a review of the prevalence and consequences of dual/triple diagnosis, HIV risk behaviour and current HIV risk-reduction interventions among persons with dual diagnosis and interventions for triply diagnosed individuals.


RESULTS
Many persons with dual diagnosis remain undetected and there is a high prevalence of sexual risk behaviours among persons with dual diagnosis. Case management and supportive housing programmes are feasible options for the delivery of HIV risk-reduction interventions among such patients, and the adaptation of integrated behavioural treatment interventions can improve behavioural and healthcare utilization outcomes.


CONCLUSIONS
The developing world continues to see an escalation in HIV incidence. A more complete understanding of mental health, substance use and HIV serostatus interactions is needed to serve vulnerable populations. Mental health status not only mediates HIV risk behaviours, but positive serostatus has various effects on mental health. Co-morbid substance abuse is common among HIV-positive individuals with mental illness, resulting in serious adverse effects. Separate services for individuals with co-occurring substance abuse are less effective than integrated treatment programmes.
Parry
Charles D
CD
Alcohol and Drug Abuse Research Unit, Medical Research Council, Tygerberg, South Africa. cparry@mrc.ac.za
Blank
Michael B
MB
Pithey
Anne L
AL
D023241:Antiretroviral Therapy, Highly Active; D001521:Behavior Therapy; D019090:Case Management; D003430:Cross-Sectional Studies; D017831:Diagnosis, Dual (Psychiatry); D006679:HIV Seropositivity / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006798:Housing; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D040242:Risk Reduction Behavior; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D047568:Unsafe Sex