title: Unmet needs among men with human immunodeficiency virus in community mental health care: a cross-sectional study.
abstract: While community-based mental health services play an important role in caring for persons with HIV (human immunodeficiency virus) and co-existing mental health disorders, the extent to which their support needs are addressed in this setting is unknown. Accordingly, we examined if HIV infection was associated with unmet support needs among men living with and without HIV receiving community mental health care. This cross-sectional study examined 215 men (135 living with HIV and 80 without HIV) receiving case management services in urban Ontario. Using the Camberwell Assessment of Need, we ascertained the prevalence of support needs in 13 domains grouped into three clusters: Basic needs (accommodation, food, benefits, and money management); self-care/functional needs (daytime activities, self-care, and looking after the home); and health/safety needs (physical, psychological distress, psychotic symptoms, safety to self, and safety to others). We used generalized estimating equations with a logit link to examine the association between HIV and unmet need in each domain. Compared to HIV-negative men, men with HIV were more likely to have mood and concurrent disorders, and intellectual and developmental disabilities. Following multivariable analyses, men with HIV had greater unmet needs related to food (odds ratio + 95% confidence interval: 9.36 (4.03, 21.75), p < 0.001); money (OR: 1.90 (1.04, 3.47), p = 0.036) [basic need domains]; psychological distress (OR: 2.39 (1.68, 3.41), p < 0.001); drug use (OR: 5.10 (2.16, 12.08) p < 0.001); and safety to self (OR: 3.35 (1.51, 7.52), p < 0.003) [health and safety domains]. Despite living in a setting with universal health insurance, men with HIV receiving community mental health support had greater unmet need in basic and health domains than HIV-negative men receiving such support. Further research is required to develop and evaluate interventions to best support community-dwelling persons with HIV and mental health disorders.
authors.affiliation: a Canadian Mental Health Association - Toronto Branch (CMHA) , Toronto , ON , Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Durbin
authors.affiliation: a Canadian Mental Health Association - Toronto Branch (CMHA) , Toronto , ON , Canada.|b Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada.
authors.forename: Frank
authors.initials: F
authors.lastname: Sirotich
authors.affiliation: c Department of Family and Community Medicine , St. Michael's Hospital , Toronto , ON , Canada.|d Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , ON , Canada.|e Institute for Clinical Evaluative Sciences , Toronto , ON , Canada.
authors.forename: Tony
authors.initials: T
authors.lastname: Antoniou
authors.affiliation: f LOFT Community Services/McEwan Housing & Support Services, Toronto, ON, Canada.
authors.forename: Kay
authors.initials: K
authors.lastname: Roesslein
authors.affiliation: g Provincial System Support Program , Centre for Addiction and Mental Health , Toronto , ON , Canada.|h Department of Psychiatry , University of Toronto , Toronto , ON , Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Durbin
authors.affiliation: e Institute for Clinical Evaluative Sciences , Toronto , ON , Canada.|h Department of Psychiatry , University of Toronto , Toronto , ON , Canada.|i Centre for Addiction and Mental Health , Toronto , ON , Canada.
authors.forename: Yona
authors.initials: Y
authors.lastname: Lunsky
mesh_terms: D000328:Adult; D019090:Case Management / Q000458:organization & administration; D003156:Community Mental Health Services / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D015897:Comorbidity; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D057187:Independent Living / Q000523:psychology / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008603:Mental Health / Q000592:standards / Q000706:statistics & numerical data; D020380:Needs Assessment; D009864:Ontario / Q000453:epidemiology; D012449:Safety / Q000592:standards*; D012648:Self Care / Q000523:psychology / Q000592:standards; D012944:Social Support
keywords: AIDS; Camberwell Assessment of Need; HIV; case management; community care; mental health; needs