HIV prevention advice for people with serious mental illness

The human immunodeficiency virus (HIV) is a condition in humans in which our immune systems steadily begins to fail and allows life-threatening infections and cancers. People with mental illness have higher than usual rates of HIV than in the general population. Despite this, UK national strategies around sexual health and HIV prevention do not state that people with serious mental illness are a high risk group. A significant number of people with mental health problems are sexually active and engage in HIV-risk behaviours such as having multiple sexual partners, not using condoms and trading sex for money or drugs. In addition, during relapse, mental illness may lead people to engage in practices they would not usually be engaged in.

The provision of HIV prevention advice could enhance the physical and social well being of people with mental health problems. HIV health advice can take many forms. Advice is the active provision of information. It has an education component and is delivered in a gentle and non-patronising manner. Advice from a healthcare professional can have a positive impact on behaviour and may motivate people to seek further support and treatment.

The review's aim was to assess the potential beneficial or harmful effects of HIV prevention advice in people with serious mental illness (SMI). A search for randomised trials comparing HIV prevention advice with standard care for people with SMI was run in January 2012 and July 2016. However, no studies or trials were found. Policy makers, health professionals, researchers and people with mental health problems need to collaborate to produce evidence-based guidance on how best to provide advice for people with serious mental illness in preventing the spread of HIV. Better guidance and information about HIV in people with mental illness could be found by conducting well-designed, simple and large studies on this important topic.

Ben Gray, Senior Peer Researcher, McPin Foundation. http://mcpin.org/

Authors' conclusions: 

Policy makers, clinicians, researchers and service users need to collaborate to produce guidance on how best to provide advice for people with serious mental illness in preventing the spread of HIV infection. It is entirely feasible that this could be within the context of a well-designed simple large randomised study.

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Background: 

People with serious mental illness have rates of Human Immuno-deficiency Virus (HIV) infection higher than expected in the general population for the same demographic area. Despite this elevated prevalence, UK national strategies around sexual health and HIV prevention do not state that people with serious mental illness are a high risk group. However, a significant proportion in this group are sexually active and engage in HIV-risk behaviours including having multiple sexual partners, infrequent use of condoms and trading sex for money or drugs. Therefore we propose the provision of HIV prevention advice could enhance the physical and social well being of this population.

Objectives: 

To assess the effects of HIV prevention advice in reducing morbidity, mortality and preserving the quality of life in people with serious mental illness.

Search strategy: 

We searched the Cochrane Schizophrenia Group’s Trials Register (24 January 2012; 4 July 2016).

Selection criteria: 

We planned to include all randomised controlled trials focusing on HIV prevention advice versus standard care or comparing HIV prevention advice with other more focused methods of delivering care or information for people with serious mental illness.

Data collection and analysis: 

Review authors (NW, AC, AA, GT) independently screened search results and did not identify any studies that fulfilled the review’s criteria.

Main results: 

We did not identify any randomised studies that evaluated advice regarding HIV for people with serious mental illness. The excluded studies illustrate that randomisation of packages of care relevant to both people with serious mental illness and HIV risk are possible.

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