208070 Predicting HIV/AIDS and sexually transmitted disease in persons with HIV/AIDS: Is serious mental illness a risk factor in medicaid beneficiaries?

Wednesday, November 11, 2009

Jonathan D. Prince, PhD , School of Social Work, Rutgers University, New Brunswick, NJ
James Walkup, PhD , Graduate School of Applied and Professional Psychology at Rutgers University, Piscataway, NJ
Stephen Crystal, PhD , Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ
Shala Amin, MS , Rutgers University, Institute for Health, Health Care Policy, and Aging Research, New Brunswick, NJ
Ayse Akincigil, PhD , Institute for Health & School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ
Background: Studies have underscored links between serious mental illness (SMI) and HIV/AIDS. A related issue is whether SMI in persons with HIV/AIDS is associated with sexually transmitted disease (STD). However little is known about longitudinal associations between: 1) SMI and subsequent HIV/AIDS diagnosis, and 2) SMI in persons with HIV/AIDS and subsequent STD diagnosis.

Methods: Using eight-state Medicaid data (2001-2004), we used logistic regression to test whether beneficiaries with: 1) an SMI diagnosis in 2001, but not an HIV diagnosis, were more likely than other beneficiaries to receive new HIV/AIDS diagnoses in 2002-2004; and (2) both HIV/AIDS and SMI diagnoses in 2001 were more likely than those with HIV/AIDS and without SMI to receive a new STD diagnosis.

Results: While a 2001 diagnosis of substance abuse (SA) alone or SA and SMI predicted a subsequent diagnosis of HIV/AIDS, a 2001 SMI diagnosis alone had either no association with subsequent HIV/AIDS diagnoses (in both bipolar disorder [BPD] and major depressive disorder [MDD]) or was associated with the absence of a subsequent HIV/AIDS diagnoses (in schizophrenia). Similarly, among beneficiaries with HIV/AIDS, SA in combination with BPD or schizophrenia was associated with subsequent diagnosis of STDs; yet SMI alone had no association with new STD diagnoses.

Conclusions: Findings are consistent with prior research indicating HIV elevation among those with SMI is concentrated among those with SA. HIV prevention programs for beneficiaries with SMI should focus largely on persons with SA, as should STD prevention programs for those with SMI and HIV.

Learning Objectives:
Objective 1: Identify whether the presence in one year of a serious mental illness (SMI), such as schizophrenia (SCH), bipolar disorder (BPD), or major depressive disorder (MDD), without an Human Immunodeficiency Virus (HIV/AIDS) diagnosis in that year increases the probability of a new HIV/AIDS diagnoses among Medicaid beneficiaries in a subsequent year, even after inclusion of control variables such as substance abuse (SA). Objective 2: Identify whether, among beneficiaries with HIV/AIDS in one year, the presence of an SMI diagnosis in that year increases the probability of a subsequent diagnosis of sexually transmitted disease (STD) in a later year among Medicaid beneficiaries with HIV/AIDS, even after inclusion of control variables such as SA.

Keywords: HIV/AIDS, Mental Illness

Presenting author's disclosure statement:

Not Answered

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