235026 Preventing HIV among women with severe mental illness: Insight from clinicians working in urban community mental health clinics

Tuesday, November 1, 2011: 5:10 PM

Madina Agénor, MPH , Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA
Pamela Y. Collins, MD, MPH , Office for Research on Disparities and Global Mental Health, National Institutes of Mental Health, Bethesda, MD
Background: People with severe mental illness (SMI) are at high risk of HIV infection. Given their knowledge of the behavioral issues related to psychiatric illness, mental health care providers are in a unique position to help prevent HIV among women with SMI. The purpose of this study was to elucidate mental health clinicians' perceptions of sexuality and HIV risk among women with SMI, as well as delineate practical considerations for conducting HIV prevention with this population. Methods: We conducted semi-structured, in-depth interviews with 12 clinicians working at two urban community mental health clinics. Results: Five major themes arose from the interviews: the tension that many providers experienced between wanting to protect patients while also respecting their autonomy; providers' views on the clinical significance of discussing sex in the midst of competing treatment priorities; providers' attitudes pertaining to the sexual behavior of women with SMI; providers' efforts to maintain clear professional boundaries with patients while talking about sex; and providers' role in preventing HIV among women with SMI. Conclusions: Our findings suggest that mental health clinicians should remain open to discussing HIV prevention with patients; in turn, they should have access to the training and institutional support that they need to do so. However, our data also show that providers should fully consider that some patients may feel uncomfortable discussing sexual health concerns with them. Finally, HIV prevention with women with SMI should not only address psychiatric risk factors, but also the social, economic, and cultural factors that shape their vulnerability.

Learning Areas:
Assessment of individual and community needs for health education
Chronic disease management and prevention
Clinical medicine applied in public health
Diversity and culture
Planning of health education strategies, interventions, and programs
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
-Understand the relationship between severe mental illness and HIV infection -Explore mental health care providers' perceptions of and attitudes toward women with severe mental illness' sexual behavior and HIV risk -Identify practical considerations for conducting HIV prevention among women with severe mental illness

Keywords: HIV/AIDS, Mental Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conducted the analysis of the data that served as the basis of this paper and drafted the manuscript summarizing the study findings. I have experience in the areas of qualitative research methods, as well as substantive knowledge of sexual and reproductive health issues -- including the social determinants of women's HIV infection risk.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: HIV/AIDS & Mental Health
See more of: HIV/AIDS