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

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.