AIDS first came to the attention of the American medical community in the early 1980s when it appeared to be confined to a single community: gay men. Over time, though, scientists learned more about the disease and its transmission, and soon it became clear the disease was not restricted to a solo demographic, even if it continues to be more prevalent in some groups rather than others. Unfortunately, a new study from the University of Pennsylvania has identified another community with a higher than average incidence rate: Mental health patients are up to four times more likely to test HIV positive than the general population. “Consistent with previous studies, we found that HIV infection is highly prevalent among persons receiving mental health care,” wrote the authors in their study published today in the American Journal of Public Health.

The team of researchers, led by Dr. Michael B. Blank, associate professor in psychiatry at the Perelman School of Medicine, estimated HIV prevalence and risk factors among persons receiving mental health treatment in Philadelphia and Baltimore between January 2009 and August 2011. The team selected Philadelphia and Baltimore because both cities are among the major metropolitan areas in the U.S. with the highest HIV prevalence. One of the largest studies to date, the project involved researchers from the Centers for Disease Control and Prevention (CDC), as well as the University of Maryland and Columbia University Medical Center. Overall, they provided HIV rapid testing for 1,061 individuals seeking treatment for mental health symptoms, including depression, psychosis, and substance abuse. “By recruiting participants from 3 distinct settings (inpatients, outpatients receiving routine care, and outpatients receiving intensive case management services), we evaluated patients served by the 3 predominant modes of delivering mental health services in the U.S.,” the authors noted in their study.

What did they discover? A total of 51 individuals (or 4.8 percent) were found to be infected with HIV: 5.9 percent within the inpatient units, 5.1 percent within the intensive case-management programs, and 4.0 percent within the community mental health centers. Overall, prevalence among those receiving mental health services was more than four times as high as in the general population. Sadly, those with more severe psychiatric symptoms were at a higher risk of testing positive. Of the 51 infected patients, 13 said they did not know they were HIV positive.

"These findings paint a recent picture of HIV infection rates in the community, and reinforce how important it is to identify patients and get them into appropriate infectious disease care in a timely manner while being treated for mental illness," Blank said in a press release. "With such a high-risk group, it's imperative to be routinely testing patients to improve care and reduce transmissions to others."

Source: Blank MB, Himelhoch SS, Balaji AB, et al. A Multisite Study of the Prevalence of HIV With Rapid Testing in Mental Health Settings. American Journal of Public Health. 2014.