HIV risk behavior in the chronically mentally ill

Patients with chronic mental illnesses including schizophrenia and bipolar disorder constitute an important risk group for AIDS. Although limited by a lack of control groups, study findings indicate that an important minority of patients report having multiple sexual partners, use alcohol or drugs preceding sexual intercourse, report a history of intravenous drug use, are coerced into unwanted sexual activity, experience homosexual or heterosexual anal intercourse, and fail to use condoms consistently, if at all. Furthermore, chronically and variably impaired autonomy may add to patients' vulnerability. In this concert the author makes recommendations for limiting chronic mental patients' risk for AIDS that include techniques for reliably assessing individual risk. Preventive clinical interventions include treating variable impairment of autonomy, communication and behavioral skills training targeted to skills deficits while augmented by educational strategies, and outreach to the partners of at-risk patients. Preventive services should also be integrated and coordinated with sexually transmitted disease clinics, substance abuse treatment programs, and family planning programs.