Patients with severe mental illness: A new approach for testing for HIV

Abstract

Background
The prevalence of infection with the Human Immuno-deficiency Virus (HIV) in South Africa is approaching 20% of young adults. In severely mentally ill people, it is probably higher. Testing for infection is subject to stringent ethical principles. Undiagnosed HIV infection in people with severe mental illness increases costs and morbidity. Since effective treatments are available, it is imperative to diagnose HIV infection early in this high risk population.

Methods
A literature review established the prevalence of HIV infection in in-patient populations with HIV infection. The pattern of testing for HIV over three years at a major psychiatric hospital was investigated. We surveyed public sector psychiatrists in the Western Cape to establish their attitudes to HIV in their patients.

Results
The HIV reported seroprevalence in psychiatric in-patients ranges from 0-59.3%, with a mean of 10%. Data show a clear trend towards an increase in prevalence: Pre 1996 the mean HIV seroprevalence was 7.4%, while post 1996 the mean was 15%. State psychiatrists in the Western Cape do not test routinely for HIV infection, mainly due to ethical constraints: 14.6% of patients at Lentegeur Hospital were tested in 2006.

Conclusions
The high prevalence of HIV infection in South Africa, that is probably higher in patients with severe mental illness (most of whom are not competent to provide informed consent) and the availability of effective treatment, requires debate and a clear policy regarding testing for HIV infection to be implemented. We recommend a new approach to HIV testing in these patients.