Reducing HIV risk among people with serious mental illness.

The rate of HIV infection among U.S. citizens who live with serious mental illness (SMI) is significantly higher than among the general population. Research on the determinants of risk behavior is limited. The purpose of this article is to explore the effects of HIV-related health disparities on people with SMI by analyzing the multiple determinants, or domains of risk, and describing issues related to tailoring HIV primary prevention risk reduction strategies to people with SMI. According to the model proposed by Meade and Sikkema, domains of risk include psychiatric illness, substance use, cognitive-behavioral factors, social relationships, and demographics. The majority of people with SMI are sexually active and engage in behaviors that place them at high risk for HIV/AIDS. Mental illness may affect HIV risk through interacting domains that influence sexual behavior. HIV risk reduction strategies must consider psychiatric illness and comorbidities, social relationships, and trauma history. In addition, these efforts should be integrated into existing services.