HIV/HCV Knowledge Among People With Severe Mental Illness and Their Providers

AIDS is the ultimate result of HIV infection, and knowledge about AIDSrelated issues among United States and Canadian psychiatric patients appears to be relatively good compared with that of nonpsychiatric groups. Correct responses to AIDS knowledge questionnaires in a variety of psychiatric patient groups ranged from 63% to 80% (Chuang and Atkinson 1996; McKinnon et al. 1996; Otto-Salaj et al. 1998), a comparable accuracy rate to that found in the general United States population (Hardy 1990). Still, many psychiatric patients held critical misinterpretations.

For example, in one study 42% were unaware they could be infected by injection drug use (Katz et al. 1994), and in another, 48% believed that careful cleansing after sex would provide protection from the virus (Otto-Salaj et al. 1998). Comparable studies about HCV knowledge among patients have not been completed. Although knowledge is necessary, it is not sufficient to reduce unsafe behaviors.

Preliminary findings from qualitative interviews with medical and mental health care providers show widespread consensus that HCV is a major public healthcare issue (P. Mendel and G. Ryan, unpublished data, February 2002). Interviews with providers at 32 agencies in New York City and Los Angeles showed adequate knowledge about how to identify HCV-antibody-positive clients, at least among agencies with established medical services. In general, testing for HCV is less burdensome because it does not involve the counseling, confidentiality, or stigma issues usually associated with HIV testing; yet there is great variation among providers on how to proceed once HCV-positive patients are identified.

Uncertainty about the efficacy of current treatments, exclusion/ inclusion criteria for treatment, and the division of responsibility among medical specialties for managing treatment are paramount concerns.

Mendel and Ryan's qualitative data suggest that, in practice, many mental health care providers are unsure of how many of their clients have HCV, except for a general sense that the numbers are increasing. Staff in mental health agencies were more concerned with diabetes and tuberculosis (because of the difficulty in daily self-management and the risk of contagion, respectively) than with either HCV or HIV. In addition, these qualitative data show that mental health and substance abuse treatment providers were generally unaware of the depressive side effects of interferon therapy, with only two agencies in New York City recounting specific in-service trainings that covered HCV along with other diseases.

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We believe that improved HCV screening followed by referral for evaluation of every HCV-positive patient, including those with schizophrenia, whose psychiatric condition is stable is now warranted.

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