Bringing Research-based HIV Prevention to Persons with Mental Illness:
Opportunities and Barriers
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John Encandela
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School of Public Health
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U. of Pittsburgh
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400 Keystone Building
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Pittsburgh PA 15260
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412 383-1619
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jaepgh@aol.com
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Wynne Korr
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School of Social Work
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U. of Pittsburgh
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2230 Cathedral of Learning
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Pittsburgh PA 15260
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412 624-3709
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sswwk@pitt.edu
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Kathleen Hulton
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University of Pittsburgh
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2230 Cathedral of Learning
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Pittsburgh PA 15260
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kehst@pitt.edu
Adults with severe mental illness are at higher risk of HIV infection than
the general population. Because these clients have regular contact with
case managers (CMs), these professionals could assist in providing clients
with HIV education/prevention. Little is known about what HIV-related services
case managers already provide, or about factors (in the mental health system)
that facilitate or hinder HIV prevention. This paper reports findings
from an NIMH-funded study of eight focus groups conducted with CMs from
urban, small town, and rural areas in a northeastern state. The focus group
facilitator and two recorders, assisted by ethnographic software, analyzed
transcripts for themes. Case managers were already engaged in education
with clients who showed obvious risky behavior, e.g. having unprotected
sex with multiple partners. While moral and legal issues were raised about
topics such as needle exchange, CMs put saving lives ahead of other concerns,
such as additional work represented by providing HIV prevention and moral
problems that others might have with discussing clients' risk behaviors.
Case managers identified the following barriers to providing HIV prevention:
clients whose illness (e.g. schizophrenia with depression) compromises
their ability to be safe; case-manager turnover and disdain for training
that may be perceived by CMs as useless; and rules of managed care organizations
regarding such things as billable services. The authors draw implications
for the transfer of research-based HIV prevention techniques tested in
clinical trials to the real world of case management.