The Evolution of HIV illness representation among marginally housed persons.

Many HIV-infected marginally housed individuals have difficulty engaging in health care. To investigate HIV health-related behaviour, 14 in-depth interviews with marginally housed HIV-infected individuals were conducted and analysed utilizing standard qualitative methodologies. The analysis was based on the Illness Representation Model, which describes five conceptual dimensions of illness: identification; cause; timeline; management; and consequences. A theoretical model of illness representation at two distinct time points emerged and included the two categories: 'didn't suspect and didn't believe it' and 'knew but needed proof'. In this study illness representation categories were found to evolve and change over time, and were associated with engagement in HIV care. This study may help guide programmes that focus on enhancing health-promoting behaviour and improving engagement in health care among marginally housed individuals.

HIV status, trust in health care providers, and distrust in the health care system among Bronx women.

Trust in health care providers and the health care system are essential. This study examined factors associated with trust in providers and distrust in the health care system among minority HIV-positive and -negative women. Interviews were conducted and laboratory tests performed with 102 women from the Women's Interagency HIV Study Bronx site. Interviews collected information about trust in providers, distrust in the system, substance use, mental health symptoms and medications, and sociodemographic characteristics. Many reported distrust of the health care system related to HIV, and most reported trust in their providers. On linear regression analyses, characteristics associated with distrust in the health care system included depressive symptoms (beta=0.48, p<0.05). Characteristics associated with trust in providers included HIV-positive status (beta=0.35, p<0.05), taking mental health medications (beta=0.39, p<0.05), and having a white provider (beta=0.36, p<0.05). Despite distrust in the health care system related to HIV, most reported high trust in their providers, with HIV-positive women trusting their providers more than HIV-negative women. Studies are needed to understand how trust in providers and the health care system is achieved and maintained, and how trust is correlated with HIV-related health outcomes.

The impact of substance dependence on HIV sexual risk-reduction among men with severe mental illness.

We explored the impact of substance dependence on the efficacy of an HIV sexual risk reduction intervention previously shown to be effective among men with severe mental illness by comparing rates of high-risk sexual behaviors among men with (n = 26) and without (n = 31) a lifetime history of substance dependence. We sub-divided subjects by alcohol and drug dependence status, comparing each intervention sub-group to the corresponding control sub-group. At each follow-up interval (six, 12 and 18 months), the intervention group as a whole and the non-substance dependent participants showed a significant reduction in risk; the substance-dependent men showed no difference from controls. These data suggest that among men with severe mental illness, substance dependence may be a further impediment to HIV risk reduction.

Psychiatric bed utilization: 1896 and 1996 compared.

BACKGROUND: The 1896 and 1996 populations of North West Wales are similar in number, ethnic and social mix and rurality, enabling a study of the comparative incidence and prevalence of service utilization over the course of a century. METHODS: We collected records on all psychiatric admissions from North-West Wales in 1894-1896 and 1996. These were assessed and diagnosed by the responsible sector area consultant. RESULTS: The data reveal substantially more patients admitted for all diagnoses in 1996. even when comparisons are restricted to detained patients. The incidence of hospitalization by detention for schizophrenia is slightly lower 1996 than in 1896 but the incidence of hospitalization is higher now than in 1996. The incidence of hospitalization by detention for non-affective disorder psychoses is the same in both 1896 and 1996 but there is a doubling of incidence of hospitalization. The incidence of hospitalization for bipolar disorders is similar in the two periods. Modern mental health services admit large numbers of personality disordered patients, where none were admitted 100 years ago. CONCLUSIONS: Factors general to changing health care and expectations and others specific to mental health would appear to have led to the increase in rates of admissions observed in the modern period.

Reliability of self-reports about sexual risk behavior for HIV among homeless men with severe mental illness.

The reliability of self-reports of sexual behaviors related to HIV transmission was examined in a study of homeless men with severe mental illness. Thirty-nine patients of a New York City shelter psychiatric program were interviewed about their sexual behaviors in the past six months. The same interview was administered twice, with a one- to two-week interval between interviews. Test-retest reliability was assessed using kappa and intraclass correlation coefficients. Reliability estimates ranged from.49 to.93 for overall sexual activity, number of partners, and specific behaviors other than receptive anal sex. Reliability was lower for condom use. The authors conclude that reliable self-reports about sexual behavior can be obtained from homeless men with severe mental illness.

Reasons given for disclosure of maternal HIV status to children.

The purpose of this investigation was to ascertain the reasons given by mothers diagnosed with AIDS (acquired immunodeficiency syndrome) for disclosing or not disclosing their HIV (human immunodeficiency virus) status to their children, a dilemma faced by most HIV-infected parents and those who counsel them. We interviewed 29 mothers residing in one of two New York City facilities that provide housing and medical treatment for adults with AIDS. The majority of these mothers do not live with their children, but all had recent face-to-face contact with them. The two reasons most frequently considered important for disclosing to children were that disclosure was the "right thing to do" and the need to make arrangements for children's future in case of maternal death or incapacity. The reason most frequently considered important for not disclosing was maternal concern about discussing death and dying with children. These findings have significant implications for counseling of HIV-positive parents.

The parent disclosure interview.

As the number of HIV-infected women and children in the USA has increased, clinicians and researchers have debated the benefits and risks of disclosure of parental HIV status to children. Disclosure is usually ascertained through interviews of unknown reliability. Given the need to advance knowledge regarding the benefits and risks of disclosure of parental HIV status to children, a reliable and comprehensive disclosure interview is needed. The Parent Disclosure Interview (PDI) was developed for this purpose. In order to study its reliability, 29 HIV-infected mothers were administered the PDI twice, on average one week apart, by two different female interviewers. Kappa statistics indicate that the PDI is highly reliable in most content areas. Researchers may use the interview for comparing the prevalence of disclosure among different groups of HIV-infected parents. Practitioners who assist parents in making decisions about disclosure of HIV status to children may use the interview to obtain a baseline assessment of the clients' disclosure history and attitudes towards disclosure.

Human immunodeficiency virus sexual risk reduction in homeless men with mental illness.

BACKGROUND: The spread of human immunodeficiency virus infection to impaired groups has intensified the challenge for its prevention; control of the epidemic now requires behavioral change among persons with limited ability to sustain attention and learn. In this randomized clinical trial, we tested an intervention to reduce sexual risk behaviors among homeless men with severe mental illness. METHODS: Men were recruited from a psychiatric program in a homeless shelter. Of 116 eligible men, 97 (83.6%) participated. Most were African American and had a chronic psychotic disorder and a comorbid substance use disorder. Participants were assigned to a 15-session experimental group intervention or to a 2-session control intervention and observed for 18 months. The 59 participants sexually active before the trial were the main target of the intervention. Sexual risk behavior was the primary outcome. RESULTS: Among the 59 sexually active men, follow-up data were obtained on 59 (100%) for the initial 6-month follow-up and on 56 (95%) for the remainder of the 18-month follow-up. The mean score on a sexual risk index for the experimental group was 3 times lower than for the control group (1.0 vs 3.1; P=.01) during the initial 6-month follow-up and 2 times lower during the remainder of the 18-month follow-up. CONCLUSIONS: This intervention successfully reduced sexual risk behaviors of homeless men with mental illness. The effect diminished over 18 months but did not disappear. Similar approaches may be effective in other impaired high-risk groups.

Acute psychoses: a proposed diagnosis for ICD-11 and DSM-V.

This paper concerns the diagnostic classification of nonaffective acute remitting psychosis (NARP), which we also term acute brief psychosis. We argue that NARP can be delineated from both schizophrenia and the affective psychoses and considered as a single diagnosis. As indicated by the term NARP, four criteria would be central to the diagnosis: 1. nonaffective, 2. acute onset (over less than two weeks), 3. recovery within a brief duration (less than six months), and 4. psychosis broadly defined. We review the rationale and the empirical evidence for this proposed classification.