Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1041 — Understanding Associations between Serious Mental Illness and HIV: A National Multivariate Analysis

Author List:
Himelhoch SS (VISN 5 MIRECC)
McCarthy JF (SMITREC)
Ganoczy D (SMITREC)
Dixon LB (VISN 5 MIRECC)
Blow FC (SMITREC)

Objectives:
While individuals with serious mental illnesses (SMI) have a high prevalence of HIV, the nature of this association remains poorly understood. This study evaluates the prevalence of HIV among VA patients with and without SMI, adjusting for important HIV risk factors.

Methods:
Using VA National Psychosis Registry data, we compared the prevalence of HIV among patients with SMI diagnoses (schizophrenia, bipolar disorder, and non-organic psychoses) in fiscal year 2002 (N=191,625) versus non-SMI patients in a random sample of VA patients in FY02 (N = 65,983). HIV was identified using ICD-9 codes 042.0-042.9 and V08. Bivariate and logistic regression analyses were used to evaluate the prevalence and predictors of HIV. Covariates included age, race, gender, marital status, substance abuse, homelessness, region, and locale.

Results:
HIV diagnoses were recorded for 1.0% of patients with SMI, compared to 0.5% of non-SMI patients. Multivariate analyses indicated that those with bipolar disorder were no more likely to have HIV (OR [95% CI] 1.08 [0.93-1.24]) than those without SMI, while those with non-organic psychoses were 20% more likely to have HIV (OR [95% CI] 1.18 [1.01-1.38]). A significant interaction was observed between having schizophrenia and substance abuse. Those with schizophrenia without substance use were 50% less likely to have HIV (OR [95% CI] 0.49 [0.42-0.58]), while those having both schizophrenia and substance abuse were 22% more likely to have HIV (OR [95% CI] 1.22 [1.04-1.43]) compared to those without SMI.

Implications:
Despite the elevated crude prevalence of HIV among persons with SMI, these findings suggest that the presence of psychosis alone may not drive HIV risk. Rather, other variables known to be associated with HIV risk are critical. Multivariate analysis demonstrated that demographic factors, substance use, and marital status significantly underlie the observed associations between HIV and each of the 3 SMI subgroups. For patients with schizophrenia, this study is the first to demonstrate significantly reduced HIV risk in the absence of substance use.

Impacts:
HIV risks vary among patients with SMI, by psychosis type. Understanding the nature of HIV risks may inform future targeted prevention efforts and reduce stigma.