Should Mental Health Professionals Provide HIV Testing?

Test tubes for blood samplesA recently released and published study by Penn Medicine and the Centers for Disease Control and Prevention found that people with mental health issues are more likely to have been tested for HIV than those without mental health issues. To break down the numbers further, by percentage, those with schizophrenia or bipolar are more likely to have been tested (64% and 63%, respectively) than those with depression and/or anxiety (48%). All of these figures are higher than for the non-diagnosed population (35%).

Why isn’t clearly known, but what is known is that people with mental health conditions have higher rates of HIV and are more likely to engage in behavior that places them at greater risk of HIV. Estimates are that between 5% and 23% of those with mental health diagnoses have HIV, and roughly 50% of the HIV-positive population has co-morbidity with mental health issues (National Health Interview Survey, 2007).

The reasons for the higher rates of HIV testing may be because of this awareness; people with diagnosed mental health issues being more vigilant about their care; or because their mental health professional contacts encourage testing.

While the higher rates of testing with these populations are something to celebrate, there is work to be done. According to Dr. Michael Blank, associate professor in psychiatry at Penn and co-director of the Penn Mental Health AIDS Research Center, “Mental health providers should consider routinely offering HIV/AIDS testing, something that does not typically occur now.” He notes that there are “few formal prevention and screening efforts targeted at this at-risk population.”

Currently, most HIV testing takes place in medical offices, HIV clinics, related facilities (such as Planned Parenthood), or public health settings. These are not always the best settings for people for whom HIV is not the primary concern but is something that needs to be tended to. Despite best efforts at encouraging counseling, the majority of these facilities have “counselors” who have had only a few days of training in counseling and testing. This is not nearly enough training to qualify people to fully grasp the complexities of HIV and mental health.

Given that 40% of those who are diagnosed with HIV are not successfully linked to care (CDC Vital Signs, 2014, and CDC National HIV Surveillance System and Medical Monitoring Project, 2011), it is clear that we need more people in the helping professions to help those getting tested for HIV get linked to care. The earlier people with HIV are engaged in care, the better the health outcomes as well as the ability to decrease the spread of HIV. The mental health profession can help ensure that this happens. But what is the best way to do this?

One possibility is to become familiar with the self-testing kits available at pharmacies. About 1.5 million of these self-tests have been sold since they were approved in 2012 in the United States. This can be a vital tool to help routinely offer HIV/AIDS testing. Given that few in the counseling profession can afford to take three to five days off of work to become testers (especially since these credentials would not count toward getting continuing education credits), mental health professionals can at least discuss with people the option, portability, and accessibility of self-testing. These tests do not require certification, and just because they are called self-tests does not mean therapists and counselors can’t offer to sit with a person as he or she does the test. It is more a matter of mental health professionals’ comfort with discussing HIV and consideration of the ethical principles that will guide them in doing so.

References:

  1. Fox, Maggie (2014, November 25). Most Americans with HIV Missing Treatment, CDC Says. com. http://www.nbcnews.com/health/health-news/most-americans-hiv-missing-treatment-cdc-says-n255921
  2. People with Mental Illness More Likely to Be Tested for HIV, Study Finds. (2010, December 4). Retrieved from http://medicalxpress.com/news/2014-12-people-mental-illness-hiv.html

© Copyright 2015 GoodTherapy.org. All rights reserved. Permission to publish granted by Bradley D. Ogilvie, MS, LPC, LMFT, therapist in Washington, District of Columbia

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Gracie

    Gracie

    January 2nd, 2015 at 6:55 AM

    Why not provide testing with these professionals? It seems like this would be a clean and safe environment for someone to not only learn the status of their physical health but would also give them someone to check with in regarding their mental well being too. I think that it makes perfect sense.

  • Blaise

    Blaise

    January 2nd, 2015 at 9:37 AM

    Awesome idea, one that I truly hope takes hold in a number of communities

  • jack

    jack

    January 3rd, 2015 at 7:12 AM

    I honestly can’t think of anyone better for someone to go to for this sort of testing than a mental health professional. You have to know that at other doctors offices and clinics there may or may not be someone working there who would be equipped to help a patient deal with and understand all of the complicated issues that could arise from a positive test result. I think that for many different people in numerous situations, this makes perfect sense. I do have some concerns to make sure that the place would be equipped to handle this from a medical standpoint but I am sure that there would be all sorts of inspections and such to make sure that everything is up to par.

  • Donatella

    Donatella

    January 3rd, 2015 at 9:33 AM

    Has anyone given any thought to perhaps this is something that is best left to medical doctors?

    I am not saying that those in mental health care should not somehow be involved, but I think that testing of this manner should be left to being performed in full on medical treatment facilities.

  • Brad Ogilvie

    Brad Ogilvie

    January 3rd, 2015 at 4:41 PM

    Donatella – MD’s, as trained as they might be, may not be the best to deal with the psycho-social issues related to HIV, especially if the person is otherwise medically healthy. In my own case (I was given my HIV+ dx from an MD), it was a case example for the wrong way to do things, having no appreciation for the psychological impact. Add to the mix other mental health challenges, it can be a bad mix; plus, with managed care what it is, MD’s may not feel they can afford to spend the time.

    In addition, HIV-testing happens in many non-medical settings already (such as DMV’s, mobile vans, pharmacies). Many of our clients may be confronted with these options, and we need to be ready to deal with this.

    For me, I think we clinicians need to look at how we can help support the community at-large as well as our clients, as HIV is as much a psycho-social challenge as a medical issue these days, and we do disservice by leaving it up to others to do what might best be ours to do.

  • Donatella

    Donatella

    January 5th, 2015 at 3:52 AM

    @ Brad- I did not mean that your field would not be able to provide adequate care, but you also have to remember that much testing is very insurance driven… I don’t really even know if an HIV test is anything that would routinely even be covered by one’s health plan, but if it is then I am sure that the insurance companies will want to have something to say about where this can be performed.

    Believe me, I too think that mental health care professionals ought to be involved in this. As a matter of fact it kind of seems like there would be no one better who actually could offer this. But there are a lot of different issues that surround this, things that can get pretty complex from a financial point of view and sadly we do have to think about that as well.

  • Jax

    Jax

    January 5th, 2015 at 11:02 AM

    but couldn’t the clinics do more to at least get the person hooked up with a counselor if the result was a positive one for HIV?

  • Brad Ogilvie

    Brad Ogilvie

    January 6th, 2015 at 5:17 AM

    Jax – Whether they could or not, the fact is that the majority of people with HIV – including those who know they have it – are missing treatment so for whatever reason, there is a gap between people getting tested in these clinics and people getting into treatment (see http://www.nbcnews.com/health/health-news/most-americans-hiv-missing-treatment-cdc-says-n255921). What I am suggesting that those of us in the mental health field can be a part of filling this gap by 1) helping to support the testing efforts by offering it with our clients and 2) by increasing the community comfort level of talking about HIV, support all people in getting good treatment.

    The reality is that the training required to do testing in a clinic is not adequate for dealing with the mental health complexities, especially where the mental health issues pre-exist. Too often it is assumed that signs of depression are caused by the HIV-diagnosis, which doesn’t serve the client well. We can work together, however, to all do better for our clients.

  • juan

    juan

    January 6th, 2015 at 10:43 AM

    This only seems like a natural fit to me. I hope that in the future the number of HIV cases go down, but until that time partnerships between health professionals from all different fields could do amazing things for patients from all walks of life.

  • Jenn

    Jenn

    January 8th, 2015 at 4:28 PM

    If the resources are there to do it, then by all means, I think that it is a wonderful and solid idea to build upon

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