Factors Influencing the Delivery of HIV-Related Services to Severely Mentally Ill Individuals: The Provider's Perspective
BACKGROUND:
Individuals
with severe mental illnesses (SMI) are disproportionately vulnerable to HIV
infection but are not consistently engaged in HIV-related services.
OBJECTIVE:
To
understand factors influencing implementation of HIV-related services to
individuals with SMI, we conducted a series of focus groups with
multidisciplinary clinicians and staff serving individuals with SMI in
outpatient, emergency, acute inpatient, and chronic inpatient levels of care.
METHOD:
Six focus
groups with 30 participants were conducted, audiotaped, and transcribed. Our
qualitative analysis drew on Grounded Theory. Using NVivo Version 9, coding was
conducted by the first and senior authors; interrater reliability was verified
by running Coding Comparison queries.
RESULTS:
The
providers' narratives highlighted (1) patient-related factors, (2) stigma, and
(3) administrative factors as themes particularly relevant to the delivery of
HIV-related services to individuals with SMI. The reported relevance of these
factors ranged across levels of care, from creating multiple barriers in the
outpatient care to relatively seamless and effective delivery of full continuum
of HIV-related services in the chronic inpatient environment, where adequate
structural support is provided.
CONCLUSION:
Providers'
narratives suggest that effective delivery of HIV-related services for
individuals with SMI requires sustained structural support that is coordinated
across levels of psychiatric care and tailored to individual patient's needs.
The narratives also suggest that such support is currently not available.
- 1Department of Sociology, American University, Washington, DC.
- 2Washington DC HIV/AIDS, Hepatitis, STD and TB Administration, Washington, DC.
- 3National Institutes of Health, National Institute of Mental Health, Bethesda, MD.
- 4National Institutes of Health, National Institute of Mental Health, Bethesda, MD; Department of Psychiatry and The Behavioral Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA. Electronic address: kapetano@usc.edu.
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