Influence of psychiatric diagnoses and symptoms on HIV risk behavior in adults with serious mental illness.

HIV seroprevalence among people with serious mental illness has increased substantially in recent years. Although the prevalence of HIV behavioral risk factors has been well documented, few researchers have chosen to investigate the impact that psychopathology may have on HIV risk behavior. A review of the literature on psychiatric diagnoses related to HIV sexual risk reveals that bipolar disorder and perhaps schizophrenia are related to increased HIV risk. Further, persons in whom both Axis I and Axis II disorders are diagnosed appear to be at greater HIV behavioral risk. Research on psychiatric symptoms shows that illness severity may vary in its relation to HIV risk according to the specific symptoms present and that excited and possibly positive symptoms may be predictors of HIV sexual risk behavior. However, there is a need for research to elucidate these relationships. Future efforts that will add most to the literature will include examinations of psychiatric symptoms and illness severity, adequate sample sizes, statistical tests showing prediction of HIV risk behavior rather than the correlation with it, controls for substance abuse or dependence, and comparisons of psychopathology across HIV-positive and HIV-negative persons.