Routine HIV testing for the severely mentally ill: considerations and cautions

The last few decades have brought major changes in both mental health laws and AIDS public health laws. The author first examines the impact of the HIV epidemic on those with severe and persistent mental illness. He then discusses how changes in public health laws have affected those infected with HIV and how changes in mental health laws have affected those with mental illness. People suffering from severe mental illness are increasingly being held legally responsible for their personal actions. At the same time, AIDS public health laws have begun to change so that those infected with HIV enjoy less legal protection and have more personal responsibility for transmitting the virus to others than in the recent past. The author then considers what impact the convergence of these legal changes is likely to have on the growing population of people with mental illness who are infected with HIV. The article concludes with some practical recommendations concerning HIV assessment and treatment in individuals with severe and persistent mental illness.