Risk of HIV infection in the homeless and chronically mentally ill

Recent data suggest that the homeless and those with chronic mental illness may be at increased risk for HIV infection. A review of the recent literature reveals insufficient rigorously collected data to identify with confidence any particular subgroup of chronically mentally ill patients at increased risk. Nonetheless, it seems reasonable to suspect that those with acute psychosis, a history of substance abuse, or a history of sexual abuse may be at higher risk. Conversely, some data currently support the conclusion that homeless persons are at increased risk for infection due to human immunodeficiency virus (HIV). Clinicians of all disciplines should be aware of these findings and be particularly vigilant when patients are members of both aforementioned groups. Future research should focus upon improving service delivery to the homeless and mentally ill, particularly with regard to sex education and substance abuse intervention. Also, continued research into causal influences of homelessness will ultimately lead to more definitive intervention.