%0 Journal Article
%T Why the Treatment of Mental Disorders Is an Important Component of HIV Prevention among People Who Inject Drugs
%A Elizabeth Buckingham
%A Ezra Schrage
%A Francine Cournos
%J Advances in Preventive Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/690386
%X People who inject drugs are more likely to be HIV positive and to have a mental disorder than the general population. We explore how the detection and treatment of mental illness among people who are injecting drugs are essential to primary and secondary prevention of HIV infection in this population. Aside from opioid addiction, few studies have been conducted on the links between mental disorders and injection-drug use. However, independent of the injection-drug use literature, a growing number of studies demonstrate that untreated mental illness, especially depression and alcohol/substance use disorders, is associated with HIV-related risk behaviors, acquiring HIV infection, failure to access HIV care and treatment, failure to adhere to HIV care and treatment, and increased morbidity and mortality from HIV-related diseases and comorbidities. In our review of both the published literature and gray literature we found a dearth of information on models for providing care for both opioid addiction and other mental illnesses regardless of HIV status, particularly in low- and middle-income countries. We therefore make recommendations on how to address the mental health needs of HIV-positive people who inject drugs, which include the provision of opioid substitution therapy and integrated mental health, substance abuse, and HIV services. 1. Introduction The HIV epidemic is intertwined with many other epidemics such as hepatitis C and tuberculosis and, just as powerfully, with substance use disorders and other mental illnesses. Throughout the world, HIV begins its spread among three vulnerable populations with high rates of mental disorders: people who inject drugs (PWID), men who have sex with men (MSM) and sex workers [1]. Following infection, the presence of HIV in the brain, HIV-related central nervous system and systemic complications, and the side effects of antiretroviral medications cause their own neuropsychiatric complications, further complicating this picture. While in many treatment settings and government agencies substance use and other mental illnesses have been separated, this separation has created barriers to holistic care because there is considerable comorbidity between these two sets of disorders with nonaddictive mental disorders often preceding substance use disorders [2]. Data shows that among individuals with a lifetime history of substance abuse, over half were also affected by another mental disorder [3]. Conversely, individuals with nonaddictive mental disorders are more likely to have substance-use disorders than the general
%U http://www.hindawi.com/journals/apm/2013/690386/