Michael D. Knox

HIV risk factors for persons with serious mental illness

HIV risk factors were assessed among 120 persons in treatment for serious mental illness. Although subjects had good general knowledge regarding HIV, many engaged in high risk behaviors. Condom use was infrequent among those who had multiple sexual partners, and sharing needles was common for those who used IV drugs. Clearly, factual knowledge about HIV was not sufficient to prevent risky behavior. Nearly half of the sample was categorized as at medium to high risk, and almost half of the participants, especially those at medium risk, underestimated their own level of risk. The results suggest that education and intervention strategies should focus on increasing the accuracy of the individuals risk assessment as well as changing attitudes towards condoms and improving skills in using condoms. Assessing personal risk and adopting risk-reduction strategies are the keys to successful AIDS prevention for persons with serious mental illness.

Community mental health's role in the AIDS crisis

Mental Health concomitants of the AIDS crisis are reviewed along with recommendations for a community mental health response. Proposed interventions range from traditional clinical services to support groups, case management, day treatment, training of caregivers, outreach, consultation, and community education. It is recommended that, at the very least, each community mental health center identify an AIDS specialist who will keep abreast of the rapidly changing information and become the in-house expert. The author predicts that AIDS is likely to become the major mental health problem of the next decade.

The HIV clinical tutorial for community mental health professionals

HIV disease is an emerging community mental health concern. The need for specialized training to help community mental health professionals develop comprehensive knowledge and skills to serve this new population of clients is evident. The HIV clinical tutorial model is an innovative approach to continuing education characterized by an experiential and clinical orientation, a small participant group, and an interdisciplinary faculty. The three-day intensive workshop provides participants with experiences that can alter their perspective toward clients affected by HIV/AIDS and toward the role of the mental health system in responding to this epidemic. Similar training programs should be developed nationwide through collaboration among medical schools, teaching hospitals, public health departments and community mental health centers.

Early HIV detection: A community mental health role

This paper documents the changing need for early detection of human immunodeficiency virus (HIV) infection and proposes a role for community mental health centers (CMHCs). Ignorance of HIV infection status can result in greater risk of medical complications and denies the individual the opportunity to take the steps necessary to prolong life and prevent further transmission of the virus Individuals who know they are infected can obtain good medical care, avoid infection, avoid becoming pregnant, behave responsibly and plan their lives appropriately. Advances in specific therapeutics now make it important for infected individuals to know their HIV status well before becoming overtly ill. The social history, sexual history, drug use history, and physical and mental status of each client will provide important clues regarding infection status. Reluctance to refer for testing because of concerns about level of stress. liability and confidentiality should be tempered by a policy of referring for testing whenever any indication of infection arises.

Training HIV Specialists for Community Mental Health

There is a critical need for trained HIV mental health specialists who possess the knowledge and attitudes necessary to meet the challenges of the HIV epidemic. A model for an intensive and experiential continuing education tutorial is briefly described, and evaluative data are presented. Upon completion of the three-day workshop, participants show an increase in HIV-related knowledge and a positive shift in attitudes regarding working with people affected by HIV disease.

Factors affecting psychiatrists' availability to serve in public programs

This paper examines the factors contributing to reduced psychiatric participation in community mental health centers and state hospitals. Important considerations include level of compensation, other incentives, experiences during medical education, affiliation with medical settings, and licensing requirements. Suggestions are offered which may improve recruitment and retention of psychiatrists, as well as increase psychiatric involvement in the public mental health sector.

HIV/AIDS and Mental Disorders

Despite advances in treatment that have resulted in decreased mortality and hospitalizations, and improved quality of life, human immunodeficiency virus (HIV) infection leading to acquired immunodeficiency syndrome (AIDS) remains a life-long, life-threatening, infectious disease that requires ongoing medical intervention and monitoring as well as intervention to reduce risk of reinfection and transmission to others. Women with HIV face many challenges in obtaining medical care, accessing services, and dealing with life circumstances that often interfere with quality self-care. Women with HIV and mental illness face additional social, economic, and healthcare challenges that are different than those that occur for the general population, as well as an increased risk of infection and decreased ability to obtain proper treatment.

A Cultural Shift Toward Peace: The Need for a National Symbol

Countless brave Americans have publicly opposed U.S. wars and advocated for peace, yet history does not often document their contributions. National monuments honor those who have engaged in combat or died in war, but there are no national memorials to indicate that U.S. society values peace and citizens who take action to oppose war. In fact, these individuals are often held in contempt. Because culturally shared symbols reinforce commonly held social sentiment, it is anticipated that the developing US Peace Memorial will significantly contribute to a cultural shift by educating and inspiring new generations of Americans to embrace and advocate for peaceful alternatives to war.