Background. The prevalence of HIV infection in South Africa
is approaching 20% of young adults. In severely mentally ill
people it is probably higher. Testing for infection is subject
to stringent ethical principles. Undiagnosed HIV infection in
people with severe mental illness increases costs and morbidity.
Since effective treatments are available, it is imperative to
diagnose HIV infection early in this high-risk population.
Methods. A literature review established the prevalence of HIV
infection in inpatient populations with HIV infection. The
pattern of testing for HIV over 3 years at a major psychiatric
hospital was investigated. We surveyed public sector
psychiatrists in the Western Cape to establish their attitudes to
HIV in their patients.
Results. The reported HIV seroprevalence in psychiatric
inpatients ranges from 0 to 59.3%, with a mean of 10%. Data
show a clear trend towards an increase in prevalence: before
1996 the mean HIV seroprevalence was 7.4%, while after 1996
the mean was 15%. State psychiatrists in the Western Cape do
not test routinely for HIV infection, mainly owing to ethical
constraints: 14.6% of patients at Lentegeur Hospital were tested
in 2006.
Conclusions. The high prevalence of HIV infection in South
Africa, which is probably higher in patients with severe mental
illness (most of whom are not competent to provide informed
consent), and the availability of effective treatment require
debate and a clear policy regarding testing for HIV infection
to be implemented. We recommend a new approach to HIV
testing in these patients. South African Medical Journal Vol. 98 (3) 2008: pp. 213-21
