April 2016
HIV Transmission

How Can Psychiatrists Prevent HIV Transmission and Stigma, and Provide Compassionate Care for Persons with HIV and AIDS –

Psychiatrists in every subspecialty are in a unique position to provide compassionate care, teach communication skills, and coordinate the care of persons with severe and complex medical illness. AIDS is a severe, complex, and prevalent illness with multimorbid and concomitant medical and psychiatric manifestations. AIDS is similar to and inclusive of other complex and severe illnesses. Persons with HIV benefit from integrated and collaborative care. The collaborative care model improves retention in care and adherence to care. HIV differs from most other complex and severe illnesses in that it is entirely preventable and is associated with stigma. HIV also presents with psychiatric responses to illness and is also often associated with psychiatric illness and HIV-associated neurocognitive disorders because of the special affinity of HIV for brain and neural tissue. 

  • Psychiatrists can play a significant role in the HIV pandemic by becoming aware of significant risk behaviors and providing individuals with options for change. Psychiatrists can also ameliorate HIV stigma and suffering and provide care for persons infected and affected by HIV. 

  • The prevalence of HIV in persons with severe untreated mental illness is 10 to 20 times that of the general population. Psychiatrists can prevent transmission by encouraging routine HIV testing, providing education for HIV prevention, and making condoms available in medical and psychiatric facilities. 

  • Every 9½ minutes one person in the United States is infected with HIV. Approximately 50,000 are newly infected each year. One in seven Americans with HIV is unaware of being infected and can unknowingly become ill or infect others. 

  • Prevention of HIV risk behaviors can prevent transmission and immediate treatment with antiretrovirals upon exposure to HIV can prevent both infection and development of independent reservoirs for HIV in the brain. 

  • Routine HIV testing is now recommended for all persons from 13 to 64 years of age and for persons of any age with risk behaviors. 

  • HIV magnifies disparities in stigma, discrimination, and health care leading to disproportionate illness burden and stigma. 

  • HIV stigma, discrimination, and criminalization perpetuate and complicate the HIV pandemic. HIV stigma remains high and fear of discrimination causes some Americans to avoid routine testing, learn their HIV status, disclose their status, or access medical care. 

  • Communication skills are key to development of trust and rapport as well as to adherence to risk reduction, behavior change, and retention in medical care. 

  • Early diagnosis and retention in care can prevent morbidity and mortality in HIV. 

  • Prevention of risky behaviors may start with parenting education that encourages secure attachments and prevents child neglect and abuse. Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) with antiretroviral medication such as Truvada as well as condom use can prevent HIV transmission in serodiscordant couples. 

  •  Adherence to safer sexual practices and use of sterile needles and drug paraphernalia can prevent transmission of HIV infection. Recognition and treatment of all psychiatric disorders can improve adherence to both risk reduction and medical care. 

  • Strategies have been developed for improving communication, improving, adherence to risk reduction and retention in medical care, and preventing HIV-associated neurocognitive disorders. 


Psychiatrists are in a unique position to prevent transmission of HIV and HIV stigma, address health care disparities, and ameliorate suffering morbidity and mortality in persons with HIV and AIDS. 



WPA Section on HIV/AIDS Psychiatry
Mary Ann Adler Cohen, MD, Chair
Jordi Blanch, MD, PhD, Secretary

Supported by Unrestricted Educational Grant by SUN Pharma SUN LOGO

>> Please click here the pdf version of this document




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