Figure 1.

Providers experiences with provision of HIV-related services to patients with SMI across continuum of psychiatric care

Patients with SMI move through levels of care depending on the severity of their mental illness. As the least restrictive level of care, outpatient care is considered suitable for individuals with SMI who are not gravely disabled or immediate danger to self or others. However, this level of care poses multiple challenges to effective delivery of HIV-related services. For this reason, providers from acute psychiatric inpatient unit and psychiatric emergency department view efforts to provide HIV testing and linkage with HIV care as mostly futile. Paradoxically, the most severely impaired individuals who require long-term stay in a chronic psychiatric facility, are best served when it comes to HIV testing and linkage with long-term, effective HIV care; an exception is the issue of condom distribution, which some providers find ethically and medico-legally disputable. (Arrows indicate possible directions of patient movement between levels of care