Positive impact: a community-based mental health center for people affected by HIV.

Abstract

Through 2001, 495,592 people were reported to be living with HIV infection or AIDS in the United States (CDC, 2001). Between 1999 and 2000 the estimated number of people living with AIDS increased 7.9 percent, and the number of estimated deaths among people with AIDS declined 11 percent, continuing a trend that began with the introduction of antiretroviral therapy in 1996 (CDC). With improved treatments and longer survival times, a major goal of treatment for people with HIV infection has become the maintenance and improvement of functioning and well-being, collectively referred to as health-related quality of life (Sherbourne et al., 2000). The impact of HIV infection extends beyond the physical health sphere, affecting social, vocational, economic, developmental, and psychological components of life (Ullery & Carney, 2000). Mental health problems among HIV-infected people may have a substantial negative effect on quality of life, adversely affect the need for and use of health services, compromise adherence to medication regimens, and affect health outcomes (Bing et al., 2001; Fairfield, Libman, Davis, Eisenberg, & Phillips, 1999; Sherbourne et al.). Conversely, a reduction in mental health problems can lead to significant improvement in health-related quality of life, which may benefit patients in terms of medication adherence, health promotion behaviors, and ultimately, overall health (Elliott, Russo, & Roy-Byrne, 2002). Comorbid psychiatric illnesses are more common in people with HIV than in the general population (Brown et al., 1992; Kessler et al., 1994). Recent studies have indicated that HIV-infected adults receiving medical care have screened positive for a mental disorder or drug dependence in the past year at a rate nearly five times higher than the general population (Bing et al., 2001; Burnam et al., 2001; Kessler et al.). Although a substantial amount of mental health and substance abuse services are provided to those with known HIV infection, inequalities in access to care are clearly evident (Burnam et al.). Poorer mental health in people who are HIV-positive is associated with lower levels of education and income, which is believed to reflect poorer access to high-quality care (Cunningham et al., 1998; Hays et al., 2000). Furthermore, the use of outpatient mental health services and psychotherapeutic medication is significantly lower among ethnic minority groups and those with lower education and income levels (Burnam et al.). The purpose of this article is to describe the efforts of one agency to address inequities in access to mental health services among people who are affected by HIV and face barriers to mental health care because of their financial status. Located in Atlanta, Georgia, Positive Impact, Inc., is a nonprofit, community-based organization that provides free mental health services to low-income individuals, groups, and families affected by HIV by using an extensive network of volunteer mental health professionals and graduate student interns. PROVISION OF MENTAL HEALTH SERVICES Intake and Assessment Following referral by local AIDS service organizations and other social services providers, clients initially contact Positive Impact by telephone and participate in a brief screening process to determine the nature of their mental health needs and their financial eligibility for service. People who have an annual income of less than 300 percent of the federal poverty level (currently $26,580), or who have inadequate mental health coverage meet eligibility requirements. Those with adequate insurance coverage or income are referred to an area mental health care provider who can appropriately address their mental health needs. If financial eligibility requirements are met, the individual is scheduled for an interview to develop a comprehensive biopsychosocial assessment that includes measurement of psychological distress, HIV-related stigma, perceived barriers to care, substance use, and level of engagement with the primary care system. …