As a group, patients with so-called severe and persistent mental illness (SPMI), which includes schizophrenia, are at higher risk for HIV/AIDS than the general population. Exact numbers are hard to come by since seroprevalence of HIV infection is often based on highly selected samples of convenience done in epicenters of the HIV epidemic. In a cohort of 320 first admissions for psychosis in all of Suffolk County, NY (also known epidemiologically as “semirural Long Island”), 3.8% of patients were known to have HIV/AIDS. This 3.8% is an estimate of the minimum prevalence since the cohort was
not systematically tested for HIV. The main cause of death in this cohort of young people was AIDS!

One obvious risk factor for HIV infection is current or past injection drug use. However, sexual transmission is the most common mode of infection for patients with schizophrenia. This is sometimes not suspected because providers consider their patients asexual, an assumption that is simply wrong. In one study of 95 patients with schizophrenia who were interviewed face-to-face about their sexual activity, about half had been sexually active in the previous 6 months (Cournos and Guido, 1994). What is problematic is that sexual encounters are often unplanned and might occur with populations at risk for sexually transmitted diseases. Add to this poor judgment and lack of social competence in negotiating sexual encounters, and many patients will have a sexual encounter in which no condoms are used. I think many patients are simply taken advantage of. In some cases, trading sex for money or drugs is a patient’s reality. Although many patients have reasonable knowledge of HIV, this is certainly not true of all patients, and misinformation about HIV is frequent in more severely ill patients. Remember also that knowledge does not necessarily change behaviors.