Mental health assessments recommended for people seeking PEP

Many people who use post-exposure prophylaxis (PEP) for HIV are also highly likely to have a mental health issue, according to new research published in AIDS and Behaviour this month.

The researchers looked retrospectively at data from a community health clinic in Boston, USA and found that over 50% of people who used PEP after consensual unprotected sex were also living with a mental health condition. Evidence has shown that mental health issues can make people more likely to engage in risk-taking behaviours related to HIV. As a result, the researchers recommend PEP users are screened and referred to appropriate care and support to reduce their vulnerability to HIV.

The study looked at medical records from 1997 to 2013, analysing data from 821 participants and 1,162 courses of PEP (as some users had more than one course over the time period). 96% of the participants were men, and 73% were white, with the average age being 33 years old. They found that 24% of the participants also had depression; 22% had anxiety; 8% had attention deficit hyperactivity disorder; 3% had post-traumatic stress; and 3% had a psychotic disorder. Those living with more than one mental health condition were also likely to have a greater risk for substance abuse – notably alcohol and crystal methamphetamine. Both factors can intensify risk-taking behaviour for HIV.

Following the findings, the researchers recommended that HIV prevention interventions be comprehensive in their approach, addressing mental health issues that may affect an individual’s likelihood of engaging in risky behaviours. Given the demographic of this particular study, and the fact they all the study participants engaged in consensual unprotected sex, they also recommended that men who seek PEP also be considered for pre-exposure prophylaxis (PrEP). Furthermore, they also highlighted the importance of combining both biomedical and behavioural interventions, by providing both PEP and counselling among those most vulnerable to engaging in risk-taking behaviours for HIV.