Right now, people who inject drugs are among the least likely to be offered HIV pre-exposure prophylaxis (PrEP), despite a clear need. So one solution could be to offer it through community mental health services that offer substance use treatment and treatment for mental illness.

This is the conclusion of a viewpoint essay published in The Lancet HIV.

Andrew Sudler, MPH, of Columbia University, and colleagues presented their case. Only 20% of people who could benefit from PrEP currently have a prescription for it; people with serious mental health issues are more likely to engage in sexual behaviors that could increase their risk of acquiring HIV; and nearly half of people who inject drugs express interested in using PrEP. And, of course, there’s the mental health benefit of taking PrEP.

“An important yet underacknowledged mental health benefit of PrEP is related to the increased pleasure through sex, derived from a decrease in concern about HIV acquisition,” the authors wrote. “Some studies suggest that taking PrEP enables partners who are HIV negative to have more emotionally and physically fulfilling sex lives by reducing concern about HIV.”

Since people with serious mental illness and those who inject drugs may not have a regular primary care clinician, providing PrEP though mental health services could be a good option.

But there are significant barriers, including potential hesitancy of mental health providers to prescribe and follow people taking PrEP for physical health problems, concerns about interactions between PrEP and mental health drugs and clinicians’ doubts about their patients remembering to take their medications. There are also questions about how mental health providers would get paid for their services and how to manage the need to navigate through the health system to access low-cost PrEP.

More research is needed to assess interest in this approach from both clinicians’ and potential PrEP users’ side.

“Integrating PrEP into community mental health settings is a patient-care issue,” Sudler and colleagues write. “Community mental health providers already deliver holistic care that takes into account patients’ sexual behaviors and drug use; these settings are therefore ideal to identify PrEP candidates.”

Click here to read the full viewpoint essay.

Click here to learn more about PrEP.