On two recent visits to South Africa to train staff of psychiatric facilities in dealing with HIV-infected patients, Columbia University psychiatry professor Francine Cournos, M.D., was shocked to learn "how little attention people were paying to HIV in the midst of an epidemic that’s devastating their country." This extended even to front-line clinical staff who were faced with caring for HIV-infected persons. Other than knowing that the disease is spread sexually and that people should use condoms, "there was a very low level of HIV knowledge" in the mental health community and among the country’s health officials.

She was quite pleased, then, when her descriptions of several of APA’s HIV/AIDS policy statements were met with enthusiasm and requests for copies. South Africa has no policies to guide administrators and staff of mental health care facilities on how to respond to the needs of HIV-infected persons while protecting themselves and other patients, Cournos told Psychiatric News. As a member of the APA Commission on AIDS and director of Columbia’s HIV Mental Health Training Project, Cournos lent her expertise to the development of several of those policies and was able to help facility administrators, staff, and the country’s mental health director begin to adapt them for their own needs.

They started, for example, with policies relating to care in inpatient units, such as how strict adherence to universal precautions obviates the need for isolating HIV-infected patients from others, as has been the rule in South African psychiatric facilities, she explained. There was also great concern over policies regarding confidentiality. "Many people thought the purpose of confidentiality is to protect the patients from discrimination," she said. Unfortunately, they were unaware that their confidentiality policy about which patients were HIV infected was so strict that it kept physicians and other staff from learning patients’ status and thus providing optimal care for the patients. "They had no concept that it is O.K. to share information for the purpose of treating the patient with the best care possible," Cournos noted.

"It was amazing to see how interested people were in the fact that APA had policies already developed and that they didn’t have to start from scratch on several clinical and ethics concerns," she said.