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HIV PrEP and Mental Health Care
Bridging Prevention and Psychiatry: Why HIV PrEP Is Also Mental Health Care

Released: November 24, 2025

Glenn J. Treisman
Glenn J. Treisman, MD, PhD
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Key Takeaways
  • Mental illness and addiction don’t biologically predispose people to HIV, but they may influence behavior that can result in increased risk of exposure to HIV.
  • Expansion of PrEP prescribing in mental health care is crucial for closing the PrEP gap among people with mental health challenges and substance use.
  • Mental health professionals are uniquely positioned to provide PrEP.

For decades, we have known that behavioral disorders dramatically increase the risk of HIV infection. In 1 study at the Johns Hopkins HIV Clinic, 54% of people had an Axis I psychiatric disorder (excluding substance use), and 74% had a substance use disorder. Despite advances in prevention, we still see approximately 31,800 new HIV cases annually in the US, many among individuals with mental health conditions.

So, why isn’t HIV prevention part of routine mental health care?

Behavioral Disorders and HIV Risk
Mental illness and addiction don’t biologically predispose someone to HIV, but they influence behavior that can result in increased risk of exposure to HIV.

In my experience, people with mental health challenges often engage in behaviors that increase their risk of HIV exposure, even if overall sexual activity is reduced. For example, people with schizophrenia may have less frequent sex, but more high-risk encounters, whereas people with bipolar disorder tend to increase sexual activity during mania and decrease it during depression, but engage in risk-taking behavior in both states. People with substance use disorder are more likely to engage in sexual risk-taking to obtain drugs and often have impaired judgment while intoxicated.

Furthermore, people with mental health challenges often experience barriers to routine healthcare, making it difficult for them to regularly access HIV prevention and screening services in primary care or with an infectious disease specialist.

The Missed Opportunity: Mental Health and PrEP
Clearly, this is a population that would greatly benefit from HIV pre-exposure prophylaxis (PrEP), yet uptake among people with mental illness remains low. Although there are many contributing elements to low uptake in this population, 1 notable factor is that mental health professionals rarely consider HIV prevention part of their role.

This is a missed opportunity.

Infectious disease specialists excel at prescribing PrEP, but they typically see people after infection has already occurred. Mental health providers, on the other hand, have direct access to key populations at increased risk of HIV exposure, including those in substance use programs, psychiatric clinics, or correctional facilities. These are precisely the settings where PrEP could have the greatest impact.

PrEP Starts With You
I am excited about prescribing PrEP, and I take every opportunity to discuss it with my patients. I think it can be an incredibly simple thing to learn how to do, especially for mental health professionals, who are already experienced with long-term management of medications for chronic conditions.

Although it may seem daunting to educate ourselves about an entirely different class of medications, PrEP is safe, effective, and increasingly easy to prescribe and manage. Oral PrEP requires minimal monitoring, and long-acting injectable options are becoming increasingly available for people who experience challenges with adherence to daily oral medication.

A 2-minute discussion about PrEP during a mental health visit can change a patient’s life. It is already part of our purview to talk about sexual health and sexual transmission of infections, so discussing HIV prevention is a natural expansion of these duties.

Mental health professionals are uniquely positioned to reduce HIV incidence among vulnerable populations. By embracing PrEP as part of routine care, we can close a critical gap in prevention and improve outcomes for people whose psychiatric conditions place them at disproportionate risk.

Your Thoughts
How do you see your role in providing PrEP? Leave a comment to join the discussion!

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