People with severe mental illnesses have a much higher prevalence HIV infection in the United States. Yet, this is not a population that we usually hear about in public health efforts to prevent HIV and care for people with HIV. But the risk for HIV infection is not solely a high-income country phenomenon. Studies from sub-Saharan Africa also show a high prevalence of HIV infection among people hospitalized in psychiatric facilities. This population also has higher rates of mortality and earlier mortality from non-communicable diseases.