HIV Risk Activity Among Persons With Severe Mental Illness: Preliminary Findings (original) (raw)
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Revista Brasileira de Psiquiatria, 2008
Reliability and validity of a questionnaire on vulnerability to sexually transmitted infections among adults with chronic mental illness -PESSOAS Project Confiabilidade e validade de um questionário sobre vulnerabilidade para infecções sexualmente transmissíveis entre adultos com transtorno mental crônico -Projeto PESSOAS Abstract Objective: To describe reliability/validity of a semi-structured questionnaire designed to assess risk behavior to sexually transmitted diseases among adults with chronic mental illness. Method: A cross-sectional pilot study was conducted in one psychiatric hospital and one mental health outpatient clinic. Clinical, behavioral and demographic data were collected from semi-structured interviews and medical charts. Onehundred and twenty patients were randomly selected from pre-defined lists in both centers while 89 (74%) were interviewed, indicating 26% nonparticipation rate. Protocol, participation rates, consent form and feasibility issues were assessed. The semi-structured interview was evaluated with regard to reliability (intra-and inter-rater) and construct validity by randomly repeating the interviews in a 1:1 ratio up to one-week interval. Reliability was estimated by percent agreement and Kappa statistics (95% confidence interval). Construct validity was assessed by Grade of Membership model. Results: Kappa statistics ranged from 0.40 to 1.00 for most variables. Grade of Membership analysis generated three profiles. Profile one was represented by mostly women with no condom use in stable relationships; profile two revealed mostly men in stable relationship but with multiple risk behaviors; while profile three indicated a higher proportion of licit or illicit substance use. Conclusions: Reliability and construct validity assessment using Grade of Membership analysis indicated that the semi-structured interview was suitable for capturing risk behavior among patients with chronic mental illness. Descriptors: Sexually transmitted diseases; Risk-taking; Reproduction of results; Validity of tests; Mental health Resumo Objetivo: Descrever a confiabilidade/validade de um questionário semi-estruturado para avaliar comportamento de risco para as infecções sexualmente transmissíveis entre adultos com doença mental crônica. Método: Estudo-piloto transversal em um hospital psiquiátrico e um centro de atenção psicossocial. Dados clínicos, comportamentais e sociodemográficos foram coletados por entrevistas semi-estruturadas/ prontuários médicos. Cento e vinte pacientes foram selecionados aleatoriamente a partir de listas pré-definidas de ambos os centros, enquanto 89 (74%) foram entrevistados, indicando uma taxa de não-participação de 26%. Protocolo, participação, consentimento e outros fatores foram avaliados. A entrevista semi-estruturada foi avaliada em sua confiabilidade (intra e inter-observador) e validade de construto, por repetição aleatória (razão 1:1), com até uma semana de intervalo. A confiabilidade foi estimada pelo percentual de concordância/coeficiente Kappa (intervalo de confiança 95%). A validade de construto foi avaliada pelo modelo Grade of Membership. Resultados: Os coeficientes Kappa variaram de 0,40-1,00 para a maioria das variáveis. A análise Grade of Membership gerou três perfis de vulnerabilidade. O perfil um representou principalmente mulheres em relacionamentos estáveis que não usavam preservativo; o perfil dois revelou principalmente homens em relacionamentos estáveis, mas múltiplos comportamentos de risco; o terceiro perfil indicou uma alta proporção de uso de substâncias lícitas e/ou ilícitas. Conclusões: A confiabilidade e validade de construto indicaram que a entrevista foi adequada para captar os comportamentos de risco nesta população.
2011
In this study, we use the Colorado Symptom Index, a measure of psychiatric symptomatology, to identify vulnerable subgroups within the severely mentally ill population at elevated risk for HIV infection. Baseline data on 228 HIV positive and 281 HIV negative participants from two clinical trials were used. With years to HIV diagnosis as our primary endpoint, Kaplan-Meier estimates were calculated to find a CSI cutoff score, and a Cox proportional hazards model was used to obtain relative risks of infection for the two CSI categories created by the cut point. We found that a CSI score C 30 was associated with a 47% increased risk for HIV infection (P \ 0.01). While this study establishes the foundation for using CSI scores to identify a vulnerable subgroup within the SMI community, further studies should develop effective approaches to mitigate psychiatric symptomatology in order to examine the impact on HIV transmission risky behaviors.
HIV prevention advice for people with serious mental illness
The Cochrane library, 2016
The problem of therapeutic efficacy indices. 3. Comparison of the indices and their use [Apercu sur la problematique des indices d'efficacite therapeutique, 3: comparaison des indices et utilisation. Groupe d'etude des Indices d'efficacite].
Understanding HIV-Related Risk Among Persons with a Severe and Persistent Mental Illness
The Journal of Nervous & Mental Disease, 1999
We conducted focus groups with 36 men and women who were receiving treatment for a severe and persistent mental illness (SPMI) to learn more about the social context of their intimate relationships and the psychological antecedents of their sexual decision-making. Qualitative analysis of focus group transcripts indicated that (a) sexual activity tended to be unplanned and occurred in social networks where HIV risk may be elevated, (b) HIV-related knowledge was superficial and insufficient to guide safer sexual behavior, (c) participants' HIV risk perception was often based upon factors unrelated to their sexual behaviors, and (d) communication skills for HIV risk reduction were poor. We discuss how qualitative methods yielded insights not readily available through quantitative approaches, and offer recommendations for HIV risk assessment and prevention among persons with a SPMI. Keywords HIV; severe and persistent mental illness (SPMI); focus groups The term "severe and persistent mental illness" (SPMI) typically refers to schizophrenia, bipolar disorder, major depression, or schizoaffective disorders that affect approximately 2.8 million individuals in the United States. Ten published studies conducted between 1990-1995 indicate that persons with a SPMI are at high risk of HIV infection; these studies yielded seroprevalence rates of 4-23% (Carey, Weinhardt, & Carey, 1995). Infection with HIV leads to AIDS, a condition associated with significant psychosocial and physical morbidity, premature mortality, and staggering cost; regarding the latter, the lifetime cost of treating a person with AIDS has been calculated to be at least 102,000(Hellinger,1992).Thus,ifonly10102,000 (Hellinger, 1992). Thus, if only 10% of the 2.8 million adults with a SPMI acquire HIV, the medical cost will approach 102,000(Hellinger,1992).Thus,ifonly1028.6 billion. This estimated cost does not include the costs associated with protease inhibitors or additional psychiatric care, nor does it address the profound human tragedy and suffering of infected and affected persons. Many reasons have been proffered to explain the elevated seroprevalence among persons with a SPMI (Carey, Carey, & Kalichman, 1997). First, their life circumstances may be associated with increased risk for HIV infection. Although medication therapy often stabilizes psychiatric symptoms, many individuals with a SPMI experience exacerbations that require ongoing care and short-term hospitalizations (Wohlford, Myers, & Callan, 1993). As a consequence of persistent psychiatric difficulties, persons with a SPMI are likely to be unemployed, economically and socially disadvantaged, and reside in transitory housing-circumstances associated with an increased vulnerability to many health threats (Adler et al., 1994), including HIV infection.
Community mental health journal, 2001
HIV prevalence is alarmingly high among persons with serious mental illness and severely mentally ill adults frequently engage in high-risk behavior practices. This study evaluated the effectiveness of a small-group HIV risk reduction intervention offered to 189 men and women in outpatient programs for severely mentally ill adults. Participants screened for HIV risk were randomly assigned to attend either a 7-session small-group cognitive-behavioral HIV risk reduction intervention or a time-matched comparison intervention and were followed at 3-month intervals for one year. Participants who attended the HIV risk reduction intervention increased their condom use, had a higher percentage of intercourse occasions protected by condoms, and held more positive attitudes toward condoms. Women showed greater response to the intervention than men. While many behavior change effects were present at 3-, 6- and 9-month followup assessments, most diminished by the 12-month followup. These result...
Lifetime sexual behavior of psychiatric inpatients
The journal of sexual medicine, 2010
Sexual life of psychiatric patients, including risk behaviors related to sexually transmitted diseases, remains a poorly studied area, especially in those with severe mental illnesses. Aims. To assess some aspects of lifetime sexual behavior of psychiatric inpatients. Methods. Patients consecutively admitted to a psychiatric unit in a general hospital were interviewed about partnerrelated lifetime sexual behavior. Main Outcome Measures. A semi-structured interview developed by the authors was used to collect information concerning their general sexual experience throughout life, homosexual and heterosexual relations, and relations with partners who were intravenous drug users (IVDU), HIV carriers or suffering from AIDS, and with sex workers. In each of these areas, time elapsed since last sexual contact; number of partners in previous year, frequency of these relations and condom use were investigated. Results. Five hundred forty-six patients (306 men and 240 women) were assessed, and 87.7% of them reported sexual relations at some point during their life. Of these, 90% reported heterosexual and 10% homosexual or bisexual sexual contacts. Further, 11.06% had had at least one partner who was an IVDU; 8.1% an HIV-positive partner, and 32.4% (50% of the men) had paid for sex. Overall 49.79% of the total sample reported never using condoms in their sexual relations, with similar percentages for those with HIV-positive (46%) and IVDU (47%) partners. Of those who paid for sex, 29% never used condoms. Conclusions. Psychiatric patients admitted to a general hospital psychiatric unit have sexual experience close to the general population, with a higher percentage of homosexual contacts and lower rates of condom use, even in higher risk situations, such as men having sex with men, and partners who are HIV-positive or IVDUs. This information obliges clinicians to systematically explore the sexual behavior of psychiatric patients, evaluate risk behaviors, and adopt measures to promote safe sex practices in this population.
HIV risk behavior of psychiatric patients with mental illness: a sample of Brazilian patients
Revista Brasileira de Psiquiatria, 2010
OBJECTIVE: The prevalence of HIV among psychiatric patients is higher than general population rates worldwide. Many risk behaviors have been identified in studies from both developing and developed countries, though sampling limitations restrict the generalizability of their results. The objective of this study was to report findings from the first national sample of psychiatric patients about lifetime practice of unsafe sex and associated factors. METHOD: A national multicenter sample of adults with mental illness was randomly selected from 26 public mental health institutions throughout Brazil. Sociodemographic, sexual behavior and clinical data were obtained from person-to-person interviews and blood was collected for serology testing. Logistic regression was used for analysis. RESULTS: The overall prevalence of lifetime unprotected sex was 80.3%. Married, older, female patients, those with multiple partners and living with children or partners only and those with less severe psy...
Salud Mental, 2017
Background. People with a severe mental illness (SMI) are a highly vulnerable group for the transmission risk of the human immunodeficiency virus (HIV). They have a higher seroprevalence compared with the general population and their life expectancy is shorter than those of people without the disease. This narrative review describes individual factors or those inherent to a person’s characteristics and the sociocultural factors conditioning sexual behaviour and prevention norms. Objective. The purpose of this narrative review is to describe individual and sociocultural factors associated with the risk of HIV in people with a severe mental illness. Method. 82 empirical studies published between 1981 and 2015, addressing HIV transmission risk factors and sociocultural dimensions related to vulnerability were selected. Four indexes were used for this purpose: ISI Web of Knowledge, Redalyc, SciELO, and PUBMED; and four multidisciplinary electronic databases: Ebscohost Web, ProQuest, Sag...