HIV prevalence in persons with severe mental illness in Uganda: a cross-sectional hospital-based study

Abstract

BackgroundIn Uganda, a previous study reported high HIV prevalence in persons with severe mental illness (SMI) compared to the general population, suggesting that persons with SMI might constitute a high-risk group for HIV. However, the study included first-time psychiatric admissions only, a group whose HIV prevalence may not reflect the prevalence in persons with SMI in general. We determined prevalence and correlates of HIV in both first-time and previous psychiatric admissions, in a psychiatric hospital in Uganda.MethodsCross-sectional study of HIV status in persons consecutively discharged from psychiatric admission wards in Butabika hospital, Uganda. Inclusion criteria: age 18–49 years; schizophrenia, bipolar disorder, depression, or other non-substance-use-related psychosis; Luganda or English proficiency. Exclusion criterion: Mental incapacity to give informed consent. Participants were HIV-tested, and interviewed using a structured questionnaire. Data were analysed using logistic regression.ResultsHIV prevalence was 11.3% (CI 8.8-13.8) overall, 7.3% (CI 4.1-10.5) in men and 14.3% (CI 10.6-18.0) in women. Females had higher risk of HIV infection than males (OR 2.10; CI 1.20-3.67), after adjustment for age. Older patients had higher risk of HIV infection than younger patients (40–49 vs. 18–29 years: OR 2.34; CI 1.27-4.32), after adjustment for sex. Place of residence, marital status, income, education, occupation, psychiatric diagnosis and history of previous admission were not associated with HIV infection, after adjustment for sex and age. The above associations did not significantly differ between men and women.ConclusionsPersons admitted for SMI in Uganda have higher HIV prevalence than persons in the general population, irrespective of previous admissions. The excess HIV prevalence is mainly confined to women. The findings call for the integration of HIV prevention, testing and care with mental health services in settings with generalized HIV epidemics. Moreover, further research is needed to clarify the mechanisms underlying the increased HIV prevalence in women with SMI in Uganda, and to identify effective community-based interventions for this vulnerable group.

Sexual Risk Behavior, Sexual Violence, and HIV in Persons With Severe Mental Illness in Uganda: Hospital-Based Cross-Sectional Study and National Comparison Data

“…However, in most participants, the year of self-reported SMI onset (and of first admission for SMI) predated the year of HIV diagnosis (data previously published 26 ). In addition, we focused on sexual risk behavior or sexual violence exposure during past year, not during lifetime, potentially decreasing the likelihood of reverse causality underlying the associations found.…”

“…26 In persons who were HIV-positive, we obtained self-reported information about previous positive HIV tests.…”

“…26 The minimum sample size was 500 to estimate HIV prevalence of 12% (63%) and for subgroup comparisons. Inclusion criteria were (1) age 18 to 49 years;…”

“…20---24 In Uganda, 2 facility-based studies have reported high HIV prevalence in persons with SMI compared with persons in the general population. 25,26 In these studies, women with SMI have had particularly high rates relative to the general population. Associations between SMI and HIV may be bidirectional, 27,28 but the Ugandan studies nevertheless raise the question as to whether persons with SMI, and women with SMI in particular, constitute a high-risk group for HIV in this low-income country with a generalized HIV epidemic.…”

Factors associated with HIV transmission risk in people with a severe mental illness. A narrative review

“…In Uganda's population (18-49 years), females had higher risk of HIV infection than males (OR 2.10) (Lundberg, Nakasujja, Musisi, Thorson, Cantor-Graae & Allebeck, 2013).…”