HIV risk behavior of psychiatric patients with mental illness: a sample of Brazilian patients

Abstract

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 psychiatric diagnosis more often practised unsafe sex. DISCUSSION: Risk behavior assessment is a critical tool for clinicians to be able to determine needed HIV-related services for their clients and ensure appropriate follow-through with care and prevention. Interventions that address situational risks in psychiatric patients' lives-institutional and individual- and increase their ability to make informed decisions about their sexual health are urgently needed.

Factors associated with unprotected sexual practice among men and women with mental illnesses in Brazil

“…The prevalence of recent unprotected sex was high in both genders in our sample, but it was higher among women than men (89% and 77%, respectively), and this result was consistent with other studies 4,5 . This is also consistent with our previous data which indicated women to practice lifetime unsafe sex more often than men in Brazil 6 . In addition, the prevalence was higher than in the Brazilian population (15 to 64 years old) for both women and men (78% and 72%, respectively) 2 .…”

“…However, other factors were equally associated with unprotected sex in both men and women (marital status, living with partners or children and cigarette smoking). More severe psychiatric diagnoses, such as psychoses, can negatively interfere in the interest and ability to initiate and maintain a sexual relationship, while other psychiatric diagnoses may favor impulsivity, decrease risk awareness and social skills, thereby reducing the ability to make decisions, negotiate condoms and adopt and maintain preventive behaviors 6,9 . We should point out that the association between depression and anxiety and unprotected sex among men may only indicate a need to focus on equal access to HIV prevention in these services regardless of severity of diagnoses or substance use disorders.…”

“…In addition, living with a partner and/or children was a significant contextual factor associated with an increased risk of unprotected sex among both, men and women. It is likely that this variable acts as a potential marker for lack of privacy, which may contribute to unprotected sex among stable couples 6 . Lower family income was associated with unprotected sex among men only.…”

“…There is evidence that rates of unprotected sex are higher among women than men -respectively, 56% and 43% of patients with severe mental illnesses in the last three months in the USA 4 ; 82% and 65% in the last year also among patients with severe mental illnesses also in the USA 5 ; and 84% and 77% among patients with chronic mental illness in Brazil during lifetime 6 . These differences are also consistent among women and men in the general population -respectively, 78% and 72% among Brazilians 15 to 64 years old in the last year 2 ; and 46% and 33% among students in the USA at last sexual intercourse 7 .…”

“…We have previously assessed correlates of unsafe sex among psychiatric patients in Brazil 6 , and female gender, depression and anxiety, among other factors, were independently associated with lifetime unsafe sex. In that report we used lifetime time-frame and considered those abstinent as safe sex.…”