To review the published literature in relation to prevalence of HIV infection and risk behaviours for HIV among the mentally ill to assist in the development of appropriate strategies for public health policy, surveillance and clinical management of HIV and HIV risk in these groups.
A search of published literature was carried out using 'Medline', in association with following up appropriate papers cited in the references of journals identified.
The North American literature shows an increased risk of HIV infection in psychiatric patients receiving treatment in both inpatient or community settings. HIV infection is associated with a number of risk behaviours, particularly male homosexual sex and injecting drug use, and being the sexual partner of a person with a history of these. Impulsivity, high levels of sexual activity during acute exacerbations of psychiatric illness, poor skills at negotiating safe sex, homelessness and drug abuse are all risk behaviours common among those affected by some mental illnesses. The mentally ill also have a comparatively poorer knowledge of HIV/AIDS. There is a dearth of published Australian data addressing the question of HIV seroprevalence or risk in the mentally ill. Although there has been development and implementation of HIV risk-reduction programs overseas, the development and evaluation of any programs in Australia has not been published.
Arguably, Australia has developed a comprehensive program of national surveillance for HIV infection and has been relatively successful in its response to the HIV epidemic, with the high rates of infection in the early to mid-1980s substantially reduced to around 600 new diagnoses per year. However, while risk behaviours which exposed those infected with the virus are recorded, underlying conditions which predispose them to these behaviours are not. Nevertheless, there is HIV infection amongst mentally ill and intellectually disabled people in Australia. Examination of the North American experience reveals opportunities to prevent a high rate of HIV infection in those with mental illness in Australia. Such a program would require adequate risk behaviour assessment, appropriate diagnostic testing and management, and development of specific educational interventions which are properly evaluated to ensure their effectiveness.
"ttesman & Groome 1997). Furthermore, HIV seroprevalence rates have been shown to be significantly higher in those with serious mental illness compared to the general population (Susser et al . 1993, Volvka et al . 1991). Grassi (1996) suggests that people with mental illness have been neglected as potential 'victims of HIV infection'. According to Checkley et al . (1996), by far the greatest risk of infection would appear to be illicit drug use and unprotected sexual activity. Perhaps not surprising, as these are important risk factors within the general population also. According to Buckley et al . (1996), the closure of psychiatric hospitals and the drive towards community living may increase the vuln"
[Show abstract][Hide abstract] ABSTRACT: This review examines the literature on sex and relationship issues in the context of serious and persistent mental health problems. It identifies gaps in the research and highlights key issues needing further investigation. The available published documents have been identified, which contain information, ideas, data and evidence on the topic. A critical analysis of the subject, through the examination of the various documents, is provided. The main themes that emerged included HIV/AIDS, medication and sexual dysfunction, sexuality needs, intimate relationships, family planning, policies and sex education. Several subthemes are discussed and include needs assessment, stigma and loneliness. The key findings highlight the lack of systematic studies in the UK, especially regarding the subjective views of patients in determining need and the subsequent development of appropriate plans of care. The author argues that future mental health research needs to go beyond investigating perceived 'risky' behaviours and should include potential therapeutic responses in all areas of sexuality. Further recommendations are made in terms of nurse education particularly the inclusion of psychosexual aspects in future pre- and postregistration curricula. This paper may be of interest to service users, mental health practitioners working alongside people with serious and persistent mental health problems as well as educators, researchers and policy makers.
Journal of Psychiatric and Mental Health Nursing 01/2004; 10(6):640-9. DOI:10.1046/j.1365-2850.2003.00635.x · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patients with chronic mental illnesses constitute an important risk group for HIV infection overseas. This study aimed to determine the prevalence of risk behaviours associated with HIV transmission and factors associated with HIV testing in psychiatric patients in Melbourne.
Inpatients and outpatients completed an interviewer-administered questionnaire which covered demographics, psychiatric diagnosis, risk behaviour, and HIV education and testing.
Of 145 participants, 60% were male and 55.2% had schizophrenia. Injecting drug use (IDU) was reported by 15.9%, a figure approximately 10 times that found in other population surveys. Most patients reported sex in the last decade and over 20% had multiple sexual partners in the last year. Of males, 12.6% reported sex with another male (9.2% anal sex); 19.0% of females reported sex with a bisexual male. Nearly half of the males reported sex with a prostitute, 2.5 times that in a population sample. Only 15.9% reported ever having someone talk to them specifically about HIV and its transmission, although one-third had been tested for HIV. In multivariate analysis, male-male sex, paying for sex, and IDU were associated with HIV testing, but those whose primary language was not English were less likely to be tested. Those who had received HIV education were more likely to have used a condom last time they had sex (OR 4.52, 95%CI 1.49-14.0).
This study provides evidence that those with serious mental illness in Victoria have higher rates of participation in risk behaviour for HIV infection than those in the general community. Attention to HIV education and prevention in this group has been inappropriately scant; strategies to encourage safer behaviour are urgently needed.
Australian and New Zealand Journal of Psychiatry 09/1997; 31(4):566-76. DOI:10.3109/00048679709065079 · 3.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Nosocomial infection among male patients in a public psychiatric hospital was studied and the definitions for use in long-term care facilities were employed for diagnosis. The overall nosocomial infection rate was 6.7 per 1,000 day inpatients; 55.6% of these infections were identified in the respiratory tract, 50% of them being respiratory viral diseases; 38.9% of the nosocomial infections involved the eyes, ears, nose, throat and mouth, and 5.6% involved the skin and soft tissues. The epidemiological characteristics and the main clinical alterations of these inpatients were also identified.
Revista do Instituto de Medicina Tropical de São Paulo 01/1999; 41(6):365-70. DOI:10.1590/S0036-46651999000600006 · 1.01 Impact Factor
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