Negotiating Risk: Knowledge and Use of HIV Prevention by Persons With Serious Mental Illness Living in Supportive Housing

Yale University, New Haven, Connecticut, USA.
American Journal of Community Psychology (Impact Factor: 1.74). 01/2006; 36(3-4):357-72. DOI: 10.1007/s10464-005-8631-1
Source: PubMed


As a population, persons with serious mental illness (SMI) have an elevated risk for HIV infection. However, relatively little is known about how the risk of HIV has affected their lives, how persons with SMI evaluate their HIV risk, and what preventive measures they undertake. Furthermore, relatively little is known about community-based HIV prevention for persons with SMI as most interventions have been restricted to clinical settings. This report presents findings on the HIV-related experiences of persons with SMI living in supportive housing programs, one possible setting for implementing community-based HIV prevention with this population. The qualitative investigation interviewed 41 men and women living in five supportive housing programs. In-depth, qualitative interviews elicited discussion of research participants' (a) experiences with HIV, (b) knowledge about HIV and HIV prevention, (c) assessments of their own risk, (d) descriptions of how they apply their prevention knowledge, and (e) reports of barriers for HIV prevention. Research participants describe social networks that have substantial contact with persons affected by HIV. However, contrary to some expectations of persons with SMI, research participants report using HIV prevention knowledge in negotiating their risk of contracting HIV. The implications of these findings are discussed in terms of their relevance for implementing community-based HIV prevention for persons with SMI.

Download full-text


Available from: Christina S Meade,
47 Reads
  • Source
    • "Risk for HIV infection among people with SMI has been associated with psychiatric symptom profile (McKinnon et al. 2001; Meade 2006) and cognitive impairment (McKinnon et al. 2002; Meade and Sikkema 2005); co-morbid substance use (McKinnon et al. 2001; Meade 2006; Meade and Sikkema 2007; Parry et al. 2007; Rosenberg et al. 2001b); history of childhood physical and sexual abuse (Devieux et al. 2007; Meade et al. 2009; Meade and Sikkema 2007); history of infection with a sexually transmitted disease (Vanable et al. 2006); relationship status (Meade 2006); type of treatment setting (Wright and Gayman 2005); inadequate assessment of personal risk (Kloos et al. 2005); multiple sexual partners, unprotected sex, and transactional sex (McKinnon et al. 2002; Meade and Sikkema 2005) and interactions among these factors. Questions remain regarding the epidemiology of HIV infection among people with SMI who live outside the epicenters of the epidemic; prevalence differences among diagnostic subgroups; as well as the intersecting social networks of people with SMI, injection drug users, and other high prevalence groups (Walkup et al. 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: We evaluated the efficacy of a gender-specific intervention to reduce sexual risk behaviors by introducing female-initiated methods to urban women with severe mental illness. Seventy-nine women received 10 sessions of an HIV prevention intervention or a control intervention. The primary outcome was unprotected oral, anal, or vaginal intercourse, expressed using the Vaginal Episode Equivalent (VEE) score. Knowledge and use of the female condom were also assessed. Women in the HIV prevention intervention showed a three-fold reduction in the VEE score at the 3-month follow-up compared to the control group, but the difference was not significant. These women were significantly more likely to know about female condoms, have inserted one and used it with a sexual partner at the 3-month follow-up and to have inserted it at 6 months compared to controls. The female condom may be a useful addition, for a subset of women with SMI, to comprehensive HIV prevention programs.
    Community Mental Health Journal 03/2010; 47(2):143-55. DOI:10.1007/s10597-010-9302-8 · 1.03 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Integrated care services specifically designed for the mentally ill homeless with HIV/AIDS
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: As in other countries worldwide, adults with severe mental illness (SMI) in Brazil are disproportionately infected with HIV relative to the general population. Brazilian psychiatric facilities lack tested HIV prevention interventions. To adapt existing interventions, developed only in the US, we conducted targeted ethnography with adults with SMI and staff from two psychiatric institutions in Brazil. We sought to characterize individual, institutional, and interpersonal factors that may affect HIV risk behavior in this population. We conducted 350 hours of ethnographic field observations in two mental health service settings in Rio de Janeiro, and 9 focus groups (n=72) and 16 key-informant interviews with patients and staff in these settings. Data comprised field notes and audiotapes of all exchanges, which were transcribed, coded, and systematically analyzed. The ethnography identified and/or characterized the institutional culture: (1) patients' risk behaviors; (2) the institutional setting; (3) intervention content; and (4) intervention format and delivery strategies. Targeted ethnography also illuminated broader contextual issues for development and implementation of HIV prevention interventions for adults with SMI in Brazil, including an institutional culture that did not systematically address patients' sexual behavior, sexual health, or HIV sexual risk, yet strongly impacted the structure of patients' sexual networks. Further, ethnography identified the Brazilian concept of "social responsibility" as important to prevention work with psychiatric patients. Targeted ethnography with adults with SMI and institutional staff provided information critical to the adaptation of tested US HIV prevention interventions for Brazilians with SMI.
    Social Science & Medicine 08/2007; 65(2):296-308. DOI:10.1016/j.socscimed.2007.03.020 · 2.89 Impact Factor
Show more