Rev Saúde Pública 2012;46(2):290-9
Ana Paula Souto MeloI
Milton L WainbergIII
Cibele Comini CésarIV
Mark Drew Crosland
I Medical School. Universidade Federal de
São João Del-Rei. Divinópolis, MG, Brazil
II Department of Psychiatry. New York State
Psychiatric Institute. Columbia University
College of Physicians and Surgeons. New
York, NY, USA
III HIV Center for Clinical and Behavioral
Studies. New York, NY, USA
IV Department of Statistics, School of Exact
Sciences, Universidade Federal de Minas
Gerais (UFMG). Belo Horizonte, MG, Brazil
V Department of Preventive and Social
Medicine. Medical School. UFMG. Belo
Horizonte, MG, Brazil
Ana Paula Souto Melo
Universidade Federal de São João Del-Rei
Av. Sebastião Gonçalves Coelho, 400 – Sala
35501-296 Divinópolis,MG, Brasil
Article available from: www.scielo.br/rsp
Psychiatric patients’ return for
HIV/STI test results in mental
Devolução dos resultados de exames
sorológicos de HIV/IST entre
pacientes psiquiátricos nos serviços
de saúde mental
OBJECTIVE: To assess individual and/or health service factors associated with
patients returning for results of HIV or sexually transmitted infection (STI)
tests in mental health centers.
METHODS: Cross-sectional national multicenter study among 2,080 patients
randomly selected from 26 Brazilian mental health centers in 2007. Multilevel
logistic regression was used to assess the effect of individual (level 1) and
mental health service characteristics (level 2) on receipt of test results.
RESULTS: The rate of returning HIV/STI test results was 79.6%. Among health
service characteristics examined, only condom distribution was associated with
receiving HIV/STI test results, whereas several individual characteristics were
independently associated including living in the same city where treatment
centers are; being single; not having heard of AIDS; and not having been
previously HIV tested.
CONCLUSIONS: It is urgent to expand HIV/STI testing in health services
which provide care for patients with potentially increased vulnerability to
these conditions, and to promote better integration between mental health
and health services.
DESCRIPTORS: Mentally Ill Persons. Acquired Immunodefi ciency
Syndrome, prevention & control. AIDS Serodiagnosis. Psychiatry.
Mental Health Services. Sex Counseling. Cross-Sectional Studies.
Rev Saúde Pública 2012;46(2):290-9
Having access to testing for HIV and sexually trans-
mitted infections (STI) to promote early treatment and
prevention is an urgent priority in reducing the rate of
new infections.2 In the specifi c population of psychiatric
patients, the prevalence of STI is high in comparison
with the general population.14 For instance, in Brazil
the rates of HIV/STI among psychiatric patients are
1.1% for syphilis; 0.8% for HIV; 1.6% for HBsAg;
14.7% for anti-HBc; and 2.6% for anti-HCV.9 A strong
argument has been made that all patients, especially
psychiatric patients, who have one STI should be
screened for the others.7 However, psychiatric patients
may encounter barriers to medical services due to lack
of social support, transportation diffi culties, psychotic
symptoms and providers’ lack of training or experi-
ence to support psychiatric patients that have HIV/STI
risk behavior.6,15,17 These barriers represent substantial
missed opportunities for STI prevention and treatment.
In a review study, Senn & Carey16 (2009) reported that
rates of lifetime HIV testing ranged from 11% to 89%
in different populations of psychiatric patients.
Even with recent public health emphasis on expan-
sion of HIV testing, many of those tested do not learn
OBJETIVO: Analisar fatores associados ao recebimento de resultados de
exames sorológicos para HIV e outras infecções sexualmente transmissíveis
(IST) entre pacientes psiquiátricos.
MÉTODOS: Estudo de corte transversal multicêntrico nacional de 2.080
participantes selecionados aleatoriamente dentre 26 instituições de saúde
mental brasileiras em 2007. O efeito do indivíduo (nível 1) e dos serviços de
saúde mental (nível 2) no recebimento dos resultados dos exames foi avaliado
utilizando-se regressão logística multinível.
RESULTADOS: A proporção de retorno dos resultados de exames HIV/IST foi
de 79,6%. Entre as características individuais, houve associação do desfecho
com: viver na mesma cidade onde se encontravam os serviços, ser solteiro, não
ter ouvido falar sobre aids e não ter sido previamente testado para HIV. Entre
as características dos serviços de saúde, apenas distribuição de preservativos
esteve associada ao recebimento dos resultados de exames.
CONCLUSÕES: É urgente promover melhor integração entre os serviços
de saúde, além de expandir a oferta de exame anti-HIV e outras IST, em
especial em serviços de atenção a pacientes psiquiátricos potencialmente mais
vulneráveis a essas condições.
DESCRITORES: Síndrome de Imunodefi ciência Adquirida, prevenção
& controle. Sorodiagnóstico da AIDS. Psiquiatria. Serviços de Saúde
Mental. Aconselhamento Sexual. Estudos Transversais.
a Centers for Disease Control and Prevention. HIV counseling and testing at CDC-supported sites-United States,1999-2004. Atlanta: US
Department of Health and Human Services; 2006 [cited 2011 Oct 09]. Available from: http://www.cdc.gov/hiv/topics/testing/resources/
their test results. The Centers for Disease Control and
Prevention (CDC) reports that from 1999 through
2004 a median of 72.2% of the U.S. general popula-
tion received their HIV test results,a i.e., 27.8% did
not. By contrast, 10% more of the general population
in Brazil or 37.7% of HIV-positive patients tested at
public testing centers did not return for the result of
their serological anti-HIV or confi rmatory tests in 2003,
and in 2004 that rate had changed very little to 36.0%.5
Until now, there have been few studies about the
psychiatric population receiving HIV/STI test results,
and none in a representative national sample. Two U.S.
studies, one among a homeless psychiatric population
and the second one among males with severe mental
illness (SMI), showed rates of 89% to 96% of people,
respectively, returning for their results.3,4 It is not clear
whether these small cross-sectional studies from the
same geographic region are representative of rates of
receipt of test results among psychiatric patients else-
where, particularly in Brazil where no studies of psychi-
atric population testing rates have been conducted and
where the general population rates appear to lag behind
those in the U.S.
Rev Saúde Pública 2012;46(2):290-9
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Research funded by the Brazilian National STD/AIDS Program, Brazilian Ministry of Health (fi nancial Support: UNESCO/
DST-AIDS 914/BRA/1101 – Project 086/05). Dr. Guimarães was granted a Visiting Scholar Fellowship from CAPES (Brazilian
Graduate Coordination, Brazilian Ministry of Education).
Article based on the doctoral thesis by Melo APS, presented to the Graduate Program in Public Health, Universidade Federal
de Minas Gerais, in 2010.
The authors declare no confl icts of interests.