Risk factors for HIV/AIDS and hepatitis C among the chronic mentally ill

OBJECTIVE: The objective of this study was to document the prevalence of risk factors for HIV/AIDS and hepatitis C among people with chronic mental illness treated in a community setting. METHOD: 234 patients attending four community mental health clinics in the North-western Health Care Network in Melbourne, Australia, completed an interviewer-administered questionnaire which covered demographics, risk behaviour and psychiatric diagnosis. RESULTS: The sample was 58% male, and 79% of the sample had a primary diagnosis of schizophrenia. Forty-three per cent of mentally ill men and 51% of mentally ill women in the survey had been sexually active in the 12 months preceding the survey. One-fifth of mentally ill men and 57% of mentally ill women who had sex with casual partners never used condoms. People with mental illness were eight times more likely than the general population to have ever injected illicit drugs and the mentally ill had a lifetime prevalence of sharing needles of 7.4%. CONCLUSIONS: The prevalence of risk behaviours among the study group indicate that people with chronic mental illness should be regarded as a high-risk group for HIV/AIDS and hepatitis C. It is essential that adequate resources and strategies are targeted to the mentally ill as they are for other high-risk groups.     

HIV risk behavior in the chronically mentally ill

Patients with chronic mental illnesses including schizophrenia and bipolar disorder constitute an important risk group for AIDS. Although limited by a lack of control groups, study findings indicate that an important minority of patients report having multiple sexual partners, use alcohol or drugs preceding sexual intercourse, report a history of intravenous drug use, are coerced into unwanted sexual activity, experience homosexual or heterosexual anal intercourse, and fail to use condoms consistently, if at all. Furthermore, chronically and variably impaired autonomy may add to patients’ vulnerability. In this context the author makes recommendations for limiting chronic mental patients’ risk for AIDS that include techniques for reliably assessing individual risk. Preventive clinical interventions include treating variable impairment of autonomy, communication and behavioral skills training targeted to skills deficits while augmented by educational strategies, and outreach to the partners of at-risk patients. Preventive services should also be integrated and coordinated with sexually transmitted disease clinics, substance abuse treatment programs, and family planning programs.     

AIDS risk and prevention for the chronic mentally ill

Some chronic mentally ill populations are at high risk for infection with human immunodeficiency virus. The authors argue that stereotypes of the mentally ill as asexual or neutered have had dangerous consequences, namely the absence of sex education and AIDS prevention as an integral part of treatment. To counter this neglect, the authors developed an AIDS prevention program in a large inner-city mental health center that serves primarily black and Latino patients. Prevention efforts include individual risk assessments and an innovative drop-in group. Central to effective patient education are the distribution of condoms and concrete instruction in their use.     

AIDS knowledge and high risk behaviors in the chronic mentally ill

Chronic mentally ill adults are a high risk group for AIDS. In the present study, we used a questionnaire to assess AIDS knowledge, attitudes, and risk behaviors in 54 men and women who were clients at a drop in center for mentally ill adults. Most of the subjects were suffering from schizophrenia and about one-third of them had co-existing drug problems. Results showed widespread misunderstandings about AIDS transmission, high risk groups, and practices. Many of the subjects had been treated for STDs such as syphilis and gonorrhea and were engaging in behaviors that increased their vulnerability to AIDS. These include casual sex, anal sex, sex with an IV drug user, or sex in exchange for money, drugs, or a place to sleep. Subjects expressed a moderately high level of concern about acquiring AIDS/HIV, and 15% of those tested (5/33) said they already had the illness. We observed a significant correlation between misinformation about AIDS and the frequency of high risk behaviors. We also detected ambivalence about using condoms and IV drugs. Although males and females did not differ in AIDS knowledge or risk behaviors, the AIDS knowledge of both groups was significantly lower than a comparison sample of public high school students. Taken together, the results underscore the immediate need for comprehensive AIDS assessment, education, and prevention in this segment of the population.     

Substance abuse among the chronic mentally ill

Substance abuse was examined in a group of 187 chronic mentally ill patients living in the community. According to ratings by aftercare clinicians, approximately onethird of the sample abused alcohol, street drugs, or both during the six months before evaluation. Patients who were dually diagnosed with substance abuse and mental illness differed from those with mental illness alone in several respects: they were younger and more often male; were less able to manage their lives in the community in terms of maintaining regular meals, adequate finances, stable housing, and regular activities; showed greater hostility, suicidality, and speech disorganization; and had poorer medication compliance. In addition, they were nearly twice as likely to be rehospitalized during one-year follow-up. Substance abuse, appeared to add the problems of disruptive, disinhibited, noncompliant behaviors to chronic mental illness.     

Group intervention to reduce HIV transmission risk behavior among persons living with HIV/AIDS

Results of a randomized controlled trial show that a behavioral intervention grounded in social cognitive theory reduces unprotected sexual behaviors among men and women living with HIV infection, with the greatest reductions in HIV transmission risk behaviors occurring with non-HIV-positive sex partners. In this article, the authors describe the intervention development and intervention content of the social cognitive risk reduction intervention for HIV-positive persons. The effective five group session intervention focused on enhancing motivation through self-reflection and developing coping efficacy skills for HIV disclosure decision making, active listening, assertiveness, and problem solving for disclosure and transmission risk reduction behaviors. Intervention components were tailored for gender and sexual orientation and integrated skills practice sessions used role-plays couched within scenes from popular films. This intervention was demonstrated to be effective in a community-service delivery setting and can be adapted for implementation in HIV-related services delivered within support groups.     

An HIV/AIDS risk-reduction program for mentally ill hospital patients: assessing readiness for change

This study evaluated the effectiveness of an HIV/AIDS cognitive-behavioral skills-training program in promoting readiness for behavior change among a sample of psychiatric inpatients. Significant differences were found in the domain of precontemplation for women patients, in domain of contemplation for patients diagnosed with a psychotic disorder, and in the domain of action for men and for patients with a mood disorder. In all areas, difference scores reflected an improvement between pre- and posttest levels.     

Therapeutic stereotypes among the mentally ill

Using mathematical models described by Overall, the authors investigated in a sample of 301 psychiatric inpatients the therapeutic stereotypes in medicating psychotropic drugs and its dependence on symptom, syndrome and diagnostic level. The psychotropic drugs were described in a dimensional representation of psychopathology ('symptomatic space'). Besides dependencey from patient's characteristics as age and clinician's characteristics as special orientation, the therapeutic stereotype is mostly influenced by the symptom level. Only lithium therapy and electroconvulsive therapy are keyed to diagnosis. Getting more familiar with a psychotropic drug increases indications and contraindications on symptom level, the therapeutic stereotype gets more differentiated. The comparison between the therapeutic stereotypes of German and French psychiatrists shows a satisfactory congruence relating to dimensionality and relationships among the drugs.     

Pathways to homelessness among the mentally ill

  Background: Persons with mental illness are over-represented among the homeless relative to the general population, and mental illness is most likely one of many vulnerabilities that confer risk for homelessness. Method: This paper elucidates the pathways to homelessness for persons with mental illness by comparing and contrasting groups of mentally ill homeless persons, non-mentally ill homeless persons, and housed mentally ill persons drawn from RAND's Course of Homelessness (COH) study and the Epidemiological Catchment Area (ECA) survey. Results: Homeless persons share childhood histories of economic and social disadvantage. The mentally ill homeless appear to have a “double dose” of disadvantage: poverty with the addition of childhood family instability and violence. Among the mentally ill homeless, those who became homeless prior to becoming mentally ill have the highest levels of disadvantage and disruption; while those who become homeless after becoming ill have an especially high prevalence of alcohol dependence. Conclusions: Mental illness may play a role in initiating homelessness for some, but is unlikely in and of itself to be a sufficient risk factor for homelessness. In addition to outreach and treatment programs for adult mentally ill homeless persons, emphasis should be placed on interventions with children and on addressing more pervasive causes of homelessness. Accepted: 14 June 2000     

Evaluating prosthetic technology for the chronic mentally ill

As treatment and rehabilitative approaches evolve, mental health administrators face an increasing number of choices in developing supportive service delivery systems for chronic patients. This paper reintroduces and elaborates upon the concept of prosthetic technology to provide administrators with a tool to aid their program selection decisions. A method is described for evaluating the prosthetic efficacy of program interventions.