Dual Taboos: Sexuality and Women with Severe Mental Illness in South Africa. Perceptions of Mental Health Care Providers

The AIDS epidemic in South Africa is among the fastest growing in the world. While much of the population is at risk for infection, marginalized groups such as women with severe mental illness (SMI) are often neglected in prevention efforts. A qualitative study of mental health care providers' perceptions of HIV risk and sexuality among women with SMI was conducted in four provinces of South Africa. Semistructured qualitative interviews explored providers' views on the impact of mental illness on sexuality and reproductive health for women with SMI. Providers described their perceptions of the role of psychiatric symptoms in sexual behavior, the kinds of sexual behavior engaged in, and the quality of sexual relationships for women with SMI. Providers prioritized family planning and prevention of pregnancy for women with SMI over HIV prevention. The findings suggest that mental health care providers' ambivalence about sexual expression in women with SMI may be a barrier to complete care as well as effective HIV prevention for this population.