Skip to main content

Advertisement

SpringerLink
Log in

HIV Prevalence Among Hospitalized Patients at the Main Psychiatric Referral Hospital in Botswana

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

We examined HIV prevalence among patients 18–49 year olds admitted to a psychiatric hospital in Botswana in 2011 and 2012. The retrospective study analyzed females (F) and males (M) separately, comparing proportions with Chi square test and continuous variables with Wilcoxon rank-sum test, assessing significance at the 5% level. HIV seroprevalence among hospitalized psychiatric patients was much more common among females (53%) compared with males (19%) (p < 0.001). These women also appeared more vulnerable to infection compared with females in the general population (29%) (p < 0.017). Among both women and men, HIV-infection appeared most common among patients with organic mental disorders (F:68%, M:41%) and neurotic, stress related and somatoform disorders (F:68%, M:42%). The largest proportion of HIV infections co-occurred among patients diagnosed with schizophrenia, schizotypal and other psychotic disorders (F:48%; M:55%), mood (affective) disorders (F:21%; M:16%) and neurotic, stress-related and somatoform disorders (F:16%; M:20%). Interventions addressing both mental health and HIV among women and men require development.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. UNAIDS. HIV and AIDS estimates. 2015.

  2. De Korte D, Mazonde P, Darkoh E. Perspectives and practice in antiretroviral treatment. Introducing ARV therapy in the public sector in Botswana. Case study. Geneva: World Health Organization; 2004.

  3. Botswana Ministry of Health. Botswana national HIV & AIDS treatment guidelines. Gaborone, Botswana: Ministry of Health; 2012.

    Google Scholar 

  4. Botswana Ministry of Health. Handbook of the Botswana 2016 integrated HIV clinical care guidelines. Botswana: Ministry of Health; 2016.

    Google Scholar 

  5. Blank MB, Mandell DS, Aiken L, Hadley TR. Co-occurrence of HIV and serious mental illness among medicaid recipients. Psychiatr Serv. 2002;53(7):868–73.

    Article  PubMed  Google Scholar 

  6. Walkup J, Crystal S, Sambamoorthi U. Schizophrenia and major affective disorder among Medicaid recipients with HIV/AIDS in New Jersey. Am J Public Health. 1999;89(7):1101–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Himelhoch S, McCarthy JF, Ganoczy D, Medoff D, Dixon LB, Blow FC. Understanding associations between serious mental illness and HIV among patients in the VA health system. Psychiatr Serv. 2007;58(9):1165–72.

    Article  PubMed  Google Scholar 

  8. Perkins DO, Stern RA, Golden RN, Murphy C, Naftolowitz D, Evans DL. Mood disorders in HIV infection: prevalence and risk factors in a nonepicenter of the AIDS epidemic. Am J Psychiatry. 1994;151(2):233–6.

    Article  CAS  PubMed  Google Scholar 

  9. Morrison MF, Petitto JM, Ten Have T, et al. Depressive and anxiety disorders in women with HIV infection. Am J Psychiatry. 2002;159(5):789–96.

    Article  PubMed  Google Scholar 

  10. Brown GR, Rundell JR, McManis SE, Kendall SN, Zachary R, Temoshok L. Prevalence of psychiatric disorders in early stages of HIV infection. Psychosom Med. 1992;54(5):588–601.

    Article  CAS  PubMed  Google Scholar 

  11. Williams JW, Rabkin JG, Remien RH, Gorman JM, Ehrhardt AA. Multidisciplinary baseline assessment of homosexual men with and without human immunodeficiency virus infection. II. Standardized clinical assessment of current and lifetime psychopathology. Arch Gen Psychiatry. 1991;48(2):124–30.

    Article  CAS  PubMed  Google Scholar 

  12. Rosenberger PH, Bornstein RA, Nasrallah HA, et al. Psychopathology in human immunodeficiency virus infection: lifetime and current assessment. Compr Psychiatry. 1993;34(3):150–8.

    Article  CAS  PubMed  Google Scholar 

  13. Shrier LA, Harris SK, Sternberg M, Beardslee WR. Associations of depression, self-esteem, and substance use with sexual risk among adolescents. Prev Med. 2001;33(3):179–89.

    Article  CAS  PubMed  Google Scholar 

  14. Nduna M, Jewkes RK, Dunkle KL, Shai NP, Colman I. Associations between depressive symptoms, sexual behaviour and relationship characteristics: a prospective cohort study of young women and men in the Eastern Cape, South Africa. J Int AIDS Soc. 2010;13:44.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Perretta P, Akiskal HS, Nisita C, et al. The high prevalence of bipolar II and associated cyclothymic and hyperthymic temperaments in HIV-patients. J Affect Disord. 1998;50(2–3):215–24.

    Article  CAS  PubMed  Google Scholar 

  16. Ayuso-Mateos JL, Montanes F, Lastra I, Picazo de la Garza J, Ayuso-Gutierrez JL. HIV infection in psychiatric patients: an unlinked anonymous study. Br J Psychiatry. 1997;170:181–5.

    Article  CAS  PubMed  Google Scholar 

  17. Cournos F, Empfield M, Horwath E, et al. HIV seroprevalence among patients admitted to two psychiatric hospitals. Am J Psychiatry. 1991;148(9):1225–30.

    Article  CAS  PubMed  Google Scholar 

  18. Lundberg P, Nakasujja N, Musisi S, Thorson AE, Cantor-Graae E, Allebeck P. HIV prevalence in persons with severe mental illness in Uganda: a cross-sectional hospital-based study. Int J Ment Health Syst. 2013;7:20.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Maling S, Todd J, Van der Paal L, Grosskurth H, Kinyanda E. HIV-1 seroprevalence and risk factors for HIV infection among first-time psychiatric admissions in Uganda. AIDS Care. 2011;23(2):171–8.

    Article  PubMed  Google Scholar 

  20. Collins PY, Berkman A, Mestry K, Pillai A. HIV prevalence among men and women admitted to a South African public psychiatric hospital. AIDS Care. 2009;21(7):863–7.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Acuda SW, Sebit MB. Serostatus surveillance testing of HIV-I infection among Zimbabwean psychiatric inpatients, in Zimbabwe. Cent Afr J Med. 1996;42(9):254–7.

    CAS  PubMed  Google Scholar 

  22. UNAIDS. Prevention gap report. Geneva: UNAIDS; 2016. http://www.unaids.org/sites/default/files/media_asset/2016-prevention-gap-report_en.pdf. Accessed 28 Aug 2016.

  23. Statistics Botswana/National AIDS Coordinating Authority (NACA). Preliminary results. Botswana AIDS impact survey IV (BAIS IV). Stats Brief No. 2013/28. Statistics Botswana: Gaborone; 2013.

  24. Nicolosi AA. The efficiency of male-to-female and female-to-male sexual transmission of the human immunodeficiency virus: a study of 730 stable couples. Italian Study Group on HIV heterosexual transmission. Epidemiology. 1994;5(6):570–5.

    Article  CAS  PubMed  Google Scholar 

  25. Andersson N, Cockcroft A. Choice-disability and HIV infection: a cross sectional study of HIV status in Botswana, Namibia and Swaziland. AIDS Behav. 2012;16(1):189–98.

    Article  PubMed  Google Scholar 

  26. Kalmuss D. Nonvolitional sex and sexual health. Arch Sex Behav. 2004;33(3):197–209.

    Article  PubMed  Google Scholar 

  27. Ramjee G, Daniels B. Women and HIV in Sub-Saharan Africa. AIDS Res Ther. 2013;10:30.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Mabala R. From HIV prevention to HIV protection: addressing the vulnerability of girls and young women in urban areas. Environ Urban. 2006;18(2):407–32.

    Article  Google Scholar 

  29. Griesbeck M, Scully E, Altfeld M. Sex and gender differences in HIV-1 infection. Clin Sci (Lond). 2016;130(16):1435–51.

    Article  CAS  PubMed  Google Scholar 

  30. Magadi MA. Understanding the gender disparity in HIV infection across countries in sub-Saharan Africa: evidence from the demographic and health surveys. Sociol Health Illn. 2011;33(4):522–39.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Republic of Botswana. Progress report of the National Response to the 2011 declaration of commitments on HIV and AIDS. Reporting period: 2014. Gaborone, Botswana: National AIDS Coordinating Agency; 2014.

    Google Scholar 

  32. Seloilwe ESE. Community mental health care in Botswana: approaches and opportunities. Int Nurs Rev. 2007;54(2):173–8.

    Article  CAS  PubMed  Google Scholar 

  33. Kenyon K. Routine HIV testing: a view from Botswana. Health Hum Rights. 2005;8(2):21–3.

    Article  PubMed  Google Scholar 

  34. Botswana Ministry of Health. Botswana national HIV/AIDS treatment guidelines: 2008 version. Department of HIV/AIDS Prevention and Care. Gaborone, Botswana; 2008. http://www.moh.gov.bw/Publications/HIVAIDS%20TREATMENT%20GUIDELINES.pdf. Accessed 12 Jun 2016.

  35. Elwert F. Chapter 13. Graphical causal models. In Morgan, SL (ed). Handbook of causal analysis for social research. Handbook of sociology and social research. Dordrecht, Netherlands: Springer Science + Business Media, 2013. doi:10.1007/978-94-007-6094-3_13. http://www.ssc.wisc.edu/soc/faculty/pages/docs/elwert/Elwert%202013.pdf.

  36. Cole SR, Platt RW, Schisterman EF, et al. Illustrating bias due to conditioning on a collider. Int J Epidemiol. 2010;39(2):417–20.

    Article  PubMed  Google Scholar 

  37. Shahar E, Shahar DJ. Causal diagrams and the cross-sectional study. Clin Epidemiol. 2013;5:57–65.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Shrier I, Platt RW. Reducing bias through directed acyclic graphs. BMC Med Res Methodol. 2008;8:70.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Textor J, Hardt J, Knuppel S. DAGitty: a graphical tool for analyzing causal diagrams. Epidemiology. 2011;22(5):745.

    Article  PubMed  Google Scholar 

  40. Langen TT. Gender power imbalance on women’s capacity to negotiate self-protection against HIV/AIDS in Botswana and South Africa. Afr Health Sci. 2005;5(3):188–97.

    PubMed  PubMed Central  Google Scholar 

  41. Weiser SD, Leiter K, Bangsberg DR, et al. Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland. PLoS Med. 2007;4(10):1589–97; discussion 98.

    Article  PubMed  Google Scholar 

  42. Ho-Foster A, Laetsang D, Masisi M, et al. Gender-specific patterns of multiple concurrent sexual partnerships: a national cross sectional survey in Botswana. AIDS Care. 2010;22(8):1006–11.

    Article  PubMed  Google Scholar 

  43. Multiprocessor STATA (for Windows) [computer program]. Version 13.1. College Station, TX: StataCorp; 2013.

  44. Multiple Imputation in Stata. The University of Wisconsin - Madison: Social Science Computing Cooperative. 2012. https://www.ssc.wisc.edu/sscc/pubs/stata_mi_intro.htm.

  45. White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30(4):377–99.

    Article  PubMed  Google Scholar 

  46. Blank MB, Himelhoch SS, Balaji AB, et al. A multisite study of the prevalence of HIV with rapid testing in mental health settings. Am J Public Health. 2014;104(12):2377–84.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Wu ES, Rothbard A, Blank MB. Using psychiatric symptomatology to assess risk for HIV infection in individuals with severe mental illness. Commun Ment Health J. 2011;47(6):672–8.

    Article  Google Scholar 

  48. Leech NK. Personal communication, Deputy Superintendent, Sbrana Psychiatric Hospital; 2016.

  49. Blume J, Douglas SD, Evans DL. Immune suppression and immune activation in depression. Brain Behav Immun. 2011;25(2):221–9.

    Article  CAS  PubMed  Google Scholar 

  50. Leserman J, Petitto JM, Perkins DO, Folds JD, Golden RN, Evans DL. Severe stress, depressive symptoms, and changes in lymphocyte subsets in human immunodeficiency virus-infected men. A 2-year follow-up study. Arch Gen Psychiatry. 1997;54(3):279–85.

    Article  CAS  PubMed  Google Scholar 

  51. Evans DL, Ten Have TR, Douglas SD, et al. Association of depression with viral load, CD8 T lymphocytes, and natural killer cells in women with HIV infection. Am J Psychiatry. 2002;159(10):1752–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study would not have been possible without the support of Veronica Moswang (SPH Medical Records) and Ontiretse Sickboy. The authors acknowledge the support of several NIH-funded programs: funding and core services support from the Penn Mental Health AIDS Research Centre (P30MH097488), and additional support from the Penn Center for AIDS Research (P30AI045008).

Author information

Author notes

  1. Philip R. Opondo and Ari R. Ho-Foster contributed equally to the study and manuscript.

Authors and Affiliations

  1. Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana

    Philip R. Opondo, James Ayugi, Bechedza Hatitchki & Margo Pumar

  2. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Philip R. Opondo, Warren B. Bilker, Michael E. Thase, John B. Jemmott III, Michael B. Blank & Dwight L. Evans

  3. Botswana-UPenn Partnership, P.O. Box AC 157 ACH, Gaborone, Botswana

    Ari R. Ho-Foster, Margo Pumar, John B. Jemmott III & Michael B. Blank

  4. Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Ari R. Ho-Foster & Dwight L. Evans

  5. Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Warren B. Bilker

  6. Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA

    John B. Jemmott III

  7. Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Dwight L. Evans

Authors
  1. Philip R. Opondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ari R. Ho-Foster
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James Ayugi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bechedza Hatitchki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Margo Pumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Warren B. Bilker
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael E. Thase
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. John B. Jemmott III
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michael B. Blank
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Dwight L. Evans
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ari R. Ho-Foster.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Opondo, P.R., Ho-Foster, A.R., Ayugi, J. et al. HIV Prevalence Among Hospitalized Patients at the Main Psychiatric Referral Hospital in Botswana. AIDS Behav 22, 1503–1516 (2018). https://doi.org/10.1007/s10461-017-1878-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-017-1878-3

Keywords

Search

Navigation