HIV seroprevalence and risk behaviors in psychiatric inpatients

doi:10.1016/0165-1781(91)90080-9

Psychiatry Research

Volume 39, Issue 2, November 1991, Pages 109-114

https://doi.org/10.1016/0165-1781(91)90080-9 Get rights and content

Abstract

The seroprevalence of the human immunodeficiency virus (HIV) in 515 patients consecutively admitted to a state psychiatric hospital in New York City was 8.9%. There were 365 patients whose results were individually traceable; the remaining 150 patients were tested anonymously. Risk factors including parenteral drug abuse, male homosexual behaviors, and other sexual behaviors were studied in the traceable patients. Logistic regressions indicated that parenteral drug abuse was the main risk factor in both males and females. In females, two additional factors were significant: sex with parenteral drug users or with partners who have the acquired immunodeficiency syndrome (AIDS), and sex with bisexual men. Females with bipolar disorders were particularly likely to report sex with parenteral drug users or with partners who have AIDS.

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Cited by (75)

Hypersexuality and couple relationships in bipolar disorder: A review
2016, Journal of Affective Disorders
Citation Excerpt :
These findings are of particular interest as they are consistent with the earlier studies (Allison and Wilson, 1960; Clayton et al., 1963; Carlson and Goodwin, 1973). Specifically, bipolar women were likely to engage in sex with intravenous drug users and with partners who had AIDS (Volavka et al., 1991). They were also more likely to be forced into sex by a partner or to be raped (Özcan et al., 2014).
Although change in sexual behavior is recognized as an integral part of bipolar disorder, most of the relevant literature on sexual issues in patients with this illness concerns medication side effects and does not differentiate bipolar disorder from other serious mental disorders. Surprisingly, little has been published on mania-induced hypersexuality and the effects of mood cycling on couple relationships. In this review, we examine the extant literature on both of these subjects and propose a framework for future research.
A search of PsycINFO and PubMed was conducted using keywords pertaining to bipolar disorder, hypersexuality and couple relationships. A total of 27 articles were selected for review.
Despite lack of uniformity in diagnosis of bipolar disorder and no formal definition of hypersexuality, the literature points to an increased incidence of risky sexual behaviors in bipolar patients during manic episodes compared to patients with other psychiatric diagnoses. Further, it appears that bipolar patients are more similar to healthy controls than to other psychiatric patients when it comes to establishing and maintaining couple relationships. Nonetheless, the studies that examined sexuality in couples with one bipolar partner found decreased levels of sexual satisfaction associated with the diagnosis, varying levels of sexual interest across polarities, increased incidence of sexual dysfunction during depressive episodes, and disparate levels of satisfaction in general between patients and their partners.
Due to changes in diagnostic criteria over time, there is a lack of uniformity in the definition of bipolar disorder across studies. Hypersexuality is not systematically defined and therefore the construct was not consistent across studies. Some of the older articles date back more than 30 years, making them subject to the biases of sexual and gender norms that have since become outdated. Finally, the heterogeneity of the samples, which include patients with comorbid substance use as well as inpatient, outpatient, symptomatic and euthymic patients, may limit the generalizability of results.
Although bipolar patients experience disease-specific sexual problems of mania-induced hypersexuality and specific effects of mood cycling on couple relationships, the existing literature is mostly outdated and lacks a consistent definition of hypersexuality. Novel research is needed to address sexual symptomatology in bipolar disorder within the context of current sexual, cultural and gender norms.
Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness: A systematic review and meta-analysis
2016, The Lancet Psychiatry
Citation Excerpt :
However, serious mental illness might not be an isolated risk factor for blood-borne virus infection, but might be better thought of as a potentially confounded association with poor socioeconomic background, drug and alcohol misuse, sex, and ethnic origin. Three USA studies18,21,26 included odds ratios adjusted for risk factors and showed that they significantly increased the risk of HIV and other blood-borne viral infections. However, these studies were done in settings where dual diagnosis of substance misuse and mental illness is very common.
Although people with serious mental illnesses have a high risk of contracting blood-borne viral infections, sexual health has largely been neglected by researchers and policy makers involved in mental health. Failure to address this shortcoming could increase morbidity and mortality as a result of undetected and untreated infection. We did a systematic review and meta-analysis to estimate the prevalence of blood-borne viral infection in people with serious mental illness.
We searched the Cochrane Library, Medline, Embase, PsycInfo, CINAHL, and DARE for studies of the prevalence of HIV, hepatitis B virus, and hepatitis C virus in people with serious mental illness, published between Jan 1, 1980, and Jan 1, 2015. We group prevalence data by region and by virus and estimated pooled prevalence. We did a sensitivity analysis of the effect of study quality on prevalence.
After removal of duplicates, we found 373 abstracts, 91 of which met our eligibility criteria. The prevalences of blood-borne viral infections in people with serious mental illness were higher than in the general population in places with low prevalence of blood-borne viruses, such as the USA and Europe, and on par with the general population in regions with high prevalence of blood-borne viruses (Africa for HIV and southeast Asia for hepatitis B virus and hepatitis C virus). Pooled prevalence of HIV in people with serious mental illness in the USA was 6·0% (95% CI 4·3–8·3). Sensitivity analysis showed that quality scores did not significantly affect prevalence.
People with serious mental illness are at risk of blood-borne viral infections. However, because of methodological limitations of the studies the prevalence might be overestimated. Serious mental illness is unlikely to be a sole risk factor and risk of blood-borne viral infection is probably multifactorial and associated with low socioeconomic status, drug and alcohol misuse, ethnic origin, and sex. Health providers should routinely discuss sexual health and risks for blood-borne viruses (including risks related to drug misuse) with people who have serious mental illness, as well as offering testing and treatment for those at risk.
Wellcome Trust.
HIV issues and people with disabilities: A review and agenda for research
2013, Social Science and Medicine
Citation Excerpt :
Studies with people with disabilities or staff and key informants report relatively high rates of unsafe sex and other risk behaviours including substance use, transactional sex, and reported incidence of previous sexually transmitted diseases (Blanchett, 2000; Brown, Kessel, Lourie, Ford, & Lipsitt, 1997; Cambridge, 1996; Carey, Carey, & Kalichman, 1997; Carey et al., 1999; Carey, Carey, Maisto, Gordon, & Vanable, 2001; Carey, Carey, Maisto, Schroder, et al., 2004; Chandra et al., 2003; Chopra et al., 1998; Choquet, Du Pasquier Fediaevsky, & Manfredi, 1997; Chuang & Atkinson, 1996; Collins, Elkington, et al., 2008; Collins, von Unger, & Armbrister, 2008; Davidson et al., 2001; Devieux et al., 2007; Gordon et al., 1999; Grassi, Pavanati, et al., 1999; Grassi, Peron, Ferri, & Pavanati, 1999; Kalichman, Kelly, Johnson, & Bulto, 1994; Katz et al., 1994; Kelly et al., 1992, 1995; Maart & Jelsma, 2010; Meade & Sikkema, 2005, 2007; Menon & Pomerantz, 1997; Menon et al., 1994; Myer et al., 2009; Ogunsemi et al., 2006; Olaleye, Anoemuah, Ladipo, Delano, & Idowu, 2007; Otto-Salaj et al., 1998; Randolph et al., 2009; Rohleder, 2010; Rosenberg, Goodman, et al., 2001; Rosenberg, Trumbetta, et al., 2001; Smit et al., 2006; Susser et al., 1995; Thompson, 1994; Touko, Mboua, Tohmuntain, & Perrot, 2010; Vanable, Carey, Carey, & Maisto, 2007; Walkup, Sambamoorthi, & Crystal, 1999; Weinhardt, Carey, & Carey, 1998). Substance use (alcohol and drug) was found to be a risk factor, particularly for people with mental health problems, which increased the risk for unsafe sex and HIV infection (Brown et al., 1997; Carey et al., 1999, 2001; Cournos et al., 1991; Davidson et al., 2001; Devieux et al., 2007; Empfield et al., 1993; Essock et al., 2003; Grassi, Pavanati, et al., 1999; Grassi, Peron, et al., 1999; Hoff, Beam-Goulet, & Rosenheck, 1997; Kalichman et al., 1994; Kelly et al., 1992, 1995; Loue, Sajatovic, & Mendez, 2011; Meade, 2006; Menon & Pomerantz, 1997; Otto-Salaj et al., 1998; Rosenberg, Goodman, et al., 2001; Rosenberg, Trumbetta, et al., 2001; Stewart, Zuckerman, & Ingle, 1994; Susser et al., 1995; Volavka et al., 1991; Weinhardt et al., 1998; Weinhardt, Carey, Carey, Maisto, & Gordon, 2001). Two studies found that HIV risk behaviours are associated with severity of mental health disability (Heaphy, Loue, Sajatovic, & Tisch, 2010; Rosenberg, Drake, Brunette, Wolford, & Marsh, 2005), although a third study did not find any significant associations with different mental health disabilities (Collins, Berkman, Mestry, & Pillai, 2009).
The recent AIDS and Disability Partners Forum at the UN General Assembly High Level Meetings on AIDS in New York in June 2011 and the International AIDS Conference in Washington, DC in July 2012 underscores the growing attention to the impact of HIV and AIDS on persons with disabilities. However, research on AIDS and disability, particularly a solid evidence base upon which to build policy and programming remains thin, scattered and difficult to access. In this review paper, we summarise what is currently known about the intersection between HIV and AIDS and disability, paying particular attention to the small but emerging body of epidemiology data on the prevalence of HIV for people with disabilities, as well as the increasing understanding of HIV risk factors for people with disabilities. We find that the number of papers in the peer-reviewed literature remains distressingly small. Over the past 20 years an average of 5 articles on some aspect of disability and HIV and AIDS were published annually in the peer-reviewed literature from 1990 to 2000, increasing slightly to an average of 6 per year from 2000 to 2010. Given the vast amount of research around HIV and AIDS and the thousands of articles on the subject published in the peer-reviewed literature annually, the continuing lack of attention to HIV and AIDS among this at risk population, now estimated to make up 15% of the world's population, is striking. However, the statistics, while too limited at this point to make definitive conclusions, increasingly suggest at least an equal HIV prevalence rate for people with disabilities as for their non-disabled peers.
Psychiatric barriers and the international AIDS epidemic
2012, Sande's HIV/AIDS Medicine: Medical Management of AIDS 2013
Receipt of preventive medical care and medical screening for patients with mental illness: A comparative analysis
2010, General Hospital Psychiatry
Citation Excerpt :
Among those with mental illness, there is higher than expected mortality rate and higher rates of medical comorbidity compared with the general population [4]. People diagnosed with psychiatric illness also carry a higher rate of background risk factors including obesity, dyslipidemia, hypertension, cigarette smoking, physical inactivity and HIV risk behaviors [5–7]. Surveys suggest that psychiatric patients consider their receipt of primary care to be lower than the general population [8] and there is evidence to support this belief [9,10].
There has been long-standing concern about the delivery of preventive and screening services to patients with mental illness.
We aimed to examine whether the quality of preventive care received by patients with mental health conditions differs from that received by individuals who have no comparable mental disorder. Our hypothesis was that patients with mental illness would be in receipt of lower quality or lower frequency of preventive care.
Studies that examined the quality of care in those with and without comorbid mental illness were reviewed and comparative data extracted. By using only comparative studies we hope to ascertain whether inequalities in care existed by virtue of psychiatric diagnoses (or closely affiliated factors).
We identified 26 studies that examined preventive care in individuals with vs. without psychiatric illness. From these eligible studies, 61 comparisons were documented across 13 health care domains. These included mammography, cervical smears, vaccinations, cholesterol screening, lifestyle counseling, colonoscopy. Twenty-seven comparisons revealed inferior preventive health care in those with mental illness, but 10 suggested superior preventive health care and 24 reached inconclusive findings. Inferior preventive care was most apparent in those with schizophrenia and in relation to osteoporosis screening, blood pressure monitoring, vaccinations, mammography and cholesterol monitoring.
We conclude there is strong evidence to suggest that the quality of preventive and screening services received by patients with mental illness is often lower, but occasionally superior to that received by individuals who have no comparable mental disorder. More work must be done to improve the quality of medical and preventive care for individuals with mental illness.
Chronic Mental Illness
2008, Massachusetts General Hospital Comprehensive Clinical Psychiatry

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^∗: Drs. Volavka, Douyon, Ventura, and Ms. O'Donnell work at the Manhattan Psychiatric Center in New York City, where all the patients were seen.

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HIV seroprevalence and risk behaviors in psychiatric inpatients

Abstract

DSM-III-R: Diagnostic and Statistical Manual of Mental Disorders

HIV/AIDS Surveillance Report

HIV seroprevalence among admissions at two psychiatric hospitals

American Journal of Psychiatry

Patients at risk for HIV

Hospital & Community Psychiatry

Prevalence of human immunodeficiency virus and hepatitis B in unselected hospital admissions: Implications for mandatory testing and universal precautions

Journal of Infectious Diseases

Prevalence of HIV infection among intravenous drug users in the United States

Journal of the American Medical Association