HIV Testing in Psychiatric Patients in Brazil

Sexual and reproductive health needs of women with severe mental illness in low- and middle-income countries: A scoping review

BACKGROUND

This scoping review aimed to understand the extent and type of evidence in relation to sexual and reproductive health needs of women with severe mental illness (SMI) in low- and middle-income countries (LMIC) and to summarise those needs.

METHODS

Inclusion criteria were 1) focus on sexual and reproductive health needs 2) women or girls with SMI, professionals, caregivers of women with SMI and community members 3) study set in a LMIC 4) peer reviewed literature (no restriction on study date or design). Studies were identified from comprehensive searches of Medline, EMBASE, CINAHL and PsycINFO (to July 2023).

RESULTS

The review included 100 papers. Most studies were cross-sectional and set in hospital outpatient departments. Only 20 of 140 LMIC countries were included in this review and only 15 studies were set-in low-income countries (LIC). Included studies often had multiple focus areas and were grouped by frequency of topic into categories of HIV (prevalence, risk behaviour and knowledge), other sexually transmitted infections (STIs), sexual function, contraception use and family planning, sexual violence, fertility, pregnancy and postpartum. Included studies indicated women with SMI have worse outcomes and worse sexual and reproductive health compared to both women without SMI and men with SMI. Women with SMI were shown to have higher rates of HIV and low levels of contraception knowledge and use, with little advice offered by professionals.

CONCLUSIONS

This review highlights the need for a greater diversity of study methodology, robustness of ethical and consensual reporting when researching vulnerable populations and for further research on interventions and models of care aimed at addressing stigma, discrimination and improving the sexual and reproductive health of women with SMI. Future research should better represent the breadth of LMIC, investigate cultural adaptability of interventions and consider sexual health needs across the life course.

Risk behaviors for sexually transmitted infections in noninjecting drug users: A cross-sectional study

The objective of this study was to investigate risk behaviors for sexually transmitted infections (STIs) in noninjecting drug users (NIDUs), using STI diagnosis history as an indicator. A cross-sectional study was conducted in 323 NIDUs of two facilities for alcohol and/or drug dependence treatment in the Goiás State, Central Brazil. All participants were interviewed about risk behaviors and STI history. Multivariable analysis was performed in order to identify predictors of STIs. Adjusted prevalence ratio (APR) with confidence intervals of 95% was obtained using a Poisson regression model. Prevalence of self-reported STIs in the previous 12 months was 25.4% (95% confidence interval [95% CI]: 21.0-30.4%). A multivariable model verified that age (APR: 1.01; 95% CI: 1.00-1.01), sexual contact with partners diagnosed with STIs (APR: 1.27; 95% CI: 1.12-1.45) and injecting drug users (IDUs) (APR: 1.14; 95% CI: 1.14; 95% CI: 1.01-1.31), exchange sex for money and/or drugs (APR: 1.12; 95% CI: 1.02-1.21), and a history of sexual violence (APR: 1.04; 95% CI: 1.04-1.32) were predictors of STIs. Elevated rates of STI history and risk behaviors were observed in NIDUs, supporting the vulnerability of this group for these infections. Public policies and health outreach should be intensified in this population, principally regular STI testing of individuals in treatment for drug dependence and their sexual partners.

HIV Testing in Non-Injection Drug Users: Prevalence and Associated Factors

The objective of this study was to estimate the prevalence of and identify factors associated with lifetime testing for the human immunodeficiency virus (HIV) in non-injection drug users (NIDU). A cross-sectional study was conducted with 323 individuals in clinics for chemical dependency in the state of Goiás in the Central-West region of Brazil. Logistic regression analysis was used to identify factors associated with lifetime HIV testing. Testing for HIV was associated with age, female gender, crack use, history of sexually transmitted infections, acquaintance with people living with HIV/AIDS and/or who had died from AIDS, and history of having received some instruction on HIV/AIDS prevention methods. It was found that only 26.6% reported having access to the HIV rapid test. We concluded determinants for HIV testing must be taken into account when planning prevention and programming strategies. These include the widening of testing coverage among NIDU, educational health actions, establishment of links between sexually transmitted infection prevention services and addiction treatment services, and the use of rapid tests to help people who are in contact with the virus learn about their HIV status, enter treatment, and improve their quality of life.

Which Psychological Factors are Related to HIV Testing? A Quantitative Systematic Review of Global Studies

Deciding to test for HIV is necessary for receiving HIV treatment and care among those who are HIV-positive. This article presents a systematic review of quantitative studies on relationships between psychological (cognitive and affective) variables and HIV testing. Sixty two studies were included (fifty six cross sectional). Most measured lifetime testing. HIV knowledge, risk perception and stigma were the most commonly measured psychological variables. Meta-analysis was carried out on the relationships between HIV knowledge and testing, and HIV risk perception and testing. Both relationships were positive and significant, representing small effects (HIV knowledge, d = 0.22, 95 % CI 0.14-0.31, p < 0.001; HIV risk perception, OR 1.47, 95 % CI 1.26-1.67, p < 0.001). Other variables with a majority of studies showing a relationship with HIV testing included: perceived testing benefits, testing fear, perceived behavioural control/self-efficacy, knowledge of testing sites, prejudiced attitudes towards people living with HIV, and knowing someone with HIV. Research and practice implications are outlined.

What leads some people to think they are HIV-positive before knowing their diagnosis? A systematic review of psychological and behavioural correlates of HIV-risk perception

Current HIV-risk perception refers to the extent to which individuals think they might be HIV-positive. This belief, distinct from the perceived risk about being infected with HIV in the future, is likely to have a range of important consequences. These consequences may include both psychological effects (e.g., impacts on well-being) and behavioural effects (e.g., HIV testing uptake). Given these possible outcomes, and the suggested importance of risk perception in health behaviour models, understanding the behavioural and psychological antecedents of current HIV-risk perception is crucial. This systematic review investigates the relationship between behavioural and psychological factors and current HIV-risk perception (in individuals who are unaware of their actual HIV status). Eight studies were eligible for inclusion in the review (five quantitative and three qualitative studies). Drug risk behaviour and sexual risk behaviour (both self and partner) were often associated with current HIV-risk perception, although other studies failed to show a relationship between one's own sexual risk behaviour and risk perception. Psychological factors were only rarely assessed in relation to current HIV-risk perception. Where these variables were included, there was evidence that experiencing symptoms perceived to be consistent with HIV and prompts to test were associated with increased current HIV-risk perception. These findings are consistent with the Common-Sense Model (CSM) of illness representation and self-regulation. Methodological quality criteria were rarely met for the included studies. In addition, it was often difficult to ascertain whether potentially includable studies were eligible due to imprecise definitions of HIV-risk perception. Research and practice implications are discussed, with particular emphasis on the role of risk appraisals as a potential mediator of the relationship between HIV-risk behaviour, symptoms and current HIV-risk perception.

Undertreatment of human immunodeficiency virus in psychiatric inpatients: a cross-sectional study of seroprevalence and associated factors

BACKGROUND

The aims of this study were to evaluate the prevalence of HIV and its associated demographic and clinical factors among psychiatric inpatients of a general hospital.

METHODS

This was a single-center, observational, cross-sectional study that included patients consecutively admitted to our unit aged 16 years or older and with no relevant cognitive problems. The patients were evaluated using a semistructured interview and an appropriate test for HIV infection.

RESULTS

Of the 637 patients who were screened, 546 (86%) who consented to participate were included in the analyses. Twenty-five (4.6%, 95% confidence interval [CI] 3.0-6.8) patients were HIV-positive. The prevalence was higher among patients with substance misuse (17.4%, 95% CI 9.7-28.8). All except one of the 25 patients knew of their seropositive condition prior to participation in the study. Only 14 (56%) of the 25 seropositive patients had previously received pharmacological treatment for their infection. According to the multiple logistic regression analysis, the likelihood of HIV infection was lower in patients with higher levels of education and higher among patients who were single, had history of intravenous drug use, and had an HIV-positive partner, particularly if they did not use condoms. Among the patients with HIV infection, 18 (72%) had a history of suicide attempts compared with 181 (34.7%) of the patients without HIV infection (relative risk 2.1, 95% CI 1.6-2.7; P<0.001).

CONCLUSION

HIV infection is highly prevalent in patients admitted to a psychiatric unit, especially those with a diagnosis of substance misuse. Seropositive patients show very poor treatment adherence. The risk of suicide seems to be very high in this population. Implementing interventions to reduce the suicide risk and improve adherence to antiretroviral therapy and psychotropic medications seems crucial.

Correlates of HIV infection among patients with mental illness in Brazil

People living with mental illness are at increased risk for HIV. There are scarce data on correlates and prevalence of HIV infection, and none with a nationally representative sample. We report on correlates of HIV infection from a cross-sectional national sample of adults receiving care in 26 publicly funded mental health treatment settings throughout Brazil. Weighted prevalence rate ratios were obtained using multiple log-binomial regression modeling. History of homelessness, ever having an STD, early age of first sexual intercourse before 18 years old, having suffered sexual violence, previous HIV testing, self-perception of high risk of HIV infection and not knowing one's risk were statistically associated with HIV infection. Our study found an elevated HIV seroprevalence and correlates of infection were not found to include psychiatric diagnoses or hospitalizations but instead reflected marginalized living circumstances and HIV testing history. These adverse life circumstances (history of homelessness, having suffered sexual violence, reporting a sexually transmitted disease, and early sexual debut) may not be unique to people living with mental illness but nonetheless the mental health care system can serve as an important point of entry for HIV prevention in this population.

Psychiatric patients' return for HIV/STI test results in mental health centers

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.