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Risk behavior among patients with chronic mental illness in a national multicenter study in Brazil: gender differences
Presented by Mark D C Guimarães, Brazil.
M.D.C. Guimarães1, M. Wainberg2, L.N. Campos1, A.P. Souto Melo1, K. Mckinnon2, Pessoas Project Network Group
1Federal University of Minas Gerais, Belo Horizonte, Brazil, 2HIV Center for Clinical and Behavioral Studies, New York, United States
Background: Patients with chronic mental illness (CMI) are known to be at increased risk for STD/HIV infection. There are scarce national representative data on risk behavior worldwide among CMI. Our objective was to compare gender differences and determine factors associated with unsafe sex in a national representative sample of CMI patients in Brazil.
Methods: Two-stage sample of adults with CMI randomly selected from 26 mental health institutions throughout Brazil. Socio-demographic and sexual behavior data were obtained from face-to-face interviews. Unsafe sex was defined as not using condoms always or most times.
Results: Among 2475 participants 51% were women, 54% were 40+ years old, and 65% practiced unsafe sex. As compared to men, women practiced more unsafe sex (62% and 70%), were married (24% and 42%), and had more depression diagnosis (7% and 20%), respectively. Women also reported more frequent sexual violence (7%) caused by intimate partners (32%), at home (48%) and during adulthood (46%). Low schooling, history of homelessness, STD or incarceration, 10+ sexual partners ever, and illicit drug or alcohol use, were more common among men. For both, men and women, age (40+ years old), being married, history of STD or incarceration, frequent sexual violence, and depression diagnosis were associated with unsafe sex, while HIV testing, low HIV/AIDS knowledge, and low schooling were associated with unsafe sex among women only. History of homelessness, frequent physical violence, reasonable perception of HIV risk, injecting drug and alcohol use, and sexual violence during adolescent were associated with unsafe sex among men only.
Conclusions: This national representative study highlights that CMI patients are at increased risk to STD/HIV infection, especially women. Severe psychiatric diagnosis, substance use and history of violence are factors that potentially increase vulnerability. This is of public health concern and prevention strategies among CMI should urgently be implemented by health authorities.
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