HIV Risk Behavior Among Psychiatric Outpatients: Association With Psychiatric Disorder, Substance Use Disorder, and Gender

People living with a mental illness are disproportionately vulnerable to human immunodeficiency virus. The current study sought to examine the influence of psychiatric disorder, substance use disorder, and gender on risky sexual behavior in this vulnerable population. Participants were 228 female and 202 male outpatients (66% mood disorder, 34% schizophrenia), each of whom took part in a Structured Clinical Interview for the DSM-IV and a comprehensive assessment of sexual risk behavior. Univariate and multivariate analyses tested a priori hypotheses. The results indicated that risk behavior was more frequent among patients diagnosed with a mood disorder (compared with those diagnosed with schizophrenia) or a substance use disorder (compared with those without a comorbid disorder) or both. We recommend routine human immunodeficiency virus risk screening and risk reduction programs for this vulnerable population.

[1]  Kerstin E. E. Schroder,et al.  Reducing HIV-risk behavior among adults receiving outpatient psychiatric treatment: results from a randomized controlled trial. , 2004, Journal of consulting and clinical psychology.

[2]  L. Y. Stevenson,et al.  Patterns, Predictors and Gender Differences in HIV Risk Among Severely Mentally Ill Men and Women , 1998, Community Mental Health Journal.

[3]  R. Hoffmann,et al.  Outcomes of a Randomized Small-Group HIV Prevention Intervention Trial for People with Serious Mental Illness , 2001, Community Mental Health Journal.

[4]  Baruch Fischhoff,et al.  Adolescent alcohol decisions. , 1991 .

[5]  K. Carey,et al.  Understanding HIV-related risk among persons with a severe and persistent mental illness: insights from qualitative inquiry. , 1999, The Journal of nervous and mental disease.

[6]  J. Wixted,et al.  An Analysis of Social Competence in Schizophrenia , 1990, British Journal of Psychiatry.

[7]  R. Dworkin,et al.  Positive and negative symptoms and social competence in adolescents at risk for schizophrenia and affective disorder. , 1990, The American journal of psychiatry.

[8]  K. Carey,et al.  HIV Risk Behavior among Outpatients at a State Psychiatric Hospital: Prevalence and Risk Modeling. , 1999, Behavior therapy.

[9]  L. Dixon,et al.  Defining subgroups of dual diagnosis patients for service planning. , 1994, Hospital & community psychiatry.

[10]  Mary V. Seeman,et al.  Social Skills Training for Schizophrenia: A Step-by-Step Guide , 1997 .

[11]  D. Ostrow,et al.  Methodological Issues in HIV Behavioral Interventions , 2000 .

[12]  K. Carey,et al.  Risk for human immunodeficiency virus (HIV) infection among persons with severe mental illnesses. , 1997, Clinical psychology review.

[13]  S. Kalichman,et al.  Factors associated with risk for HIV infection among chronic mentally ill adults. , 1994, The American journal of psychiatry.

[14]  K. Carey,et al.  PREVALENCE OF INFECTION WITH HIV AMONG THE SERIOUSLY MENTALLY ILL: REVIEW OF RESEARCH AND IMPLICATIONS FOR PRACTICE , 1995 .

[15]  K. Carey,et al.  The feasibility of enhancing psychiatric outpatients' readiness to change their substance use. , 2002, Psychiatric services.

[16]  C. Steele,et al.  Alcohol myopia. Its prized and dangerous effects. , 1990, The American psychologist.

[17]  P. J. Schroder Sexual Dysfunction: A Guide for Assessment and Treatment , 1993 .

[18]  K. Fromme,et al.  Intoxicated sexual risk taking: an expectancy or cognitive impairment explanation? , 1999, Journal of studies on alcohol.

[19]  E. Hudes,et al.  Predictors of HIV-related risk behaviors among heterosexuals in alcoholism treatment. , 1996, Journal of studies on alcohol.

[20]  K. Carey,et al.  Prevalence and correlates of sexual activity and HIV-related risk behavior among psychiatric outpatients. , 2001, Journal of consulting and clinical psychology.

[21]  M. Carey,et al.  Reliability and Validity of Self-Report Measures of HIV-Related Sexual Behavior: Progress Since 1990 and Recommendations for Research and Practice , 1998, Archives of sexual behavior.

[22]  K. Carey,et al.  Behavioral Risk for HIV Infection Among Adults with a Severe and Persistent Mental Illness: Patterns and Psychological Antecedents , 1997, Community Mental Health Journal.

[23]  M. Carey,et al.  Does Alcohol Lead to Sexual Risk Behavior? Findings from Event-Level Research , 2000, Annual review of sex research.

[24]  E. Susser,et al.  Sexual behavior of homeless mentally ill men at risk for HIV. , 1995, The American journal of psychiatry.

[25]  E. Susser,et al.  Human immunodeficiency virus sexual risk reduction in homeless men with mental illness. , 1998, Archives of General Psychiatry.

[26]  S. Kalichman,et al.  Behavioral research in HIV/AIDS primary and secondary prevention: recent advances and future directions. , 2002, Journal of consulting and clinical psychology.

[27]  K. Carey,et al.  Reliability of the Timeline Follow-Back sexual behavior interview , 1998, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[28]  S. Kalichman,et al.  Use of a brief behavioral skills intervention to prevent HIV infection among chronic mentally ill adults. , 1995, Psychiatric services.

[29]  M. Carey,et al.  Sexual coercion among women living with a severe and persistent mental illness: Review of the literature and recommendations for mental health providers , 1999 .

[30]  S. Kalichman,et al.  Substance-abusing adolescents at varying levels of HIV risk: psychosocial characteristics, drug use, and sexual behavior. , 2001, Journal of substance abuse.

[31]  K. Carey,et al.  Assessing sexual risk behaviour with the Timeline Followback (TLFB) approach: continued development and psychometric evaluation with psychiatric outpatients , 2001, International journal of STD & AIDS.

[32]  M. L. Cooper,et al.  Alcohol use, condom use and partner type among heterosexual adolescents and young adults. , 2000, Journal of studies on alcohol.

[33]  V. Sadock The Social Organization of Sexuality: Sexual Practices in the United States , 1995 .

[34]  R. Collins,et al.  The role of women's alcohol consumption in evaluation of vulnerability to sexual aggression. , 2000, Experimental and clinical psychopharmacology.

[35]  Kerstin E. E. Schroder,et al.  Methodological challenges in research on sexual risk behavior: I. Item content, scaling, and data analytical options , 2003, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[36]  The relation of alcohol use to HIV-risk sexual behavior among adults with a severe and persistent mental illness. , 2001, Journal of consulting and clinical psychology.

[37]  K. Mckinnon,et al.  A Lifetime Alcohol or Other Drug Use Disorder and Specific Psychiatric Symptoms Predict Sexual Risk for HIV Infection Among People With Severe Mental Illness , 2001, AIDS and Behavior.

[38]  S. Schinke,et al.  Building skills of recovering women drug users to reduce heterosexual AIDS transmission. , 1991, Public health reports.

[39]  Michelle P. Salyers,et al.  Recent Victimization in Women and Men with Severe Mental Illness: Prevalence and Correlates , 2001, Journal of traumatic stress.

[40]  David R. Holtgrave,et al.  NIMH/APPC workgroup on behavioral and biological outcomes in HIV/STD prevention studies: a position statement. , 2000, Sexually transmitted diseases.

[41]  S. Kalichman,et al.  Sensation seeking as an explanation for the association between substance use and HIV-related risky sexual behavior , 1996, Archives of sexual behavior.

[42]  Michelle P. Salyers,et al.  Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness. , 2001, American journal of public health.