Prevalence and correlates of sexual activity and HIV-related risk behavior among psychiatric outpatients.

This study investigates the prevalence and correlates of sexual activity and HIV-risk behavior among adults with a mental disorder.Demographic, psychiatric, sexual behavior, and substance use data were available for 1558 outpatients.During the past year, 69% were sexually active and 23% engaged in risky behavior.Risk markers included multiple sexual partners (19%), a sexually transmitted disease (4%), sex trading (3%), injection drug use (1%), and needle sharing (< 1%).Being sexually active and being at risk for HIV infection were associated with alcohol and drug use, psychiatric diagnoses other than schizophrenia, and younger age.Married patients were more likely to be sexually active but less likely to engage in risk behavior.Screening for HIV risk in psychiatric settings can identify patients who may benefit from risk reduction programs.Elevated HIV seroprevalence rates among persons living with a mental disorder have been well-documented.For example, Ayuso-Mateos et al. (1997) reported that 20 of 390 psychiatric inpatients (5.1%) tested positive for HIV.Comprehensive reviews of the published literature indicate that seroprevalence rates among the psychiatric patients have ranged from 4% to 23% (Carey, Weinhardt, & Carey, 1995;Cournos & McKinnon, 1997).The HIV infection rates far exceed the 0.3% rate estimated for the general population (McQuillan, Khare, Karon, Schable, & Vlahov, 1997), and suggest a high prevalence of risk behavior among psychiatric patients.Research to determine the prevalence of HIV-related risk behaviors among psychiatric patients has revealed that one-half to three-quarters of all patients report that they have been sexually active in the last year with approximately one-third reporting multiple sexual partners (Carey, Carey, & Kalichman, 1997).Among those who were sexually active, condom use was inconsistent.As many as one-third of all patients also reported a history of injection drug use.Overall, the data indicate that the severely mentally ill engage regularly in practices known to involve increased risk for HIV transmission.Confidence in the representativeness of data from these risk behavior studies is reduced, however, by limitations such as the use of small convenience samples or by the fact that many of the larger studies have been completed in New York City, an AIDS epicenter that is not representative of most US cities (Centers for Disease Control and Prevention, 1997).Confidence in the inferences drawn from these data are also limited because of the tendency to rely upon univariate analyses, which did not adjust for relationships among predictor variables.We recently reported the results of a study that sought to overcome the limitations of prior research (Carey et al., 1999).Hospital records at a public psychiatric hospital were reviewed to obtain data from 889 outpatients, including demographic, psychiatric, sexual behavior, and