Seroprevalence and HIV-associated factors among adults with severe mental illness – a vulnerable population

Abstract

Background: Adults with severe mental illness (SMI) have increased prevalence of HIV compared to the general population. Recommendations for provider initiated testing in South Africa lacks robust evidence because the studies mainly from low prevalence regions overestimate the risk of HIV among adults with SMI.
Objective: We aimed to assess if the mentally ill are a vulnerable population in South Africa.
Methods: All new admissions to an acute psychiatric ward from July to December 2000 were tested for HIV anonymously and this was linked to socio-demographic and clinical data. We did a restricted analysis of African females from a population based survey with the African females with SMI.
Results: There were 216 admissions and 206 were included in the analysis. The seroprevalence of HIV-1 was 29.1 % (CI 27.8-32.4); seroprevalence of HIV among women was 40%. The following predicted HIV positivity: Female [OR 3.5 (1.7-6.9)], infections of the chest or central nervous system [OR 3.2 (1.4-7.5)], age group 30-39 years [OR 2.3 (1.1-4.8)] and aggression on admission. There age and sex ratio among the SMI is similar to the general population. Adults with SMI have almost three time’s greater prevalence of HIV than the general population after controlling for age and gender.
Conclusions: Adults with SMI is a vulnerable population, thus provider initiated HIV testing and other prevention and treatment programs must be tailored to their needs.