HIV Risk Behavior among Outpatients at a State Psychiatric Hospital: Prevalence and Risk Modeling

The purpose of this archival study was to determine the prevalence and correlates of HIV-related risk behavior among adults with a severe and persistent mental illness (SPMI). Hospital records at a public psychiatric hospital were reviewed to obtain data on demographic and psychiatric characteristics, sexual behavior, and substance use. Data were available from 889 (73%) of 1214 eligible outpatients. Of these 889 patients, 49% were sexually active, 52% used alcohol, and 18% used street drugs during the past year. Eleven percent were at high risk for HIV infection: 7% reported having 3 or more sexual partners, 3% had been infected with an STD, 3% had traded sex, and fewer than 1% had shared injection equipment. HIV-risk status was modeled with logistic regression using diagnosis, type of residence, drug and alcohol use, and demographic variables; five- and six-predictor models were derived for two HIV-risk indicators. A bootstrap simulation supported the reliability of each model. We conclude that approximately one-half of adults living with a SPMI are sexually active, and a minority engages in behaviors that increase risk of HIV infection. Routine screening for HIV risk in psychiatric settings can identify patients who may benefit from risk reduction programs.