Advertisement

AIDS and Behavior

, Volume 22, Issue 5, pp 1503–1516 | Cite as

HIV Prevalence Among Hospitalized Patients at the Main Psychiatric Referral Hospital in Botswana

  • Philip R. Opondo
  • Ari R. Ho-Foster
  • James Ayugi
  • Bechedza Hatitchki
  • Margo Pumar
  • Warren B. Bilker
  • Michael E. Thase
  • John B. JemmottIII
  • Michael B. Blank
  • Dwight L. Evans
Original Paper

Abstract

We examined HIV prevalence among patients 18–49 year olds admitted to a psychiatric hospital in Botswana in 2011 and 2012. The retrospective study analyzed females (F) and males (M) separately, comparing proportions with Chi square test and continuous variables with Wilcoxon rank-sum test, assessing significance at the 5% level. HIV seroprevalence among hospitalized psychiatric patients was much more common among females (53%) compared with males (19%) (p < 0.001). These women also appeared more vulnerable to infection compared with females in the general population (29%) (p < 0.017). Among both women and men, HIV-infection appeared most common among patients with organic mental disorders (F:68%, M:41%) and neurotic, stress related and somatoform disorders (F:68%, M:42%). The largest proportion of HIV infections co-occurred among patients diagnosed with schizophrenia, schizotypal and other psychotic disorders (F:48%; M:55%), mood (affective) disorders (F:21%; M:16%) and neurotic, stress-related and somatoform disorders (F:16%; M:20%). Interventions addressing both mental health and HIV among women and men require development.

Keywords

HIV/AIDS Mental health Psychiatry Hospitalized Gender 

Notes

Acknowledgements

This study would not have been possible without the support of Veronica Moswang (SPH Medical Records) and Ontiretse Sickboy. The authors acknowledge the support of several NIH-funded programs: funding and core services support from the Penn Mental Health AIDS Research Centre (P30MH097488), and additional support from the Penn Center for AIDS Research (P30AI045008).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

References

  1. 1.
    UNAIDS. HIV and AIDS estimates. 2015.Google Scholar
  2. 2.
    De Korte D, Mazonde P, Darkoh E. Perspectives and practice in antiretroviral treatment. Introducing ARV therapy in the public sector in Botswana. Case study. Geneva: World Health Organization; 2004.Google Scholar
  3. 3.
    Botswana Ministry of Health. Botswana national HIV & AIDS treatment guidelines. Gaborone, Botswana: Ministry of Health; 2012.Google Scholar
  4. 4.
    Botswana Ministry of Health. Handbook of the Botswana 2016 integrated HIV clinical care guidelines. Botswana: Ministry of Health; 2016.Google Scholar
  5. 5.
    Blank MB, Mandell DS, Aiken L, Hadley TR. Co-occurrence of HIV and serious mental illness among medicaid recipients. Psychiatr Serv. 2002;53(7):868–73.CrossRefPubMedGoogle Scholar
  6. 6.
    Walkup J, Crystal S, Sambamoorthi U. Schizophrenia and major affective disorder among Medicaid recipients with HIV/AIDS in New Jersey. Am J Public Health. 1999;89(7):1101–3.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Himelhoch S, McCarthy JF, Ganoczy D, Medoff D, Dixon LB, Blow FC. Understanding associations between serious mental illness and HIV among patients in the VA health system. Psychiatr Serv. 2007;58(9):1165–72.CrossRefPubMedGoogle Scholar
  8. 8.
    Perkins DO, Stern RA, Golden RN, Murphy C, Naftolowitz D, Evans DL. Mood disorders in HIV infection: prevalence and risk factors in a nonepicenter of the AIDS epidemic. Am J Psychiatry. 1994;151(2):233–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Morrison MF, Petitto JM, Ten Have T, et al. Depressive and anxiety disorders in women with HIV infection. Am J Psychiatry. 2002;159(5):789–96.CrossRefPubMedGoogle Scholar
  10. 10.
    Brown GR, Rundell JR, McManis SE, Kendall SN, Zachary R, Temoshok L. Prevalence of psychiatric disorders in early stages of HIV infection. Psychosom Med. 1992;54(5):588–601.CrossRefPubMedGoogle Scholar
  11. 11.
    Williams JW, Rabkin JG, Remien RH, Gorman JM, Ehrhardt AA. Multidisciplinary baseline assessment of homosexual men with and without human immunodeficiency virus infection. II. Standardized clinical assessment of current and lifetime psychopathology. Arch Gen Psychiatry. 1991;48(2):124–30.CrossRefPubMedGoogle Scholar
  12. 12.
    Rosenberger PH, Bornstein RA, Nasrallah HA, et al. Psychopathology in human immunodeficiency virus infection: lifetime and current assessment. Compr Psychiatry. 1993;34(3):150–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Shrier LA, Harris SK, Sternberg M, Beardslee WR. Associations of depression, self-esteem, and substance use with sexual risk among adolescents. Prev Med. 2001;33(3):179–89.CrossRefPubMedGoogle Scholar
  14. 14.
    Nduna M, Jewkes RK, Dunkle KL, Shai NP, Colman I. Associations between depressive symptoms, sexual behaviour and relationship characteristics: a prospective cohort study of young women and men in the Eastern Cape, South Africa. J Int AIDS Soc. 2010;13:44.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Perretta P, Akiskal HS, Nisita C, et al. The high prevalence of bipolar II and associated cyclothymic and hyperthymic temperaments in HIV-patients. J Affect Disord. 1998;50(2–3):215–24.CrossRefPubMedGoogle Scholar
  16. 16.
    Ayuso-Mateos JL, Montanes F, Lastra I, Picazo de la Garza J, Ayuso-Gutierrez JL. HIV infection in psychiatric patients: an unlinked anonymous study. Br J Psychiatry. 1997;170:181–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Cournos F, Empfield M, Horwath E, et al. HIV seroprevalence among patients admitted to two psychiatric hospitals. Am J Psychiatry. 1991;148(9):1225–30.CrossRefPubMedGoogle Scholar
  18. 18.
    Lundberg P, Nakasujja N, Musisi S, Thorson AE, Cantor-Graae E, Allebeck P. HIV prevalence in persons with severe mental illness in Uganda: a cross-sectional hospital-based study. Int J Ment Health Syst. 2013;7:20.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Maling S, Todd J, Van der Paal L, Grosskurth H, Kinyanda E. HIV-1 seroprevalence and risk factors for HIV infection among first-time psychiatric admissions in Uganda. AIDS Care. 2011;23(2):171–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Collins PY, Berkman A, Mestry K, Pillai A. HIV prevalence among men and women admitted to a South African public psychiatric hospital. AIDS Care. 2009;21(7):863–7.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Acuda SW, Sebit MB. Serostatus surveillance testing of HIV-I infection among Zimbabwean psychiatric inpatients, in Zimbabwe. Cent Afr J Med. 1996;42(9):254–7.PubMedGoogle Scholar
  22. 22.
    UNAIDS. Prevention gap report. Geneva: UNAIDS; 2016. http://www.unaids.org/sites/default/files/media_asset/2016-prevention-gap-report_en.pdf. Accessed 28 Aug 2016.
  23. 23.
    Statistics Botswana/National AIDS Coordinating Authority (NACA). Preliminary results. Botswana AIDS impact survey IV (BAIS IV). Stats Brief No. 2013/28. Statistics Botswana: Gaborone; 2013.Google Scholar
  24. 24.
    Nicolosi AA. The efficiency of male-to-female and female-to-male sexual transmission of the human immunodeficiency virus: a study of 730 stable couples. Italian Study Group on HIV heterosexual transmission. Epidemiology. 1994;5(6):570–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Andersson N, Cockcroft A. Choice-disability and HIV infection: a cross sectional study of HIV status in Botswana, Namibia and Swaziland. AIDS Behav. 2012;16(1):189–98.CrossRefPubMedGoogle Scholar
  26. 26.
    Kalmuss D. Nonvolitional sex and sexual health. Arch Sex Behav. 2004;33(3):197–209.CrossRefPubMedGoogle Scholar
  27. 27.
    Ramjee G, Daniels B. Women and HIV in Sub-Saharan Africa. AIDS Res Ther. 2013;10:30.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Mabala R. From HIV prevention to HIV protection: addressing the vulnerability of girls and young women in urban areas. Environ Urban. 2006;18(2):407–32.CrossRefGoogle Scholar
  29. 29.
    Griesbeck M, Scully E, Altfeld M. Sex and gender differences in HIV-1 infection. Clin Sci (Lond). 2016;130(16):1435–51.CrossRefPubMedGoogle Scholar
  30. 30.
    Magadi MA. Understanding the gender disparity in HIV infection across countries in sub-Saharan Africa: evidence from the demographic and health surveys. Sociol Health Illn. 2011;33(4):522–39.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Republic of Botswana. Progress report of the National Response to the 2011 declaration of commitments on HIV and AIDS. Reporting period: 2014. Gaborone, Botswana: National AIDS Coordinating Agency; 2014.Google Scholar
  32. 32.
    Seloilwe ESE. Community mental health care in Botswana: approaches and opportunities. Int Nurs Rev. 2007;54(2):173–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Kenyon K. Routine HIV testing: a view from Botswana. Health Hum Rights. 2005;8(2):21–3.CrossRefPubMedGoogle Scholar
  34. 34.
    Botswana Ministry of Health. Botswana national HIV/AIDS treatment guidelines: 2008 version. Department of HIV/AIDS Prevention and Care. Gaborone, Botswana; 2008. http://www.moh.gov.bw/Publications/HIVAIDS%20TREATMENT%20GUIDELINES.pdf. Accessed 12 Jun 2016.
  35. 35.
    Elwert F. Chapter 13. Graphical causal models. In Morgan, SL (ed). Handbook of causal analysis for social research. Handbook of sociology and social research. Dordrecht, Netherlands: Springer Science + Business Media, 2013. doi: 10.1007/978-94-007-6094-3_13. http://www.ssc.wisc.edu/soc/faculty/pages/docs/elwert/Elwert%202013.pdf.
  36. 36.
    Cole SR, Platt RW, Schisterman EF, et al. Illustrating bias due to conditioning on a collider. Int J Epidemiol. 2010;39(2):417–20.CrossRefPubMedGoogle Scholar
  37. 37.
    Shahar E, Shahar DJ. Causal diagrams and the cross-sectional study. Clin Epidemiol. 2013;5:57–65.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Shrier I, Platt RW. Reducing bias through directed acyclic graphs. BMC Med Res Methodol. 2008;8:70.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Textor J, Hardt J, Knuppel S. DAGitty: a graphical tool for analyzing causal diagrams. Epidemiology. 2011;22(5):745.CrossRefPubMedGoogle Scholar
  40. 40.
    Langen TT. Gender power imbalance on women’s capacity to negotiate self-protection against HIV/AIDS in Botswana and South Africa. Afr Health Sci. 2005;5(3):188–97.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Weiser SD, Leiter K, Bangsberg DR, et al. Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland. PLoS Med. 2007;4(10):1589–97; discussion 98.CrossRefPubMedGoogle Scholar
  42. 42.
    Ho-Foster A, Laetsang D, Masisi M, et al. Gender-specific patterns of multiple concurrent sexual partnerships: a national cross sectional survey in Botswana. AIDS Care. 2010;22(8):1006–11.CrossRefPubMedGoogle Scholar
  43. 43.
    Multiprocessor STATA (for Windows) [computer program]. Version 13.1. College Station, TX: StataCorp; 2013.Google Scholar
  44. 44.
    Multiple Imputation in Stata. The University of Wisconsin - Madison: Social Science Computing Cooperative. 2012. https://www.ssc.wisc.edu/sscc/pubs/stata_mi_intro.htm.
  45. 45.
    White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30(4):377–99.CrossRefPubMedGoogle Scholar
  46. 46.
    Blank MB, Himelhoch SS, Balaji AB, et al. A multisite study of the prevalence of HIV with rapid testing in mental health settings. Am J Public Health. 2014;104(12):2377–84.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Wu ES, Rothbard A, Blank MB. Using psychiatric symptomatology to assess risk for HIV infection in individuals with severe mental illness. Commun Ment Health J. 2011;47(6):672–8.CrossRefGoogle Scholar
  48. 48.
    Leech NK. Personal communication, Deputy Superintendent, Sbrana Psychiatric Hospital; 2016.Google Scholar
  49. 49.
    Blume J, Douglas SD, Evans DL. Immune suppression and immune activation in depression. Brain Behav Immun. 2011;25(2):221–9.CrossRefPubMedGoogle Scholar
  50. 50.
    Leserman J, Petitto JM, Perkins DO, Folds JD, Golden RN, Evans DL. Severe stress, depressive symptoms, and changes in lymphocyte subsets in human immunodeficiency virus-infected men. A 2-year follow-up study. Arch Gen Psychiatry. 1997;54(3):279–85.CrossRefPubMedGoogle Scholar
  51. 51.
    Evans DL, Ten Have TR, Douglas SD, et al. Association of depression with viral load, CD8 T lymphocytes, and natural killer cells in women with HIV infection. Am J Psychiatry. 2002;159(10):1752–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Philip R. Opondo
    • 1
    • 2
  • Ari R. Ho-Foster
    • 3
    • 4
  • James Ayugi
    • 1
  • Bechedza Hatitchki
    • 1
  • Margo Pumar
    • 1
    • 3
  • Warren B. Bilker
    • 2
    • 5
  • Michael E. Thase
    • 2
  • John B. JemmottIII
    • 2
    • 3
    • 6
  • Michael B. Blank
    • 2
    • 3
  • Dwight L. Evans
    • 2
    • 4
    • 7
  1. 1.Department of Psychiatry, Faculty of MedicineUniversity of BotswanaGaboroneBotswana
  2. 2.Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Botswana-UPenn PartnershipGaboroneBotswana
  4. 4.Department of Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.Department of Biostatistics and Epidemiology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  6. 6.Annenberg School for CommunicationUniversity of PennsylvaniaPhiladelphiaUSA
  7. 7.Department of Neuroscience, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA

Personalised recommendations