Skip to main content
SpringerLink
Log in

HIV Risk Behaviors and Their Correlates Among HIV-Positive Adults with Serious Mental Illness

  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

HIV risk behaviors and their correlates were examined in a sample of 154 HIV-seropositive and seriously mentally ill adults (83% male, 56% sexually active). Most sexually active participants engaged in HIV risk behavior during the past 6 months, although the rates of these behaviors were generally not higher, and in some cases were lower, than those reported in studies of otherwise comparable noninfected people. Variables significantly associated with one or more HIV risk behaviors in bivariate analyses included being female, any limitation in instrumental functioning, not having a bipolar disorder, more psychotic mental health symptoms, problem drinking, and not receiving HIV counseling. The latter three variables accounted for 22% of the variance in the total number of HIV risk behaviors. Interventions to reduce risky sexual practices may be most appropriately provided through public mental health systems, given that this is the primary setting in which seriously mentally ill adults receive formal treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Bozzette, S. A., Berry, S. H., Duan, N., Frankel, M. R., Leibowitz, A. A., Lefkowitz, D., Emmons, C. A., Senterfitt, J. W., Berk, M. L., Morton, S. C., Shapiro, M. F., Andersen, R. M., Cunningham, W. E., Marcus, M., Wenger, N. S., Athey, L. A., Smith, S. M., Bing, E. G., Brown, J. A., Burnam, M. A., Goldman, D. P., Kanouse, D. E., Keesey, J. W., McCaffrey, D. F., Perlman, J. F., Schuster, M. A., Cleary, P. D., Fleishman, J. A., Hays, R. D., McCutchan, J. A., and Richman, D. (1998). The care of HIV-infected adults in the United States. New England Journal of Medicine, 339, 1897-1904.

    Google Scholar 

  • Brick, J. M., and Kalton, G. (1996). Handling missing data in survey research. Statistical Methods in Medical Research, 5, 215-238.

    Google Scholar 

  • Carey, M. P., Weinhardt, L. S., and Carey, K. B. (1995). Prevalence of infection with HIV among the seriously mentally ill: Review of research and implications for practice. Professional Psychology: Research and Practice, 26, 262-268.

    Google Scholar 

  • Carey, M. P., Carey, K. B., and Kalichman, S. C. (1997). Risk for human immunodeficiency virus (HIV) infection among adults with a severe mental disorder. Clinical Psychology Review, 17, 271-291.

    Google Scholar 

  • Carey, M. P., Carey, K. B., Maisto, S. A., Gleason, J. R., Gordon, C. M., and Brewer, K. K. (1999). HIV-risk behavior among outpatients at a state psychiatric hospital: Prevalence and risk modeling. Behavior Therapy, 30, 389-406.

    Google Scholar 

  • Carey, M. P., Carey, K. B., Maisto, S. A., Gordon, C. M., and Vanable, P. A. (2001). Prevalence and correlates of sexual activity and HIV-related risk behavior among psychiatric outpatients. Journal of Consulting and Clinical Psychology, 69, 846-850.

    Google Scholar 

  • Carmen, E., and Brady, S. M. (1990). AIDS risk and prevention for the chronic mentally ill. Hospital and Community Psychiatry, 41, 652-657.

    Google Scholar 

  • Cournos, F., and McKinnon, K. (1997). Substance use and HIV risk among people with severe mental illness. NIDA Research Monograph, 172, 110-129.

    Google Scholar 

  • Cournos, F., McKinnon, K., Meyer-Bahlburg, H. F. L., Guido, J. R., and Meyer, I. (1993). HIV risk activity among persons with severe mental illness: Preliminary findings. Hospital and Community Psychiatry, 44, 1104-1106.

    Google Scholar 

  • Cournos, F., Guido, J. R., Coomaraswamy, S., Meyer-Bahlburg, H., Sugden, R., and Horwath, E. (1994a). Sexual activity and risk of HIV infection among patients with schizophrenia. American Journal of Psychiatry, 151, 228-232.

    Google Scholar 

  • Cournos, F., Horwath, E., Guido, J. R., McKinnon, K., and Hopkins, N. (1994b). HIV-1 infection at two public hospitals in New York City. AIDS Care, 6, 443-452.

    Google Scholar 

  • Derogatis, L. R., Lipman, R. S., and Covi, L. (1973). The SCL-90: An outpatient psychiatric rating scale. Psychopharmacology Bulletin, 9, 13-28.

    Google Scholar 

  • Drake, R. E., and Wallach, M. A. (1989). Substance abuse among the chronic mentally ill. Hospital and Community Psychiatry, 40, 1041-1046.

    Google Scholar 

  • Gordon, C. M., Carey, M. P., Carey, K. B., Maisto, S. A., and Weinhardt, L. S. (1999). Understanding HIV-related risk among persons with a severe and persistent mental illness. Journal of Nervous and Mental Disease, 187, 208-216.

    Google Scholar 

  • Grassi, L., Pavanati, M., Cardelli, R., Ferri, S., and Peron, L. (1999). HIV-risk behaviour and knowledge about HIV/AIDS among patients with schizophrenia. Psychological Medicine, 29, 171-179.

    Google Scholar 

  • Hanson, M., Kramer, T. H., Gross, W., Quintana, J., Ping-Wu, L., and Asher, R. (1992). AIDS awareness and risk behaviors among dually disordered adults. AIDS Education and Prevention, 4, 41-51.

    Google Scholar 

  • Heckman, T. G., Kelly, J. A., and Somlai, A. M. (1998). Predictors of continued high-risk sexual behavior in a community sample of persons living with HIV/AIDS. AIDS and Behavior, 2, 127-135.

    Google Scholar 

  • Holmberg, S. D. (1996). The estimated prevalence and incidence of HIV in 96 large US metropolitan areas. American Journal of Public Health, 86, 642-654.

    Google Scholar 

  • Horwath, E., Cournos, F., McKinnon, K., Guido, J. R., and Herman, R. (1996). Illicit-drug injection among psychiatric patients without a primary substance use disorder. Psychiatric Services, 47, 181-185.

    Google Scholar 

  • Kalichman, S. C., Kelly, J. A., Johnson, J. R., and Bulto, M. (1994). Factors associated with risk for HIV infection among chronic mentally ill adults. American Journal of Psychiatry, 151, 221-227.

    Google Scholar 

  • Kalichman, S. C., Kelly, J. A., and Rompa, D. (1997). Continued high-risk sex among HIV seropositive gay and bisexual men seeking HIV prevention services. Health Psychology, 16, 369-373.

    Google Scholar 

  • Kelly, J. A. (1997). HIV risk reduction interventions for persons with severe mental illness. Clinical Psychology Review, 17, 293-309.

    Google Scholar 

  • Kelly, J. A., Murphy, D. A., Bahr, G. R., Brasfield, T. L., Davis, D. R., Hauth, A. C., Morgan, M. G., Stevenson, L. Y., and Eilers, M. K. (1992). AIDS/HIV risk behavior among the chronic mentally ill. American Journal of Psychiatry, 149, 886-889.

    Google Scholar 

  • Kelly, J. A., Murphy, D. A., Sikkema, K. J., Somlai, A. M., Mulry, G. W., Fernandez, M. I., Miller, J. G., and Stevenson, L. Y. (1995). Predictors of high and low levels of HIV risk behavior among adults with chronic mental illness. Psychiatric Services, 46, 813-818.

    Google Scholar 

  • Kwiatkowski, C. F., and Booth, R. E. (1998). HIV-seropositive drug users and unprotected sex. AIDS and Behavior, 2, 161-169.

    Google Scholar 

  • Lansky, A., Nakashima, A. K., and Jones, J. L. (2000). Risk behaviors related to heterosexual transmission from HIV-infected persons. Supplement to HIV/AIDS Surveillance Study Group. Sexually Transmitted Diseases, 27, 483-489.

    Google Scholar 

  • Leigh, B. C., and Stall, R. (1993). Substance use and risky sexual behavior for exposure to HIV: Issues in methodology, interpretation, and prevention. American Psychologist, 48, 1035-1045.

    Google Scholar 

  • McDermott, B. E., Sautter, F. J., Jr., Winstead, D. K., and Quirk, T. (1994). Diagnosis, health beliefs, and risk of HIV infection in psychiatric patients. Hospital and Community Psychiatry, 45, 580-585.

    Google Scholar 

  • McKinnon, K., and Cournos, F. (1998). HIV infection linked to substance use among hospitalized patients with severe mental illness. Psychiatric Services, 49, 1269.

    Google Scholar 

  • McKinnon, K., Cournos, F., Sugden, R., Guido, J. R., and Herman, R. (1996). The relative contributions of psychiatric symptoms and AIDS knowledge to HIV risk behaviors among people with severe mental illness. Journal of Clinical Psychiatry, 57, 506-513.

    Google Scholar 

  • Menon, A. S., and Pomerantz, S. (1997). Substance use during sex and unsafe sexual behaviors among acute psychiatric inpatients. Psychiatric Services, 48, 1070-1072.

    Google Scholar 

  • Meyer, I., Empfield, M., Engel, D., and Cournos, F. (1995). Characteristics of HIV-positive chronically mentally ill inpatients. Psychiatric Quarterly, 66, 201-207.

    Google Scholar 

  • Otto-Salaj, L. L., and Stevenson, L. Y. (2001). Influence of psychiatric diagnoses and symptoms on HIV risk behavior in adults with serious mental illness. AIDS Reader, 11, 197-208.

    Google Scholar 

  • Otto-Salaj, L. L., Heckman, T. G., Stevenson, L. Y., and Kelly, J. A. (1998). Patterns, predictors and gender differences in HIV risk among severely mentally ill men and women. Community Mental Health Journal, 34, 175-190.

    Google Scholar 

  • Rahav, M., Nuttbrock, L., Rivera, J. J., and Link, B. G. (1998). HIV infection risks among homeless, mentally ill, chemical misusing men. Substance Use and Misuse, 33, 1407-1426.

    Google Scholar 

  • Regier, D. A., Boyd, J. H., Burke, J. D., Jr., Rae, D. S., Myers, J. K., Kramer, M., Robins, L. N., George, L. K., Korno, M., and Locke, B. Z. (1988). One-month prevalence of mental disorders in the United States: Based on five epidemiologic catchment area sites. Archives of General Psychiatry, 45, 977-986.

    Google Scholar 

  • Rost, K., Burnam, M. A., and Smith, G. R. (1993). Development of screeners for depressive disorders and substance disorder history. Medical Care, 31, 189-200.

    Google Scholar 

  • Sacks, M. H., Perry, S., Graver, R., Shindledecker, R., and Hall, S. (1990a). Self-reported HIV-related risk behaviors in acute psychiatric inpatients: A pilot study. Hospital and Community Psychiatry, 41, 1253-1255.

    Google Scholar 

  • Sacks, M. H., Silberstein, C. H., Weiler, P., and Perry, S. (1990b). HIV-related risk factors in acute psychiatric inpatients. Hospital and Community Psychiatry, 41, 449-451.

    Google Scholar 

  • Safer, D. J. (1987). Substance abuse among young adult chronic patients. Hospital and Community Psychiatry, 38, 511-514.

    Google Scholar 

  • Sohler, N., Colson, P. W., Meyer-Bahlburg, H. F. L., and Susser, E. (2000). Reliability of self-reports about sexual risk behavior for HIV among homeless men with severe mental illness. Psychiatric Services, 51, 814-816.

    Google Scholar 

  • Stevenson, L. Y., Otto-Salaj, L. L., Hoffmann, R., and Kelly, J. A. (1998). Psychiatric diagnoses and symptomatology as predictors of HIV risk behaviors in adults with serious mental illness. In 12th International Conference on AIDS (p. 448, Abstract 23531).

  • Sullivan, G., Koegel, P., Kanouse, D. E., Cournos, F., McKinnon, K., Young, A. S., and Bean, D. (1999). HIV and people with serious mental illness: The public sector's role in reducing HIV risk and improving care. Psychiatric Services, 50, 648-652.

    Google Scholar 

  • Sullivan, G., Dumenci, L., Burnam, A., and Koegel, P. (2001). Validation of the Brief Instrumental Functioning Scale in a homeless population. Psychiatric Services, 52, 1097-1099.

    Google Scholar 

  • Susser, E., Valencia, E., Miller, M., Tsai, W.-Y., Meyer-Bahlburg, H., and Conover, S. (1995). Sexual behavior of homeless mentally ill men at risk for HIV. American Journal of Psychiatry, 152, 583-587.

    Google Scholar 

  • Volavka, J., Convit, A., Czobor, P., Douyon, R., O'Donnell, J., and Ventura, F. (1991). HIV seroprevalence and risk behaviors in psychiatric inpatients. Psychiatric Research, 39, 109-114.

    Google Scholar 

  • Weinhardt, L. S., Carey, M. P., and Carey, K. B. (1998). HIV-risk behavior and the public health context of HIV/AIDS among women living with a severe and persistent mental illness. Journal of Nervous and Mental Disease, 186, 276-282.

    Google Scholar 

  • Wenger, N. S., Kusseling, F. S., Beck, K., and Shapiro, M. F. (1994). Sexual behavior of individuals infected with the human immunodeficiency virus. Archives of Internal Medicine, 154, 1849-1854.

    Google Scholar 

  • Wiktor, S. Z., Biggar, R. J., Melbye, M., Ebbesen, P., Colclough, G., DiGioia, R., Sanchez, W. C., Grossman, R. J., and Goedert, J. J. (1990). Effect of knowledge of human immunodeficiency virus infection status on sexual activity among homosexual men. Journal of Acquired Immune Deficiency Syndromes, 3, 62-68.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. RAND, Santa Monica, California

    Joan S. Tucker, David E. Kanouse, Angela Miu & Paul Koegel

  2. Department of Psychiatry, University of Arkansas for Medical Sciences, North Little Rock, AK

    Greer Sullivan

Authors
  1. Joan S. Tucker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David E. Kanouse
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angela Miu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paul Koegel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Greer Sullivan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joan S. Tucker.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tucker, J.S., Kanouse, D.E., Miu, A. et al. HIV Risk Behaviors and Their Correlates Among HIV-Positive Adults with Serious Mental Illness. AIDS Behav 7, 29–40 (2003). https://doi.org/10.1023/A:1022557222690

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1022557222690

Search

Navigation