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Analyzing data from structured interviews with 96 women with severe mental illness [SMI], Randolph et al. (2007) found that
nearly two-thirds had not used condoms during sexual intercourse in the past 3 months, more than two-thirds had sex with multiple partners, and almost one-third had been treated for a sexually transmitted infection (STI) in the past year. Women who reported fewer sexual risk context factors, such as having sex with someone the participant did not know or transactional sex, had fewer sexual partners. Larger social support networks were associated with less frequent sex after drug use. In turn, women who less often had sex after using drugs had unprotected intercourse less frequently. (p. 33)
Randolph and colleagues conclude that "sexual risk reduction programs for ... women [with SMI] would greatly benefit from the inclusion of elements that help these women increase their social support networks, reduce alcohol and substance use, and recognize dangers associated with particularly risky situations" (p. 45).
Similarly, Meade and Sikkema (2007) conducted structured interviews with a convenience sample of 152 adults with SMI and found that "[t]he majority was sexually active (65%), and many reported unprotected intercourse (73%), multiple partners (45%), and sex trading (21%) in the past year. ... [S]exual behaviors were differentially associated with non-psychotic disorder, psychiatric symptoms, substance abuse, childhood sexual abuse, romantic partnership, and social support ..." (p. 153). "Social support emerged as both a risk and protective factor: Participants with greater social support were more likely to have multiple partners and engage in sex trading, but less likely to have unprotected intercourse" (p. 164).
The findings of this study underscore the need for routine risk assessment, HIV/STI testing, and sexual risk reduction interventions for adults with SMI. Cognitive-behavioral group interventions can effectively promote short-term risk reduction but are limited by their relatively weak and diminishing effects over time ... . Moreover, they have not been widely disseminated from clinical trials into mental health care settings ... . In addition to teaching HIV risk reduction skills, interventions must address psychiatric and psychosocial risk factors. In particular, mental health programs must prioritize effective treatment of substance abuse and sexual trauma. To further improve outcomes, interventions will likely need to occur on multiple levels and within the context of integrated services that address the multiple needs of persons with SMI. Integration of HIV prevention services into ongoing mental health services is a cost-effective strategy ... . Community-level interventions may also be necessary to create social norms supportive of HIV risk reduction ... . (pp. 165-166)
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Summer 2007 Newsletter / Volume 8, Issue 4
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