Self-Reported Prevalence of HIV Infection, Sexually Transmitted Infections and Risky Sexual Behavior among Mental Health Care Users Accessing Healthcare Services in Tshwane District, South Africa.

Mathildah Mpata Mokgatle

doi:10.3390/healthcare9101398

Mathildah Mpata Mokgatle

Open Access

https://doi.org/10.3390/healthcare9101398

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Abstract

The rate of HIV and sexually transmitted infections among mental patients is higher than that of the general population worldwide. Many risky sexual behaviors are associated with mental illness. However, mental health care users (MHCUs) are not specifically targeted for HIV preventative care, and routine HIV testing is not done among this population. Limited studies have investigated self-reported HIV and STI prevalence and associated risky sexual behavior in persons with mental illnesses accessing health care services in South Africa in particular. This study set out to determine both the Sexually Transmitted Infections (STI) and human immunodeficiency virus (HIV) self-reported prevalence and sexual practices of MHCUs. A descriptive cross-sectional survey using purposive sampling was used to select 107 MHCUs across five clinics within Gauteng Province of South Africa who were above the age of 18, had a mental illness, and were currently stable and receiving chronic medication. Descriptive statistics were performed using Stata IC version 16. The chi square test was used to indicate statistical significance (p < 0.05) of differences in frequency distributions. More males (52.5%) than females were currently in a sexual relationship (50.0%), having multiple sexual partners (n = 4.13%), and having alcohol-driven sex (n = 4.19%). The majority of MHCUs (n = 82.77%) had an STI in the past six months, and a quarter (n = 21.25%) were HIV-positive with over two-thirds of MHCU (n = 69.70%) perceiving themselves not at risk for HIV. MHCUs engaged in risky behaviors had a low perception of the risks of contracting HIV. Bivariate analysis of gender by sexual behavior revealed that female MHCUs are more at risk of being forced to have sex compared to males (p = 0.006). Integrated interventions should be put in place to ensure that MHCUs’ sexual and reproductive health are not left behind and issues such as sexual education, safe sex, and sexually transmitted infections should form part of the care of MHCUs.

Highlights

Transmitted infections (STIs) remain highly prevalent worldwide and they increase an individual’s susceptibility for human immunodeficiency virus (HIV) infection, making this a major public health concern [1]
Studies done in sub-Saharan Africa over time have shown a higher HIV prevalence among Mental health care users (MHCUs) than in the general population, and prevalence was found to be higher among women than in men [7,8]
Health care facility managers took the decision to protect the MHCUs accessing care in their institution as they were sensitised by the allegations of neglect of

Summary

Introduction

Transmitted infections (STIs) remain highly prevalent worldwide and they increase an individual’s susceptibility for HIV infection, making this a major public health concern [1]. Mental disorders have been found to be related to the risk of sexually transmitted diseases with elevated rates of high risk sexual behavior among this population group [3,4,5]. Despite developing countries having the highest prevalence of HIV infection in the world, much lower HIV testing rates have been reported [9,10]. Do these findings show a lack of targeted and regular HIV testing among MHCUs as a preventative strategy in developing countries, and the majority of MHCUs in high endemic developing countries could be living with undiagnosed and untreated HIV infection. The psychological problems that affect personal cognition, emotional regulation, and behavior are some of the reasons for this association [11]

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