Knowledge, Attitudes and Personal Beliefs About HIV and AIDS Among Mentally Ill Patients in Soweto, Johannesburg (Original Article) (Report‪)‬

The prevalence of HIV in developed countries is higher among patients with mental illness than among those without. (1) In the USA it is estimated to be 13-76 times that of the general population. (2) In southern Africa the prevalence ranges from 0% to 59% (0-22.9% before 1996 and 2.6-59% after 1996, suggesting an upward trend). (3) The prevalence also varies according to where the study was performed, the highest being in Zimbabwe. (4) Collins et al. more recently reported that in South Africa, despite the supposition that people with mental illness may engage in high-risk sexual behaviours more than the general population, the prevalence largely matches that of the general population. (5) They suggest that as there is little injection drug use, the high prevalence of HIV in the general population is probably due to acquisition of the virus shortly after sexual initiation. (5) Nonetheless, there is sufficient evidence that mental illness increases the individual's vulnerability to HIV infection. (6,7) HIV risk among people with mental illness has been associated with lack of condom use, multiple sexual partners and injection drug use. (8,9) The social exclusion that often accompanies life with mental illness may also increase vulnerability to infection. It may lead to exchange of sex for money or goods and an increase in coercive sexual encounters. In addition, cognitive deficits associated with certain mental disorders may impair judgement and the ability to negotiate safe sexual encounters. (10) In the general population, education and providing information about HIV and AIDS is one of the important ways of reducing risky sexual behaviour and the spread of the disease. (11) Yet studies have shown that levels of knowledge about HIV and AIDS are sub-optimal among patients with mental illness, and that levels differ among inpatients and outpatients and are influenced by psychiatric diagnosis. (12) Patients with mental illness tend to engage in risky sexual behaviour because of these lower levels of knowledge, which places them at risk of contracting or transmitting HIV. (1,3,14) Melo et al. found in their study that high HIV and AIDS knowledge scores were associated with a past history of sexually transmitted infections, previous HIV testing and consistent condom use and that low knowledge scores were associated with mental illness. (11) Similarly, a study in a psychiatric hospital in Rio de Janeiro also showed knowledge to be lower in patients with mental illness compared with the general population. (15) The authors used a 17-item AIDS knowledge test and found the average correct score to be only 61.2%. Chandra et al., who assessed HIV knowledge among a group of Indian patients with mental illness at baseline and 5 days later after an HIV risk reduction programme, showed that brief HIV-focused educational intervention can improve knowledge. (16) However, different methodologies employed in the various studies make it difficult to ascertain accurate knowledge among psychiatric patients.