Avaliação de serviços de saúde mental na assistência e prevenção às doenças sexualmente transmissíveis (Aids, Sífilis, Hepatite B e C)

Abstract

Introduction: There is evidence that patients with mental illness have increased prevalence of sexually transmitted infections (STI) when compared with the general population, and also high rates of sexual risk behavior. This study analyzes the prevention and treatment of STI / AIDS in mental health patients in Brazil with focus on the assessment of mental health services, considering aspects of structure and process in the care of STI / AIDS in a Brazilian multicenter study - Project PESSOAS (Research Seroprevalence AIDS in Mental Health). The patients return for Syphilis, Hepatitis B and C test results was evaluated. We measured HIV/AIDS knowledge among mentally ill patients in Brazil and examined individual and treatment setting predictors of knowledge. Methods: We conducted a cross-sectional national multicenter study in a representative sample among 2475 patients in mental health services. We randomly selected 11 psychiatric hospitals and 15 CAPS (Mental Health Outpatient Clinics) in all regions of the country. A mental health service evaluation questionnaire was applied by the local research supervisor to assess selected indicators of structure and process. A semi-structured person-to-person interview was conducted to obtain socio-demographic, clinical and behavioral data. A questionnaire for HIV/STI testing and receipt of exam results was applied in the last phase of the research, when the 2300 participants consented to blood draws. Results: In general, there was a lack of preparation for the implementation of prevention and care for psychiatric patients at risk for STI / AIDS. More specifically, it was observed in mental health services, inadequate human resources and equipment, unavailability of medicines primarily for emergency medical attention, difficulties of providing clinical support to patients (STI / AIDS inclusive), precarious structure of the reference and counterreferral systems, and in addition, few services had sex education or condom distribution, despite the existence of patients with known HIV infection. When evaluating the return of exams results, it was observed that among the 2080 participants who had blood collection and had a questionnaire regarding returning exams results completed, 1656 (80%) received their exams results accompanied by post-test counseling. The CAPS returned results for 89% of the participants while hospitals returned only 60%. The mental health services received only 68% of counter-referral that were requested to specialized services for those patients who had a positive marker in exams results of STI / AIDS. It is important to emphasize the low rate of previously HIV-tested (27%) among psychiatric patients, and the mental health services which reported distribution of condoms to their patients returned more STI / AIDS tests to the participants. Mean HIV/AIDS knowledge score was 6.78 (range 1-10). Treatment setting characteristics were not associated with knowledge scores. Lower HIV/AIDS knowledge scores were significantly associated with: low schooling ( 5 years), being illiterate, being over 40 years of age, being a resident of a psychiatric hospital, having delusional/delirious behavior during the interview, being diagnosed with schizophrenia-spectrum, having been previously admitted in a psychiatric hospital, having a low score in the brief-MMSE, not having heard of AIDS and not knowing for sure of the risk of being HIV infected. The variables which presented associations with higher HIV/AIDS knowledge scores were: having an STD history, having been HIV tested and using condoms most of the time. Conclusion: When we considered the psychiatric population as a group potentially more vulnerable to STIs, the prevention and intervention policies in Brazil are insufficient. The proposal of effective prevention and intervention on HIV / AIDS specific to this population should be addressed. It is necessary to provide and offer education strategies for both psychiatric patients and professionals working in mental health services. It is essential to develop public policies that promote preventive health care and improve medical assistance to these patients with mental disorders.