Comportamento sexual de risco para o HIV em pacientes com transtornos mentais: uma comparação de gênero

Abstract

Patients with mental illness (PMI) are disproportionately vulnerable to HIV infection and there is evidence that the prevalence and factors associated with unprotected sex differ among men and women. The objective of this dissertation was to assess the prevalence and factors associated with recent unprotected sex among sexually active PMI stratified by gender in Brazil. A sample of adult (>18 year old) PMI was randomly selected from 26 mental health institutions proport ional to type of care (hospital or outpatient) and number of reported AIDS cases by Brazilian regions in 2006. Sociodemographic, clinical and behavioral data were obtained from face-to-face interviews and psychiatric diagnoses from medical charts. For this analysis only sexually active PMI in the past six months were included. Unprotected sex was defined as not always using condoms in all practices in the past six months. Odds Ratios with 95% confidence limits were estimated by logistic regression to assess the independent association (p<0.05) between explanatory variables and unprotected sex. Among 2475 PMI, 1475 (60%) were sexually active - 791 (54%) were women and 684 (46%) were men. The prevalence of unprotected sex in the last six months was 89% among women and 77% among men. Women were more likely to be married or in union (57%), to be living with children and/or partner (74%), to have ever suffered verbal and sexual violence (76% and 29%, respectively), to have been previously tested for HIV (35%), and to have more depression or anxiety diagnoses (30%). Men were younger (40 years or less) (55%), with family income greater than the Brazilian minimum wage (R$350) in the last month (52%), reported more sex under the influence of alcohol or drugs (47%), lifetime cigarette smoking (83%), and had more severe psychiatric diagnoses (any psychoses, bipolar disorder or depression with psychotic symptoms) (55%). Factors associated with recent unprotected sex among men only were: lower family income in the last month (< R$350) and depression or anxiety diagnoses, while older age (> 40 years old), no previous HIV testing, sex under the influence of drugs or alcohol and history of verbal violence were associated with unprotected sex among women only. Being married or in union, to be living with children and/or partner, and having ever smoked cigarettes were associated with unprotected sex among both, men and women. The prevalence of recent unprotected sex was high, especially among women. Recent sexual behavior and risk profile differed by gender, including psychiatric diagnoses. Interventions to reduce risk behavior among psychiatric in Brazil are urgent and should take into account gender differences.