Prevalence and Factors Associated with Risky Sexual Behaviors among Patients with Severe Mental Illness in Uganda: A Descriptive Cross Sectional Study

Abstract

Background: Persons living with severe mental illness (SMI) which includes schizophrenia, bipolar affective disorder and recurrent major depressive disorder are predisposed to risky sexual behavior (RSB). There is a paucity of data on this problem in sub-Saharan Africa and where research has been undertaken, only a limited range of risk factors have been considered and most of it was undertaken before antiretroviral therapy was universally available, hence the need for this study. The objective of this study was to determine the prevalence and factors associated with risky sexual behavior among individuals with SMI attending care in central and south western Uganda. Methods: A cross sectional study was conducted among 393 persons with SMI attending two psychiatric out-patient facilities in Uganda. Psychiatric disorder was confirmed using MINI International Neuropsychiatric Interview version 7.2. RSB was defined as engaging in at least one of four risky sexual behaviours that have been associated with HIV infection in the Ugandan psychosocial environment in the last three months using an 8 item RSB questionnaire used for assessment of RSB. Prevalence of RSB and associated correlates were determined using multiple logistic regression. Results: The Prevalence of RSB in last 3 months’ periods was 24.2% (95% CI: 20.2% - 28.7%). The factors that were independently significantly associated with RSB were: trauma related (history of childhood trauma, past and current sexual abuse, past and current physical abuse) current psychosocial challenges (mental health stigma) and psychiatric illness factors (history of a past manic episode, current psychotic episode, severity of depressive symptoms and severity of manic symptoms). Conclusions: One quarter of clinic attending respondents with severe mental illness in Uganda practice risky sexual behaviour. Factors associated with risky sexual behaviour fall under the domains of past and present trauma, current psychosocial challenges and psychiatric illness factors. This calls for a multi-sectoral approach that includes community awareness about the nature of SMI and the rights of persons with SMI and measures to improve Psychiatric symptom management.