AIDS education for patients with chronic mental illness

Sex education for patients with severe mental illness in Iran: A qualitative study

Objective

Patients with severe mental illness may experience cognitive deficits, impaired judgment or loss of skills. Therefore, they are prone to sexual health complications. Sex education can promote sexual health, and in many countries, it is integrated into other domains of education. The educational contents taught in western countries are not necessarily appropriate for developing countries.This study aims to address sex educational content for these patients in Iran.

Methods

We have conducted twenty-three face-to-face, deep and semi-structured interviews with patients, family members, psychiatrists, general practitioners, nurses and psychologists. We used the strategy of maximum diversity in selecting the participants.

Results

"Improving basic knowledge," "decreasing the risk of unsafe sex", "empowerment" and "persuading to ask for help" should be covered in the education.

Conclusions

Sexuality is not considered a priority for these patients. It is necessary to develop a training program with simple educational content for this high-risk group.

Innovation

Raising awareness and knowledge about the possible risks of social media on high-risk behaviours, developing social and behavioural skills, and encouraging patients to talk about their new challenges in sexual life is recommended. Cultural, spiritual and personal beliefs should be considered in designing the educational program.

Video-based patient decision aids: A scoping review

OBJECTIVE

This study reviews the published literature on the use of video-based decision aids (DA) for patients. The authors describe the areas of medicine in which video-based patient DA have been evaluated, the medical decisions targeted, their reported impact, in which countries studies are being conducted, and publication trends.

METHOD

The literature review was conducted systematically using Medline, Embase, CINAHL, PsychInfo, and Pubmed databases from inception to 2016. References of identified studies were reviewed, and hand-searches of relevant journals were conducted.

RESULTS

488 studies were included and organized based on predefined study characteristics. The most common decisions addressed were cancer screening, risk reduction, advance care planning, and adherence to provider recommendations. Most studies had sample sizes of fewer than 300, and most were performed in the United States. Outcomes were generally reported as positive. This field of study was relatively unknown before 1990s but the number of studies published annually continues to increase.

CONCLUSION

Videos are largely positive interventions but there are significant remaining knowledge gaps including generalizability across populations.

PRACTICE IMPLICATIONS

Clinicians should consider incorporating video-based DA in their patient interactions. Future research should focus on less studied areas and the mechanisms underlying effective patient decision aids.

HIV, STD, and Sexual Risk Reduction for Individuals with a Severe Mental Illness: Review of the Intervention Literature

Seroprevalence studies indicate that HIV infection rates are elevated among individuals with a severe mental illness (SMI) compared to the general population. The higher prevalence of HIV among individuals with SMI has prompted the development and evaluation of tailored sexual risk reduction programs for these individuals. In this paper, we review the literature on sexual risk-reduction interventions for individuals with SMI, including interventions for both uninfected and infected individuals. We discuss components of successful interventions, identify limitations in the current literature, and highlight directions for future research. Finally, we conclude with implications for clinical practice, including a discussion of the challenges and advantages to implementing sexual risk reduction interventions for individuals with SMI.

Sexual health education for people with mental health problems: what can we learn from the literature?

Research into sexual risk behaviour among people with 'severe' mental health problems suggested that they are likely to engage in high-risk sexual behaviour, for a number of reasons, putting them at risk of sexually transmitted diseases. The aim of this review is to describe approaches, content and outcomes of sexual health education programmes, developed and implemented for people with mental health problems. A literature review from 1980 to 2005 was carried out using the electronic databases CINAHL, PsycINFO, British Nursing Index, Pubmed and Medline, and the Cochrane library was also searched. The literature search was confined to papers written in English. The keywords 'sexuality', 'sexual health education', 'sexual health promotion', 'HIV', 'sexually transmitted disease' were combined with 'mental illness', 'chronic mental illness''severe mental illness''persistent mental illness''psychiatry', 'mental disorder', 'education interventions' and 'evaluation'. A vast amount of literature was recovered on sexual risk behaviour in people with severe mental health problems, and sexual dysfunction as a result of prescribed medication. As the focus of the review was on sexual health education, this literature was omitted. Although the literature on sexual health education for people experiencing mental health problems was sparse, 14 studies were located that either described or evaluated sexual health education programmes. Most sex education programmes focused on topics such as HIV and other sexually transmitted diseases, negotiating safe sex and skill development in condom use. Findings suggested that the people who attended benefited from sexual health education programmes, facilitated in a sensitive and supportive manner. Education tended to produce a reduction in sexual risk behaviour as opposed to complete cessation. Nevertheless, it is appropriate to consider integrating such education with service provision. The results of the review provide guidance to service providers and mental health nurses wishing to develop and evaluate sexual health education programmes for service users. Areas for future research are also identified.

The Impact of AIDS Continuing Education on Psychiatric and Non-Psychiatric Nurses' Knowledge

BACKGROUND

Because an increasing number of chronically mentally ill individuals are HIV-positive, continuing education must include AIDS content to ensure psychiatric nurses provide competent care. The Fundamentals of Mental Health and HIV/AIDS Program was tested to determine its effectiveness in augmenting the AIDS knowledge of mental health professionals.

METHOD

Two hundred forty RNs attended the Fundamental of Mental Health and HIV/AIDS Program. They completed pretest and posttest measures.

RESULTS

The program significantly increased AIDS knowledge. The increase in AIDS knowledge was more dramatic for psychiatric nurses than for non-psychiatric nurses.

CONCLUSION

This study reinforces the need for AIDS continuing education.

The expression of sexuality in people with psychosis: breaking the taboos

While mental health professionals should recognize that people suffering from schizophrenia have sexual and relationship requirements, there appears to be a failure to address adequately the subject of human sexuality, particularly in the area of psychosocial rehabilitation. The broad aim of this small study was to identify the sexual and relationship needs of people being cared for in hospital and preparing for a return to community living. The objectives of the study were to discover the clients' sexual expressions in the past and present, and to try to elicit hopes and aspirations for the future. An attempt was made to uncover some of the obstacles to the expression of sexuality and explore some of the clients' subjective experiences of the issues. The number of respondents was 11 from a possible 15. Data were collected through: a questionnaire on demographic characteristics; an adapted version of a questionnaire investigating the determinant factors of sexual behaviour through life; and a semi-structured interview devised to elicit subjective experiences regarding sexual expression. The findings show that people with psychotic illness are prepared to discuss issues relating to sex and relationship matters. No interviews had to be prematurely terminated. No exacerbations of symptoms were noted. All of the respondents showed an openness to discuss a range of intimate feelings. Most respondents seemed hopeful about the opportunity to form intimate and fulfilling relationships in the future. A drive towards more rigorous holistic nursing assessments and appropriate psychosocial responses is proposed.

HIV/AIDS prevention: a model for educating the inpatient psychiatric population

Scientific and medical research in the field of HIV/AIDS prevention has recently moved closer to finding a vaccine and a cure. Behavior change, however, is currently the only available means to decrease new cases of HIV, and the proper use of condoms is the most effective preventative measure for people with severe and persistent psychiatric disabilities who are sexually active. It is now well-documented that educating this population about safer-sex practices can reduce their risk of getting HIV/AIDS and other sexually transmitted diseases (STDs). The following article is a brief review of a model used to educate clients in an inpatient, state psychiatric hospital. Strategies that focus on developing behavioral skills are outlined.

HIV risk reduction interventions for persons with severe mental illness

Recent seroprevalence studies have shown alarming rates of HIV infection among severely mentally ill men and women in large urban areas, and HIV behavioral epidemiology research indicates that a substantial proportion of seriously mentally ill adults engage in activities that increase their vulnerability to HIV/AIDS. In this paper, the research literature on HIV prevention interventions is reviewed including reports that have described HIV prevention programs, studies that have used uncontrolled pre- and postintervention methods to evaluate risk reduction interventions, and those that have used rigorous randomized designs and examined risk behavior change. Collectively, these studies show that intensive, small-group interventions that target a variety of risk-related dimensions-including knowledge, attitudes, and motivations, and behavioral and cognitive skills-can produce at least short-term reductions in high-risk sexual behavior among the severely mentally ill. A number of gaps in the research literature are identified including the need to: (a) better tailor interventions to risk situations encountered by the mentally ill; (b) develop gender-tailored interventions; (c) examine and implement HIV prevention programs so they help persons sustain behavior change; (d) explore one-on-one counseling and community-level intervention methods; and (e) develop risk reduction interventions for already-seropositive individuals. Implications for service provision are discussed.

AIDS knowledge and high-risk behaviour in the chronic mentally ill

OBJECTIVE

To ascertain the degree of HIV-risk knowledge among patients attending a downtown program and to identify the extent of high-risk behaviour for HIV infection.

METHOD

A total of 151 patients were selected at the Calgary Community Mental Health Clinic (N = 110) and the nearby Self Help Association (N = 41). Most of the subjects were being treated for either schizophrenia (n = 69), bipolar disorder (n = 37), or unipolar mood disorder (n = 35). Questionnaires included a 10-item instrument that assessed subjects' knowledge about HIV or AIDS and another 10-item tool that assessed the high-risk situations patients might have encountered over the past month or past year.

RESULTS

Although the percentage of subjects erring on questions about AIDS knowledge was smaller when compared with previous studies, a significant number of subjects believed that one could acquire AIDS by donating blood, and 25% did not think that having only one unsafe sexual contact would make them vulnerable to HIV infection. At least 50% of the participants have had sex with at least one partner in the past year, and 33% of the participants indicated that they would not insist that they or their partners wear a condom.

CONCLUSIONS

This Canadian study confirms the need for psychiatrists and mental health workers to continue to explore high-risk behaviour in the chronic mentally ill population and to further educate these patients through the development of prevention and risk-reduction strategies.

'Coffee & condoms': the implementation of a sexual health programme in acute psychiatry in an inner city area

A sexual health programme was set up specifically to target mentally ill individuals, providing a distinct group of interventions designed to assist this specialist cohort in acquiring knowledge, skills, and attitudes that will directly contribute to their mental health. The programme consisted of gender-specific and mixed groups, a drop-in service, condom provision and a full-time programme coordinator. Areas covered were safer-sex, knowledge of HIV/AIDS and other sexually transmitted diseases, assertiveness and practical skills of condom use. Mental health nurses possessed the skills to offer sexual health advice to mentally ill individuals. Mentally ill individuals were enthusiastic to attend groups, and were able to participate in the programme.

Sexually transmitted disease prevention services for female chronically mentally ill patients

Chronically and variably impaired autonomy makes women with chronic mental illness particularly vulnerable to contracting sexually transmitted diseases (STDs) including AIDS. A lack of female controlled protective devices also adds to the vulnerability of these patients. In this context, the authors make recommendations for the design of clinically comprehensive and ethically justified programs to minimize the risk of mentally ill women for STDs. When female chronically mentally ill patients are at risk of STDs, barriers to the exercise of their autonomy must be identified and clinically treated. Preventive clinical interventions can also be usefully augmented by educational strategies and facilitate patients' communication and behavioral skills, particularly in order to enable them to abstain from unwanted sex or to make prospective male partners wear a condom. Outreach efforts to the male partners of female patients and to the homeless mentally ill may also be required. Preventive services could be integrated and coordinated with STD clinics, substance abuse treatment programs and family planning programs.

AIDS knowledge and high risk behaviors in the chronic mentally ill

Chronic mentally ill adults are a high risk group for AIDS. In the present study, we used a questionnaire to assess AIDS knowledge, attitudes, and risk behaviors in 54 men and women who were clients at a "drop in" center for mentally ill adults. Most of the subjects were suffering from schizophrenia and about one-third of them had co-existing drug problems. Results showed widespread misunderstandings about AIDS transmission, high risk groups, and practices. Many of the subjects had been treated for STDs such as syphilis and gonorrhea and were engaging in behaviors that increased their vulnerability to AIDS. These include casual sex, anal sex, sex with an IV drug user, or sex in exchange for money, drugs, or a place to sleep. Subjects expressed a moderately high level of concern about acquiring AIDS/HIV, and 15% of those tested (5/33) said they already had the illness. We observed a significant correlation between misinformation about AIDS and the frequency of high risk behaviors. We also detected ambivalence about using condoms and i.v. drugs. Although males and females did not differ in AIDS knowledge or risk behaviors, the AIDS knowledge of both groups was significantly lower than a comparison sample of public high school students. Taken together, the results underscore the immediate need for comprehensive AIDS assessment, education, and prevention in this segment of the population.

HIV and serious mental illness: reducing the risk

Persons with SMI residing in community mental health center group homes received an educational intervention program on HIV/AIDS. As with virtually all such approaches provided for this population, the intervention was generalized from programs used with other populations, for example, users of intravenous drugs, gay men, and adolescents. Assessment of pre- and postintervention knowledge indicated no increase in accurate information. Further, consumers were initially uncertain regarding their risk for HIV infection; this attitude, too, remained unchanged. The research design employed did not compare persons with SMI with a normative sample receiving the same information, and assessed with the same instruments, limiting hypotheses about the generalizability of existing interventions. However, the data seems to suggest its potential inefficacy. Several findings are germane to effective educational intervention techniques.