Psychopathology Subgroups and HIV Risk Among Women in Psychiatric Treatment

Predictors of Preexposure Prophylaxis Eligibility among Pregnant People with Opioid Use Disorder

OBJECTIVE

 We seek to evaluate risk factors for eligibility for preexposure prophylaxis (PrEP) among pregnant people with opioid use disorder (OUD).

STUDY DESIGN

This is a single-site retrospective cohort study of pregnant people admitted for management of OUD at an urban, tertiary care center from 2013 to 2022. PrEP eligibility was defined based on (1) modified American College of Obstetricians and Gynecologists' (ACOG) 2014 criteria: diagnosis of a sexually transmitted infection (STI), engagement in transactional sex work, intravenous drug use (IVDU), or incarceration and (2) modified 2021 Centers for Disease Control (CDC) criteria: diagnosis of bacterial STI (e.g., gonorrhea or syphilis) or transactional sex work. Risk factors associated with PrEP eligibility were evaluated using chi- square or Fischer's exact tests for categorical variables and t-tests or Wilcoxon rank-sum tests for continuous variables. Multivariable regression was used to control for confounding covariates, defined as p < 0.10 on bivariate analysis. p < 0.05 was used to indicate statistical significance.

RESULTS

 A total of 132 individuals met inclusion criteria, of whom 101 (76.5%) were deemed eligible for PrEP by meeting one or more modified 2014 ACOG criteria: 42 (31.8%) were incarcerated or had one or more STIs, while 30 (22.7%) endorsed engaging in transactional sex work and 68 (58.6%) endorsed IVDU. Using modified 2021 CDC criteria, 37 (28%) met PrEP eligibility, with 12 (9.1%) diagnosed specifically with a bacterial STI and 30 (22.7%) engaging in transactional sex work. Only comorbid psychiatric illness was associated with an increased risk for PrEP eligibility based on 2014 criteria, which persisted after controlling for maternal race/ethnicity (aRR 1.52, 95% confidence interval [CI] 1.24-1.86), and 2021 criteria, which persisted after controlling for nulliparity (aRR 2.12, 95% CI 1.30-3.57).

CONCLUSION

 A significant number of pregnant people with OUD meet one or more criteria for PrEP, with comorbid psychiatric conditions increasing the risk of meeting criteria.

KEY POINTS

· Comorbid psychiatric illness is significantly associated with high risk of PrEP eligibility.. · A large proportion of pregnant individuals with active OUD meet criteria for PrEP prescribing.. · Risk-based screening algorithms for PrEP eligibility have limitations..

Social Support, Relationship Power, and Knowledge of HIV+ Serostatus in Sexual Risk Behavior Among Women in Psychiatric Treatment

This study examined social support, perceived relationship power, and knowledge of HIV+ serostatus in relation to frequency of unprotected sex acts and number of partners among women with comorbid psychiatric illness receiving treatment. Data were drawn from an initial assessment of participants enrolled in an HIV risk reduction intervention (N = 284), and two generalized linear models were used to examine the potential associations. Relationship power was significantly associated with fewer unprotected sex acts. This relationship was stronger among those with greater social support. Knowledge of HIV+ serostatus was linked with fewer sexual partners and less unprotected sex. Findings also revealed that the protective nature of support varies by level of perceived relationship power, with higher power indicative of a stronger protective relationship. Study findings suggest that the potential protective benefits of social support may depend on one's perceived relationship power. Implications for HIV prevention intervention for this at-risk group are discussed.

The impact of psychiatric symptoms on condom self-efficacy among people with serious mental illness

OBJECTIVE

To determine how psychiatric symptoms affect the self-efficacy of people with serious mental illness to protect themselves and their partners from HIV and other sexually transmitted infections (STIs) by using condoms.

METHOD

As part of a National Institute of Mental Health-Funded study, people with serious mental illness (N = 467) were recruited in public psychiatric outpatient clinics in Rio de Janeiro, Brazil for an HIV prevention intervention. We examined the effects of psychiatric symptom severity on condom self-efficacy at baseline across 4 symptom clusters: affect, positive, negative, and activation.

RESULTS

Greater activation symptom severity (e.g., elated mood) was related to better condom self-efficacy, whereas greater negative symptom severity (e.g., blunted affect, emotional withdrawal) was related to worse condom self-efficacy.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Our findings suggest that people living with serious mental illness who exhibit more severe negative symptoms are less likely to perceive themselves as capable of using condoms, condom negotiation, and/or condom acquisition, whereas those with more severe activation symptoms are more likely to express confidence in their capabilities. Interventions to prevent HIV and other STIs among people living with serious mental illness should take into account the effects of these symptom clusters on condom skills acquisition and perceptions of self-efficacy in carrying out needed protective behaviors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Impact of personality disorders on leaving hospital against medical advice among people living with HIV in British Columbia, Canada

PURPOSE

Leaving hospital against medical advice (AMA) is a significant source of morbidity, mortality, and a major burden to the healthcare system. Studies have indicated that marginalized populations, including people living with HIV (PLHIV) and those living with a personality disorder (PD), experience high hospitalization rates. We sought to identify whether being diagnosed with a PD was associated with leaving hospital AMA among PLHIV in British Columbia (BC), Canada.

METHODS

Data were derived from the STOP HIV/AIDS in BC cohort, a provincial-level linkage of a series of surveillance, laboratory, and health administrative databases of all identified PLHIV in BC. Using multivariable generalized estimating equations (GEE), we examined the relationship between diagnoses of PD and premature hospital discharge among PLHIV.

RESULTS

Among 8763 PLHIV included in the study sample, 1321 (15%) were diagnosed with a PD. The prevalence of leaving hospital AMA at least once during the study period was 9%. In multivariable GEE analyses, after adjusting for a range of demographic and clinical confounders, there remained a positive association between being diagnosed with a PD and leaving hospital prematurely. Results showed a significant and independent association between a PD diagnosis and leaving AMA among PLHIV.

CONCLUSIONS

These findings underscore the importance of identifying and addressing specific PD-related behaviour which negatively impact inpatient treatment completion among this subpopulation of PLHIV. Furthermore, these findings suggest a need to develop novel health system interventions to minimize AMA discharge among this population.