Prevalence of HIV, syphilis, hepatitis B and C among adults with mental illness: a multicenter study in Brazil Prevalência de HIV, sífilis, hepatites B e C entre adultos com transtornos mentais: um estudo multicêntrico no Brasil

Objective: There is evidence that patients with mental illness have increased prevalence of sexually transmitted infections, but data in Brazil are scarce. The objective of this study was to determine the prevalence of HIV, hepatitis C and B, and syphilis among patients with mental illness in Brazil. Method: A multicenter representative sample of adults with mental illness was randomly selected from 26 mental health institutions throughout Brazil. Sociodemographic, sexual behavior and clinical data were obtained from person-to-person interviews and blood was collected for serology testing. Seroprevalence with 95% confidence limits were obtained correcting for sampling scheme. Results: Of the 2,475 patients interviewed, 2,238 had blood collected. Most participants were sexually active ever (88.8%) or in the last 6 months (61.6%), female (51.9%), and single (66.6%). Half of the sample had less than 5 years of schooling and the mean monthly individual income was low (US$ 210.00). Condom use was very low either during lifetime (8%) or in the last 6 months (16%). Overall seroprevalence were 1.12%, 0.80%, 1.64%, 14.7% and 2.63% for, respectively, syphilis, HIV, HBsAg, anti-HBc and anti-HCV. Conclusions: Seroprevalences found were higher than other populations with representative studies in Brazil, with high rates of sexual risk behavior. This is of public health concern, and prevention and care strategies for sexually transmitted infections among psychiatric patients should urgently be implemented by health authorities. Descriptors: Mental disorders; HIV seroprevalence; Syphilis; Multicenter study; Hepatitis B Resumo Objetivo: Evidências indicam que pacientes com transtornos mentais têm elevada prevalência de infecções sexualmente transmissíveis, mas dados brasileiros são escassos. O objetivo deste estudo foi determinar a prevalência do HIV, hepatites C e B, e sífilis entre pacientes com transtornos mentais no Brasil. Método: Uma amostra representativa de pacientes adultos com transtornos mentais foi aleatoriamente selecionada de instituições públicas de saúde mental no Brasil. Dados sociodemográficos, comportamentais e clínicos foram obtidos por entrevista face-a-face e sangue foi coletado para exames sorológicos. Soroprevalências com intervalo de 95% de confiança foram obtidas com correção para o esquema amostral. Resultados: Dos 2.475 pacientes entrevistados, 2.238 tiveram sangue coletado. A maioria era sexualmente ativa ao longo da vida (88,8%) ou nos últimos seis meses (61,4%), do gênero feminino (51,9%), solteira (66,6%), com metade dos participantes com menos de cinco anos de escolaridade e renda média mensal baixa individual (US$210). Uso de preservativo foi baixo em toda a vida (8%) ou nos últimos seis (16%). As soroprevalências gerais foram 1,12%, 0,80%, 1,64%, 14,7% e 2,63% para, respectivamente, sífilis, HIV, HBsAg, anti-HBc e anti-HCV. Conclusões: As soroprevalências encontradas são maiores do que outros estudos com populações representativas no Brasil, com altos índices de comportamento sexual de risco. Isto é preocupante e estratégias de prevenção e cuidado para as infecções sexualmente transmissíveis entre pacientes psiquiátricos devem ser urgentemente implementadas pelos serviços de saúde. Descritores: Transtornos mentais; Soroprevalência de HIV; Sífilis; Estudo multicêntrico; Hepatite B Submitted: July 21, 2008 Accepted: October 22, 2008 Rev Bras Psiquiatr. 2009;31( 1):43-7 BRIEF REPORT Mark Drew Crosland Guimarães1, Lorenza Nogueira Campos1, Ana Paula Souto Melo1,2, Ricardo Andrade Carmo3, Carla Jorge Machado4, Francisco de Assis Acurcio5, for the PESSOAS Project Network Group6 1 Department of Preventive and Social Medicine, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil 2 Raul Soares Institute and Teaching Hospital, State Health Department, Belo Horizonte (MG), Brazil 3 Eduardo de Menezes Hospital, State Health Department, Belo Horizonte (MG), Brazil 4 Center of Regional Development and Planning, School of Economic Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil 5 Department of Social Pharmacy, School of Pharmacy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil Correspondence Mark Drew Crosland Guimarães Av. Alfredo Balena, 190 Bairro Santa Efigênia 30130-100 Belo Horizonte, MG, Brazil Phone/Fax: (55 31) 3409-9109 E-mail: [email protected] Artigo 09_RBP385_V04.indd 43 09.03.09 11:38:41 Rev Bras Psiquiatr. 2009;31(1):43-7 44 Guimarães MDC et al. Introduction The Brazilian National STD/AIDS Program has developed an integral and universal approach, i.e., curative, preventive and promotional aspects, in providing care for those with HIV infection, with widely international recognition1. In addition, the development of surveillance tools for monitoring the dissemination of HIV infection and other sexually transmitted infections (STI) to vulnerable populations has been a priority2. Studies with national representative samples have been conducted among pregnant women3,4, military recruits5, and more recently studies among men who have sex with men, female sex workers and injecting drug users (IDU) are currently under way in 10 major Brazilian metropolitan areas6 . There is evidence that patients with mental illness have increased prevalence of STI, including HIV, with rates varying from 3% to 22%7. However, most of these seroprevalence studies have been conducted in developed countries among patients with severe mental illness (SMI), i.e., schizophrenia, bipolar disorders and depression with psychotic symptoms8, or in mental health care facilities which over represent populations with substance use disorders and IDU. As a consequence, seroprevalence and behavioral characteristics may either be overestimated or lack representativeness to warrant estimates with more reliable external validity. Therefore, STI seroprevalence studies that target patients with greater variety of psychiatric conditions are highly desirable and much needed. In Brazil, data on both seroprevalence of STI and risk behavior among patients with mental illness are scarce and there is none with a national representative sample of patients with general psychiatric diagnoses. Consonant with its policy, the Brazilian National STD/AIDS Program, in collaboration with the National Mental Health Coordination and the Universidade Federal de Minas Gerais, launched a study designed to assess risk behavior and STI/HIV prevalence among patients with mental illness under public hospital or outpatient care, namely PESSOAS Project (HIV Seroprevalence Survey in Mental Health). The aim of this brief communication is to describe the seroprevalence of HIV, syphilis, hepatitis B and C from PESSOAS Project and compare these rates to other representative data in Brazil.