Stigma and HIV risk among adults in public psychiatric care in Rio de Janeiro, Brazil
C.B.S. Borges1, E. Wright2, K. McKinnon1, C. Dolezal1, K. Elkington1, C.G. Mann3, D. Pinto4, M.L. Wainberg1
1New York State Psychiatric Institute/Columbia University, HIV Center for Clinical and Behavioral Studies, New York, United States, 2Indiana University-Purdue University Indianapolis, Department of Public Health, Indianapolis, United States, 3Instituto Psiquiatria da UFRJ - IPUB, Rio de Janeiro, Brazil, 4Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, United States
Background: The stigma of mental illness has a dramatic effect on the lives of people receiving psychiatric care; however, its impact on HIV risk behavior is less clear. Modified labeling theory suggests that stigma influences behavior both through social environmental and social psychological processes. Using a new measure of stigma, this paper examines the impact of mental illness stigma-related dynamics on the HIV risk behavior of adults receiving psychiatric care in Rio.
Methods: As part of the “RCT of a Brazilian HIV Prevention Intervention for the SMI” study, funded by the National Institute of Mental Health (NIMH), R01 MH65163 Wainberg (PI), outpatients were recruited at four community mental health clinics and four major psychiatric hospitals in Rio de Janeiro, Brazil. Detailed interviews were conducted to develop an instrument to measure mental illness stigma and sexuality among patients with mental illness. Between June 2007 and November 2009, 3811 outpatients were screened, 1348 participants were eligible and interested, and 609 consented and completed the interview.
Results: Sample consisted of 58% female, and the mean age was 42.8 (SD=10.15). Subjects reported many direct and indirect stigma-related experiences. More important, these experiences appear to be associated with HIV risk. Subjects who are more frequently exposed to treatment-related structural discrimination report having significantly more sex partners. At the same time, greater exposure to stigma was also associated with fewer instances of unprotected vaginal or anal sex and altered perceptions of their sexuality. Together, these findings indicate that the effect of mental illness stigma on HIV risk is complex and multidimensional.
Conclusions: The stigma of mental illness is shaping the HIV epidemic among people with SMI. Mental health professionals in Brazil and elsewhere should incorporate strategies to address the stigma of mental illness as part of treatment and a more comprehensive approach to HIV prevention in this high risk population.
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