Promoting HIV and sexual safety behaviour in people with severe mental illness: A systematic review of behavioural interventions

Abstract

People diagnosed with severe mental illness (SMI) are at greater risk of HIV than the general population. However, little attention has been given to how best to reduce sexual risk taking in this group. The aim of the review was to evaluate the effectiveness of behavioural interventions to promote sexual safety behaviour in people diagnosed with SMI. A comprehensive search of relevant databases was undertaken, and studies were included if they were randomized, controlled trials; behavioural intervention related to sexual behaviour; included adults diagnosed with SMI; and if a behavioural outcome was reported. The Cochrane Assessment of Bias Tool was used. Of the initial 515 papers identified, 11 trials were included for quality assessment and data extraction. The studies were heterogeneous in content and dose of intervention, as well as outcome measure and follow‐up periods, and all had some risk of bias. Four of the studies demonstrated significant improvement in safer sexual behaviour at follow up, but this effect diminished over time. The effect sizes were extremely variable. There is emerging evidence to suggest that a behavioural intervention has the potential to reduce sexual risks in people diagnosed with SMI. However, further high‐quality research is needed in this area.

Sexuality and intimacy among people living with serious mental illnesses: Factors contributing to sexual activity.

“…On a grander scale, behavioral interventions designed to decrease risky sexual behavior may benefit from incorporating these concepts into curricula. Although most interventions show some improvement after consumers have completed the program, no intervention has shown continued improvements six months after termination of the program (Walsh et al, 2014). It is possible that providing individually-tailored information based on consumers' levels of mastery, which inherently influences one's world view and self-efficacy for implementing changes in life, could improve outcomes for these programs.…”

“…While providers have a difficult time addressing sexual health in general, stigma about mental illness may lead providers to see these individuals as asexual, or to view romantic relationships as inappropriate in this population (Walsh, McCann, Gilbody, & Hughes, 2014). Person-centered care has gained recognition and increased importance over the last decade in mental health care (National Research Council, 2006); in striving to improve delivery of person-centered care, greater knowledge of how yet-unstudied constructs such as mastery and self-esteem relate to sexuality and intimate relationships is needed for individuals diagnosed with a severe mental illness.…”

“…E. Wright (2006) reported that even among consumers who regularly see providers, conversations about sex are infrequent; the mental health nursing literature also speaks to this issue, acknowledging that these conversations happen far less often than desirable (Higgins et al, 2008; McCann, 2010; Quinn et al, 2011). Further, despite the development of numerous behavioral interventions designed to reduce sexual risk behavior (Walsh et al, 2014), these interventions have had mixed results, and have yet to see widespread dissemination (Meade & Sikkema, 2007). Although false ideas about the asexuality of those diagnosed with a severe mental illness have long existed in the mental health field (Test & Berlin, 1981; Walsh et al, 2014), research suggests the contrary—that these individuals perceive sex as an important area of life (McCann, 2010; Werner, 2012).…”

“…Further, despite the development of numerous behavioral interventions designed to reduce sexual risk behavior (Walsh et al, 2014), these interventions have had mixed results, and have yet to see widespread dissemination (Meade & Sikkema, 2007). Although false ideas about the asexuality of those diagnosed with a severe mental illness have long existed in the mental health field (Test & Berlin, 1981; Walsh et al, 2014), research suggests the contrary—that these individuals perceive sex as an important area of life (McCann, 2010; Werner, 2012). Relatively little is known about the nature and extent of sexuality-related attitudes among those diagnosed with a severe mental illness (i.e., permissive versus conservative sexual ideas about things like pornography and sex outside of marriage).…”

Correction to: Sexuality and Reproductive Health in Young People with Disability: A Systematic Review of Issues and Challenges

“…Unsafe and unplanned sexual behavior can lead to sexually transmitted diseases or unwanted pregnancies [25]. One situation where sexual victimization could occur may be an inpatient psychiatric ward, where one might be exposed to sexual harassment, and having unwanted sexual contact and decreased ability to protect oneself physically [26,27].…”