Factors associated with unprotected sexual practice
					among men and women with mental illnesses in Brazil

Peixoto, Eliane Rezende de Morais; Barros, Fabiana Cristina Ribeiro de; Guimarães, Mark Drew Crosland

doi:10.1590/0102-311X00029313

Acessibilidade / Reportar erro

Brasil

Cadernos de Saúde Pública

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ARTICLE • Cad. Saúde Pública 30 (7) • July 2014 • https://doi.org/10.1590/0102-311X00029313 copy

Factors associated with unprotected sexual practice among men and women with mental illnesses in Brazil

Fatores associados com a prática do sexo desprotegido entre homens e mulheres com transtornos mentais no Brasil

Los factores asociados con la práctica del sexo sin protección entre hombres y mujeres con trastornos mentales en Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

This study estimated the rate and correlates of recent unprotected sex among sexually active psychiatric patients in Brazil, stratified by gender. The prevalence of unprotected sex among women and men were 89% and 77%, respectively. Significant correlates with unprotected sex were: being married/in union, living with children/partner, and cigarette smoking in both genders; lower income, depression and anxiety diagnoses among men only; older age, no previous HIV testing, sex under the influence of alcohol/drugs, and verbal violence among women only. Interventions to reduce risk behavior among psychiatric patients in Brazil are urgent and should take into account gender differences.

HIV; Sexual Behavior; Mental Disorders

Characteristics	Men (N = 684 *)	Women (N = 791 *)	p-value
Characteristics	n (%)	n (%)	p-value
Sociodemographic
Type of recruitment center
CAPS	373 (54.5)	578 (73.1)	< 0.001
Hospital	311 (45.5)	213 (26.9)	< 0.001
Skin color
White	332 (48.5)	416 (52.7)	0.115
Black/Mulatto	352 (51.5)	374 (47.3)	0.115
Age (years)
≤ 40	373 (54.5)	397 (50.2)	0.096
> 40	311 (45.5)	394 (49.8)	0.096
Marital status
Married or in union	246 (36.0)	449 (56.8)	< 0.001
Other (single/separated/widower)	438 (64.3)	342 (43.2)	< 0.001
Schooling (years)
< 5	309 (45.6)	372 (47.5)	0.476
≥ 5	368 (54.4)	411 (52.5)	0.476
Family income in the last month **
> US$ 200	345 (51.7)	361 (46.8)	< 0.001
≤ US$ 200	129 (19.3)	222 (28.8)	< 0.001
Current housing partnership
Living with children and/or partner	245 (35.8)	580 (73.6)	<0.001
Living with others or alone	439 (64.2)	208 (26.4)	<0.001
Clinical
Psychiatric diagnoses (ICD-10)
Psychoses/Bipolar disorder/Depression with psychotic symptoms	377 (55.1)	367 (46.4)	< 0.001
Depression/Anxiety	83 (12.1)	235 (29.7)
Substance use disorder	117 (17.1)	24 (3.0)
Other	107 (15.6)	165 (20.9)
Previous hospitalization
Yes	423 (62.0)	365 (46.3)	< 0.001
No	259 (38.0)	424 (53.7)	< 0.001
STD in the last year
Yes	48 (7.2)	101 (13.2)	< 0.001
No	615 (92.8)	664 (86.8)	< 0.001
Clinical
Previous HIV testing
Yes	216 (32.1)	268 (34.7)	0.300
No	457 (67.9)	505 (65.3)	0.300
Behavioral
Age of first sexual intercourse (years)
< 18	454 (69.4)	404 (52.4)	<0.001
≥ 18	200 (30.6)	367 (47.6)	<0.001
Condom use in the last six months
Always	156 (22.8)	89 (11.2)	< 0.001
Inconsistent use	528 (77.2)	702 (88.8)	< 0.001
Refusal of condom use by partner
Yes	158 (23.6)	308 (40.0)	< 0.001
No	511 (76.4)	463 (60.0)	< 0.001
Received/Offered money or drugs for sex
Yes	318 (47.0)	130 (16.6)	< 0.001
No	358 (53.0)	653 (83.4)	< 0.001
Sex under the influence of drugs or alcohol
Yes	322 (47.4)	160 (20.4)	< 0.001
No	357 (52.6)	626 (79.6)	< 0.001
Number of sexual partners in the last six months
Only one	337 (36.6)	548 (69.3)	< 0.001
> 1	250 (49.3)	128 (16.2)	< 0.001
Lifetime alcohol use
Yes	581 (85.1)	447 (56.6)	< 0.001
No	102 (14.9)	343 (43.4)	< 0.001
Lifetime illicit drug use
Yes	289 (42.3)	139 (17.6)	< 0.001
No	394 (57.7)	651 (82.4)	< 0.001
Lifetime cigarette smoking
Yes	566 (83.0)	506 (64.4)	< 0.001
No	116 (17.0)	280 (35.6)	< 0.001
Lifetime verbal violence
Yes	477 (69.7)	597 (75.6)	< 0.012
No	207 (30.3)	193 (24.4)	< 0.012
Lifetime physical violence
Yes	408 (59.9)	463 (58.5)	0.592
No	273 (40.1)	328 (41.5)	0.592
Lifetime sexual violence
Yes	84 (12.4)	227 (28.8)	< 0.001
No	596 (87.7)	562 (71.2)	< 0.001
HIV/AIDS knowledge
Good	431 (64.1)	503 (64.2)	0.967
Poor	241 (35.9)	280 (35.8)	0.967
HIV risk self-perception
High/Some risk/Do not know	444 (66.8)	539 (70.1)	0.176
No risk	221 (33.2)	230 (29.9)	0.176

Characteristics	Men (N = 684)					Women (N = 791)
Characteristics	Total **	n (%) ***	OR	(95%CI)	χ² (p-value)	Total **	n (%) ***	OR	(95%CI)	χ² (p-value)
Sociodemographic
Type of recruitment center
CAPS	373	286 (76.7)	0.94	(0.65-1.34)	0.12 (0.72)	578	514 (88.3)	1.07	(0.65-1.75)	0.07 (0.79)
Hospital	311	242 (77.8)	1.00		0.12 (0.72)	213	188 (88.9)	1.00		0.07 (0.79)
Skin color
White	332	255 (76.8)	0.96	(0.67-1.37)	0.05 (0.82)	416	365 (89.8)	0.81	(0.52-1.26)	0.87 (0.35)
Black/Mulatto	352	273 (77.6)	1.00		0.05 (0.82)	374	336 (87.7)	1.00		0.87 (0.35)
Age (years)
> 40	311	258 (83.0)	1.86	(1.28-2.70)	10.77 (< 0.01) ^#	394	364 (92.4)	2.11	(1.33-3.37)	10.40 (< 0.01) ^#
≤ 40	373	270 (72.4)	1.00		10.77 (< 0.01) ^#	397	338 (85.1)	1.00		10.40 (< 0.01) ^#
Marital status
Married or in union	246	224 (91.1)	4.49	(2.77-7.27)	41.94 (< 0.01) ^#	449	418 (93.1)	2.75	(1.74-4.37)	19.65 (< 0.01) ^#
Other (single/separated/widower)	438	304 (69.4)	1.00		41.94 (< 0.01) ^#	342	284 (83.0)	1.00		19.65 (< 0.01) ^#
Schooling (years)
< 5	309	245 (79.3)	1.26	(0.87-1.81)	1.53 (0.22)	372	344 (92.5)	2.10	(1.31-3.37)	9.79 (< 0.01) ^#
≥ 5	368	277 (75.3)	1.00		1.53 (0.22)	411	351 (85.4)	1.00		9.79 (< 0.01) ^#
Family income in the last month ^##
≤ US$ 200	129	106 (82.2)	1.55	(0.93-2.59)	2.84 (0.09)	222	194 (87.4)	0.77	(0.45-1.30)	0.98 (0.32)
> US$ 200	345	258 (74.8)	1.00		2.84 (0.09)	361	325 (90.0)	1.00		0.98 (0.32)
Current housing partnership
Living with children and/or partner	245	223 (91.0)	4.45	(2.75-7.21)	41.46 (< 0.01) ^#	580	533 (91.9)	2.87	(1.83-4.51)	22.33 (< 0.01) ^#
Living with others or alone	439	305 (69.5)	1.00		41.46 (< 0.01) ^#	208	166 (79.8)	1.00		22.33 (< 0.01) ^#
Clinical
Psychiatric diagnoses (ICD-10)
Psychoses/Bipolar disorder/Depression with psychotic symptoms	377	284 (75.3)	1.19	(0.73-1.93)	0.50 (0.48)	367	324 (88.3)	1.16	(0.67-2.01)	0.28 (0.60)
Depression/Anxiety	83	74 (89.2)	3.20	(1.42-7.20)	7.93 (< 0.01) ^#	235	214 (91.1)	1.57	(0.83-2.96)	1.93 (0.16)
Substance use disorder	117	93 (79.5)	1.51	(0.82-2.80)	1.71 (0.19)	24	21 (87.5)	1.08	(0.29-3.91)	0.01 (0.91)
Other	107	77 (72.0)	1.00			165	143 (86.7)	1.00
Previous hospitalization
Yes	423	320 (75.7)	0.80	(0.55-1.16)	1.28 (0.24)	365	324 (88.8)	1.01	(0.65-1.57)	0.002 (0.97)
No	259	206 (79.5)	1.00		1.28 (0.24)	424	376 (88.7)	1.00		0.002 (0.97)
STD in the past year
Yes	48	39 (81.3)	1.32	(0.63-2.80)	0.55 (0.46)	101	92 (91.1)	1.32	(0.64-2.73)	0.57 (0.45)
No	615	471 (76.6)	1.00		0.55 (0.46)	664	588 (88.6)	1.00		0.57 (0.45)
Previous HIV testing
No	457	359 (78.6)	1.31	(0.90-1.91)	2.02 (0.15)	505	460 (91.1)	2.01	(1.29-3.13)	9.68 (< 0.01) ^#
Yes	216	159 (73.6)	1.00		2.02 (0.15)	268	224 (83.6)	1.00		9.68 (< 0.01) ^#
Behavioral
Age of first sexual intercourse (years)
< 18	454	343 (75.6)	0.75	(0.50-1.13)	1.92 (0.17)	404	365 (90.4)	1.41	(0.90-2.21)	2.25 (0.13)
≥ 18	200	161 (80.5)	1.00		1.92 (0.17)	367	319 (86.9)	1.00		2.25 (0.13)
Behavioral
Refusal of condom use by partner
Yes	158	111 (70.3)	0.63	(0.42-0.95)	5.03 (0.02) ^#	308	271 (87.9)	0.91	(0.58-1.42)	0.18 (0.67)
No	511	403 (78.9)	1.00		5.03 (0.02) ^#	463	412 (89.0)	1.00		0.18 (0.67)
Received/Offered money or drugs for sex
Yes	318	232 (73.0)	0.63	(0.44-0.94)	6.20 (0.01) ^#	130	110 (84.6)	0.64	(0.37-1.10)	2.69 (0.10)
No	358	290 (81.0)	1.00		6.20 (0.01) ^#	653	585 (89.6)	1.00		2.69 (0.10)
Sex under the influence of drugs or alcohol
Yes	322	250 (77.6)	1.04	(0.72-1.48)	0.04 (0.85)	160	148 (92.5)	1.70	(0.90-3.22)	2.76 (0.10)
No	357	275 (77.0)	1.00			626	550 (87.9)	1.00
Number of sexual partners (past six months)
Only one	337	283 (84.0)	2.80	(1.89-4.13)	27.73 (< 0.01) ^#	548	486 (88.7)	1.04	(0.57-1.90)	0.02 (0.90)
> 1	250	163 (65.2)	1.00			128	113 (88.3)	1.00
Lifetime alcohol use
Yes	581	450 (77.5)	1.12	(0.68-1.82)	0.19 (0.66)	447	398 (89.0)	1.07	(0.69-1.67)	0.10 (0.76)
No	102	77 (75.5)	1.00			343	303 (88.3)	1.00
Lifetime illicit drug use
Yes	289	221 (76.5)	0.92	(0.64-1.32)	0.20 (0.66)	139	123 (88.5)	0.97	(0.55-1.73)	0.01 (0.92)
No	394	307 (77.9)	1.00		0.20 (0.66)	651	578 (88.8)	1.00		0.01 (0.92)
Lifetime cigarette smoking
Yes	566	444 (78.5)	1.51	(0.96-2.36)	3.28 (0.07)	506	462 (91.3)	1.91	(1.22-2.98)	8.13 (< 0.01) ^#
No	116	82 (70.7)	1.00		3.28 (0.07)	280	237 (84.6)	1.00		8.13 (< 0.01) ^#
Lifetime verbal violence
Yes	477	368 (77.2)	0.99	(0.67-1.46)	0.002 (0.97)	597	536 (90.3)	1.78	(1.11-2.85)	5.88 (0.02) ^#
No	207	160 (77.3)	1.00		0.002 (0.97)	193	162 (83.9)	1.00		5.88 (0.02) ^#
Lifetime physical violence
Yes	408	318 (77.9)	1.13	(0.78-1.62)	0.42 (0.52)	463	416 (89.9)	1.30	(0.84-2.02)	1.35 (0.24)
No	273	207 (75.8)	1.00		0.42 (0.52)	328	286 (87.2)	1.00		1.35 (0.24)
Lifetime sexual violence
Yes	84	62 (73.8)	0.82	(0.48-1.38)	0.57 (0.45)	227	208 (91.6)	1.56	(0.91-2.65)	2.70 (0.10)
No	596	462 (77.5)	1.00		0.57 (0.45)	562	492 (87.5)	1.00		2.70 (0.10)
Knowledge HIV/AIDS
Poor	241	195 (80.9)	1.44	(0.97-2.11)	3.35 (0.07)	280	257 (91.8)	1.66	(1.01-2.73)	4.00 (0.045) ^#
Good	431	322 (74.7)	1.00		3.35 (0.07)	503	438 (87.1)	1.00		4.00 (0.045) ^#
HIV risk self-perception
High/Some risk/Do not know	444	346 (77.9)	1.17	(0.80-1.71)	0.66 (0.42)	539	486 (90.2)	1.54	(0.96-2.45)	3.31 (0.07)
No risk	221	166 (75.1)	1.00		0.66 (0.42)	230	197 (85.7)	1.00		3.31 (0.07)

Characteristics	Men * (n = 665) **		Women * (n = 759)
Characteristics	OR (95%CI)	p-value	OR (95%CI)	p-value
Age > 40 years old	-	-	1.77 (1.08-2.89)	0.02 ^#
To be married or in union	2.46 (1.14-5.32)	0.02 ^#	2.22 (1.22-4.05)	0.01 ^#
Family income in the last month (≤ US$200 ^##)	1.97 (1.15-3.38)	0.01 ^#	-	-
Living with children and/or partner	2.49 (1.14-5.45)	0.02 ^#	1.85 (1.03-3.31)	0.04 ^#
Psychiatric diagnoses (ICD-10)
Psychoses/Bipolar disorder/Depression with psychotic symptoms	1.33 (0.79-2.23)	0.29	-	-
Depression/anxiety	2.63 (1.10-6.27)	0.03 ^#	-	-
Substance use disorder	1.85 (0.95-3.60)	0.07	-	-
No previous HIV testing	-	-	2.06 (1.27-3.34)	< 0.01 ^#
Sex under the influence of drugs or alcohol	-	-	2.52 (1.14-4.46)	0.02 ^#
Lifetime verbal violence	-	-	1.71 (1.02-2.85)	0.04 ^#
Lifetime cigarette smoking	1.86 (1.13-3.07)	0.01*	1.87 (1.16-3.03)	0.01 ^#

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rua Leopoldo Bulhões, 1480 , 21041-210 Rio de Janeiro RJ Brazil, Tel.:+55 21 2598-2511, Fax: +55 21 2598-2737 / +55 21 2598-2514 - Rio de Janeiro - RJ - Brazil
E-mail: cadernos@ensp.fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence E. R. M. Peixoto. Universidade Federal de Minas Gerais. Av. Prof. Alfredo Balena 190, Belo Horizonte, MG 30130-100, Brasil. elianer@ufmg.br