Sexual risk factors among HIV-infected individuals presenting at a mental health clinic

Background: Secondary prevention efforts among HIV-infected populations have focused on reducing high-risk sexual behaviors. This study was conducted to examine the prevalence of unprotected sexual behaviors and its relationship with psychological distress among HIV-infected individuals.

Methods: Assessments were completed upon self-enrollment in HIV-related mental health care. Participants were classified into sexual risk categories, as determined by their reported unprotected sexual activity within the past 30 days: receptive anal or vaginal sex (high), insertive anal or vaginal sex (moderate), oral sex (low), and no sexual active (no). The Brief Symptom Inventory was used to measure psychological distress.

Results: A total of 1037 individuals enrolled into mental health care between May 2002 and December 2007, 16% of which were classified as high-risk, 5% moderate-risk, 11% low-risk, and 67% no-risk categories. The high-risk group reported unprotected receptive anal sex 3.2+5.3 times and unprotected receptive vaginal sex 3.1+3.6 times within the past 30 days. The majority of the high-risk group reported 1 sex partner for anal sex (66.7%) and vaginal sex (82.1%) within the past 30 days. The moderate-risk group reported unprotected insertive anal sex 3.2+5.3 times with 1.4+1.5 partners, insertive vaginal sex rarely occurred. The low-risk group reported having unprotected oral sex 5.0+11.1 times with 1.7+2.1 partners. Dimensions of psychological distress did not differ by risk category.

Conclusions: While this sample was not remarkably sexually active, there is still substantial risk among this population. These findings indicate a need to further incorporate sex-related prevention efforts among individuals with HIV.