THE RELATIVE CONTRIBUTIONS OF PSYCHIATRIC-SYMPTOMS AND AIDS KNOWLEDGETO HIV RISK BEHAVIORS AMONG PEOPLE WITH SEVERE MENTAL-ILLNESS

Background: This study was designed to determine whether psychiatric s ymptoms and acquired immunodeficiency syndrome (AIDS) knowledge predic t human immunodeficiency virus (HIV) risk behavior among people with s evere mental illness. Method: We interviewed 178 psychiatric patients to determine Axis I diagnosis, level of functioning, severity of psych iatric symptoms, knowledge about AIDS, sexual risk behaviors in the pr evious 6 months, and drug injection since 1978. Severity of psychiatri c symptoms was rated on the Positive and Negative Syndrome Scale withi n the classification of positive, negative, cognitive, excited, and de pressed/anxious symptoms. Results: Ninety-two patients (51.7%) reporte d being sexually active in the previous 6 months. Of sexually active p atients for whom data were available, 44 (47.8%) of 92 had multiple se x partners; 32 (35.2%) of 91 used drugs during sex; 27 (29.7%) of 91 t raded sex for drugs, money, or other goods; and 50 (58.1%) of 86 never used condoms. Thirty-one patients (17.5%) had drug-injection historie s. The median AIDS knowledge score was 23 (82.1%) of 28. Although AIDS knowledge was negatively correlated with cognitive and negative sympt oms and positively correlated with excitement, knowledge alone did not predict any risk behavior. However, when AIDS knowledge was taken tog ether with age and excited symptoms, the odds of being sexually active versus abstinent were three times higher among patients with better A IDS knowledge and twice higher among patients with greater excited sym ptoms. Having multiple sex partners was nearly three times as likely a mong patients with greater positive symptoms. Trading sex was more tha n three times as likely among patients with schizophrenia than among t hose with other diagnoses and more than five times as likely among tho se with more excitement symptoms. Conclusion: Patients, particularly t hose who were sexually active, were well informed about AIDS. Specific psychiatric conditions, including the presence of positive and excite d symptoms and a diagnosis of schizophrenia, predicted certain sexual risk behaviors and must be the focus of innovative prevention efforts.