A survey of risk behaviour for contracting HIV among adult psychiatric patients. A South African study - Part 1.

OBJECTIVE: Various studies have reported increased prevalence of HIV infection among psychiatric patients. Psychiatric patients are under-evaluated in terms of their HIV risk behaviour. The study sought to establish the prevalence of HIV risk behaviour and determine the association between risk behaviour and demographic and clinical variables. METHOD: Participants were 113 consenting adult in-patients. A structured interview was conducted with each participant. A total risk behaviour score was calculated. From the risk score, three risk behaviour categories were identified: 0 = no risk; 1 to 3 = medium risk; 4 to 9 = high risk. Associations between HIV risk behaviour and demographic and clinical variables were analysed. RESULTS: Of the 113 participants, 68% were men and 32% women. The mean age was 38. Forty-five per cent were sexually active and 48% fell into the "no-risk group", 29% in the "medium-risk" group, and 23% in the "high-risk" group. Female patients with a history of treatment for sexually transmitted disease and a diagnosis of personality disorder were associated with being sexually abused. Having multiple sex partners was associated with diagnoses of substance-related disorders and cognitive disorders. Sex with someone known for less than 24 hours was associated with long-term hospitalisation and diagnoses of cognitive and personality disorders. CONCLUSION: The study confirmed that mentally ill patients are vulnerable and may be victimised. The study also suggests that mental illness may impair appreciation of consequences and lead to high-risk behaviour for contracting HIV. Special care should be taken to protect female patients in psychiatric institutions.

A survey of HIV-related knowledge among adult psychiatric patients. A South African Study - Part 2.

OBJECTIVE: Studies have reported an increased prevalence of HIV infection among psychiatric patients. Inaccurate HIV knowledge is included as a factor in the increased risk of HIV infection in the mentally ill, but few studies have looked specifically at this factor. The aims of the study were to determine the knowledge of HIV and its transmission among adult psychiatric patients at Weskoppies Hospital and to determine the relationship between HIV knowledge and HIV risk behaviour. METHOD: Structured interviews were conducted with 113 consenting adult patients at Weskoppies Hospital. They were divided into three groups according to their length of hospital stay. The structured interview included questions about demographic data, the diagnoses and the AIDS Risk Behaviour Knowledge Test (AIDS-KT). Scores of 13 out of 13 represented accurate knowledge of HIV (level I); scores of 10-12 represented good knowledge (level II); scores of ≤ 9 represented poor knowledge (level III). RESULTS: A total of 104 patients (92%) demonstrated excellent knowledge of HIV and its transmission (levels I and II). There was no significant linear association between HIV knowledge and risk-behaviour scores (Pearson's correlation coefficient r= -0.11). CONCLUSION: The presence of high-risk behaviours despite good HIV-related knowledge in this group of patients, leads us to think that knowledge alone will not limit HIV risk behaviours. For this reason, educational programmes should not be limited to interventions that simply increase knowledge about HIV infection but should extend to clinical factors, including patients' motivation and readiness to change their behaviour.

Thrombectomy in HIV related peripheral arterial thrombosis: a preliminary report.

OBJECTIVES: To evaluate the limb salvage rate in patients undergoing thrombectomy for HIV related peripheral arterial thrombosis. METHODS: A prospective review of patients with HIV related peripheral arterial thrombosis managed at the Durban Metropolitan Vascular Service in Kwazulu-Natal South Africa over a 5-year (1998-2003) period. All patients underwent thrombectomy. RESULTS: Twenty-two patients (20 males) with HIV related peripheral arterial thrombosis (two upper limbs, 20 lower limbs) were included in the study. The median age was 36 years (24-46 years). All patients had rest pain and seven patients had gangrene (digital five, forefoot two). Seven patients had a short history of claudication before development of rest pain. Mean duration of symptoms was 30 days (1-120 days) with 10 patients presenting within 24 h. Most patients had a good general state of health and only three had clinical evidence of HIV infection. Ten patients who presented with threatened limbs from acute arterial occlusion were subjected to thrombectomy without any diagnostic investigations. Twelve patients who did not present with critical limb ischaemia had duplex ultrasonography, which showed arterial occlusion by a thrombus with normal proximal arteries. The striking features were the normal proximal vessels and absence of distal run-off. The search for an underlying cause, echocardiography in seven patients and coagulation screening in 10 patients, was always negative. All patients were subjected to thrombectomy with an on-table angiogram and received systemic heparin intra-operatively and deltaparin post-operatively. In 20 patients, duplex ultrasonography confirmed re-thrombosis within 48 h. Two patients remained with patent arteries. Most (16/20) patients who re-thrombosed required a major amputation and thrombectomy did not alter the level of amputation. The other four patients with re-thrombosis had symptomatic relief. Three patients died within 30 days of thrombectomy, all of HIV related complications. Overall the limb salvage rate was 6/22 (27%). CONCLUSION: Limb salvage rate following thrombectomy in HIV related peripheral arterial thrombosis is very low. Duplex ultrasonography appears to be an adequate radiological diagnostic investigation for these patients.