ABSTRACT
Background: People
with psychiatric disorders are at increased risk to HIV, Hepatitis B C and
Syphilis infections as compared to general population. Many risk behaviours
have been identified in studies from both developed and developing countries.
The psychiatric population is usually neglected in terms of prevention and
control programs as compared to the general population.
Aim: This
research is the first of its kind in Ghana and seeks to determine the
prevalence of HIV, HBV, HCV and Syphilis infections, its related risk
behaviours among people with psychiatric disorders at the Ankaful psychiatric
hospital.
Methodology: This is a
cross-sectional study of the Ankaful psychiatric hospital with a total
of 200 in-patients and out-patients surveyed. Participants (male/female) who
were included in the study were clinically stable and above 18 years old.
Questionnaire was administered on socio-demographic characteristics,
psychiatric disorders, knowledge, attitude and substance use/abuse risk related
practices for HIV, HBV, HCV and Syphilis infections. Serologic test was done
for HIV, HBV, HCV and Syphilis after interview.
Results: The results
revealed that, 55% (n=110) were male whilst 45% (n=90) were female. The
mean age was 35.60 and most participants were in the age group 20-39 years i.e.
64.5% (n=129) as compared to 4.5% (n=9) for the age group of less than 20 years
and above 60 years respectively.
Conclusion: The overall
prevalence of HIV (5.0%), HBV (9.5%), HCV (2.0%) and Syphilis (13.5%)
were recorded. Multiple infections to HBV+Syphilis (0.5%), HBV+HIV (1.0%)
HBV+Syphilis (0.5%) and HIV+HBV+Syphilis (0.5%) respectively.
CHAPTER 1
1.0 INTRODUCTION
Psychiatric patients are at risk of being infected with Human
immunodeficiency virus (HIV), Hepatitis B virus (HBV), Hepatitis C virus (HCV)
and Syphilis infections since they lack knowledge about contraception and may
make poorer decisions regarding sexual behavior (Sikkema, 2007). Relationships
between people with psychiatric disorders and HIV, HBV, HCV and Syphilis
infections may exist because patients with complex and varied social and sexual
interactions may experience higher needs for both types of services.
Alternatively, people with psychiatric disorders may exhibit less conscious
control over their sexual interactions because of feelings of worthlessness,
restlessness, boredom or anxiety (Carey et al., 2001).
A research conducted by the World Health Organization (WHO)
on updates of the AIDS epidemic revealed that, about 33million HIV persons are
chronically infected (WHO, 2007), 170 million with HCV (WHO, 2002), 350 million
with HBV (WHO, 2004) and also 12 million people acquire Syphilis infections
each year (WHO, 2001). Majority of the people affected are found in the
developing countries. HIV, HBV, HCV and Syphilis infections are the most
prevalent STIs which have similar transmission routes, mostly through
unprotected sex, needle/razor sharing, blood transfusion, and offering of
drugs, shelter or food in exchange for sex which is of public health concern.
A research conducted by the WHO in 2001 to determine the prevalence
and incidences of some selected curable sexually transmitted infections found
out that, about 450 million people suffered from psychiatric or behavioural
disorders, making it the fourth (4th) leading cause of disability in the world.
Due to neuropsychiatric disorders, the WHO estimated an increase between 10.5%
to 14.7% from 1990 to 2020 and also ranked major depression second after ischemic heart disease which is
anticipated to be higher in developing countries.
Over the past two decades, a lot of articles have reported
increased rate of STIs including HIV and AIDS, Hepatitis B and C virus, and
Syphilis infection among people with psychiatric disorders (Hughes et al.,
2015). Comparable estimate of HIV infections in the overall US adult’s
non-psychiatric and the psychiatric population is approximately 0.3% to 0.4%
(NCHS, 2009). Relative to the general population, research has shown that women
with psychiatric disorders appear to be at higher risk (estimated infection
rate of 5% vs. 0.17%) for sexually transmitted infections (Marks, Senterfitt
& Janssen, 2005)
Published studies has shown that, people with psychiatric
disorders appears to be at increased risk of HIV, HBV, HCV and Syphilis
infections and these people may indulged in risky sexual practices such as
having multiple sexual partners, inconsistent condom use, same sex sexual
activity and sex in exchange for money or drugs (Sikkema, 2007).These risk
factors coupled with poverty and neglect among people with severe mental
illness raises the concern that this population is at risk HIV, HBV, HCV and
Syphilis infections.
In 2001, one hundred and eighty heads of states and
government representatives declared commitment on HIV and AIDS acknowledging that,
the epidemic constitutes a Global emergency and one of the most formidable
challenges to human life and dignity in the first ever special session of the
United Nations General assembly. In addressing this emergency, which sub-Sahara
Africa is the worst affected region in the world (Fitzpatrick et al., 2004),
there needs to be an urgent analysis of the situation in all spheres of the human
population especially the most at risk groups which includes people with
psychiatric disorders.
A research conducted by World Health Organization(WHO) in the
early 1990s validated a panel of neurological, neuropsychiatric and
psychological measures across five geographical areas (Thailand, Zaire, Germany, Kenya and
Brazil) with participants of varied risk behaviors and stages of HIV diseases
(including seronegative participants) (Maj et al., 1994) . In all sites and
across risk behaviors, they found a higher rate of depressing symptoms
(affective and somatic) in symptomatic HIV-positive participants than in
seronegative participants (Maj et al., 1994) as well as higher rate of
cognitive impairment. Evidence was found in some sites that low educational
status among asymptomatic HIV positive participants was associated with impaired
neuropsychological performance compared to seronegative participants (Maj et
al., 1994) concluding the fact that there is actually a relationship between
HIV, HBV, HCV and Syphilis infections and psychiatric disorders.
A case control study conducted in London found out that Black
Africans were nearly three times likely to be referred for mental health
assistance than the general population of patients (Malanda et al., 2001) and
were more likely to be suffering from STIs including HIV and AIDS at the time
of referral indicating that racial lines (i.e. Black Africans ) stand the
chance to be the hardest hit in terms of mental illness and HIV, HBV, HCV and
Syphilis infections.
There are no publish data on HIV, HBV, HCV and Syphilis
infections among psychiatric patients in Ghana to address risk because of the
relationship between psychiatric disorders and HIV, HBV, HCV and Syphilis
infections is an important research focus with implication for preventive
programs.
Despite the growing epidemic in sub-Sahara Africa, almost all
the research on mental health aspects of HIV, HBV HCV and Syphilis infections
has been done in Europe, America and Southern Africa, much more studies have
not been done in West Africa and none can be said about Ghana to effectively address
the concerns. This research therefore seeks to determine the prevalence of HIV, HBV, HCV and
Syphilis infections and its risk related practices among people with
psychiatric disorders.
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