Presentation on theme: "NIMH - R01 MH65163-01: Brazilian HIV Prevention for the Severely Mentally Ill - Inside The Institution: Ethnography Demonstrates The Need for an HIV Prevention."— Presentation transcript:
NIMH - R01 MH : Brazilian HIV Prevention for the Severely Mentally Ill - Inside The Institution: Ethnography Demonstrates The Need for an HIV Prevention Intervention P L E Mattos 1, M L Wainberg 2, D Pinto 1, C Grubber-Mann 1, S Oliveira-Broxado 1, D Feijo 1, T Dutra 1, C Lihnares 1, C Passarelli 3, U S B Prissma Project 1, 2, 3 3 ABIA Associação Brasileira Interdisciplinar de AIDS 2 HIV Center for Clinical and Behavioral Studies New York State Psychiatric Institute Columbia University 1 Instituto de Psiquiatria Universidade Federal do Rio de Janeiro Brazil Themes Low condom use and low condom satisfaction: “O. also told me that people are not used to protecting themselves when they have sex in the wards.” “I tried once with condom, but it’s too annoying, you see? I think that what bothers, squeezes, stick on the pubic hair, gives a kind of … It sucks, it gives a hell of a headache, you see?” “you’ll always have to live with that, that stupid annoying condom, that thing that does not … you know ?It’s got nothing to do, it’s a strange element. It takes away half of the pleasure...” “but using condoms is much more dangerous, the condom might break.” Fear of stigmatizing: “cause when I use a condom with a woman, I think I’ll … uh, like be hurting her, thinking that she’s sick.. Well, I keep this in my head …” Regret of no using condoms: “Oh! We think about it later, but right at the moment it’s just the desire to have sex, and then the regret. After you cum, there’s the regret...” SMI internalized stigma: “But if I have to have sex with a woman outside the hospital, I won’t use the condom. I don’t think that it is risky, it is my concept, right?” “Now, this HIV thing is also a mental thing, you know? I’ve already had a very weak mind; I was considered a hypochondriac person …” “As a crazy person, I can not choose (partners), I can only be chosen” God as protection: “I think that He is aware of everything that He’ll do to me.” “God” SMI sexuality only perceived as a pathology: “It depends a lot on the patient, right? …we mentioned the differences among the in-patient, the outpatient and the day hospital one. And the sexualities of all these three types of patients are very different, right?” Lack of institutional guidelines: “Dealing and handling patients’ sexual behaviors and habits are not part of the policies of the institution” “People here don't talk about that (the patients' sexuality), they prefer to say that it doesn't happens here” Recommendations Psychiatric Institutions need to address HIV prevention in a systematic process that should include training of providers and development of an HIV prevention intervention for their SMI patients. Issues People with severe mental illness (SMI) are at elevated risk for HIV-4% to 23% seroprevalence-in the U.S., among whom several prevention interventions have been found efficacious. Despite the Brazilian government's commitment to HIV prevention, psychiatric facilities do not offer HIV prevention interventions and lack trained staff to intervene effectively. Our NIMH-funded US-Brazil project, "Brazilian HIV Prevention Intervention for the SMI," conducted formative research in 2 psychiatric settings using ethnography to determine HIV prevention needs and to inform the adaptation process of extant HIV prevention interventions. Besides adapting and piloting an HIV prevention intervention for men and women with SMI, our goals include: imparting skills to mental health care providers (MHCP) to help their SMI clients reduce their HIV risk behaviors; establishing an infrastructure for further research; and guaranteeing community participation throughout the study. Description 9 months of formative research in 2 psychiatric settings included: a. 350 hours of ethnographic observations b. 9 focus groups: 6 with M/F SMI, n=45 & 3 with MHCP, n=27 c. 18 in-depth interviews with key informants: 12 M/F SMI & 6 MHCP Atlas software was used to analyze all data Lessons Learned Triangulation data analysis revealed that SMI: a.are sexually active and use condoms infrequently b.are subject to stigma (HIV + and/or SMI) which may increase risk c.are comfortable talking about sex and d.want to learn HIV prevention skills e.can function as peer-educators. Institutionally: a.there are no explicit policies regarding sexual behavior b.MHCP address HIV prevention idiosyncratically c.there is need for training and for systematic HIV prevention interventions.