Sexual Risk Behavior, Sexual Violence, and HIV in Persons With Severe Mental Illness in Uganda: Hospital-Based Cross-Sectional Study and National Comparison Data

Objectives. We investigated prevalence of past-year sexual risk behavior and sexual violence exposure in persons with severe mental illness (SMI) in Uganda, and compared results to general population estimates. We also investigated whether persons with SMI reporting sexual risk behavior and sexual violence exposure were more likely to be HIV-infected. Methods. We included 602 persons consecutively discharged from Butabika Hospital, Kampala, Uganda, February to April 2010. We asked about past-year number of sexual partners and condom use. We assessed sexual violence with the World Health Organization Violence Against Women Instrument. We performed HIV testing. We used data from 2011 Uganda Demographic and Health Survey for comparison. Results. Women with SMI had more sexual risk behavior and more sexual violence exposure than women in the general population. We found no difference in sexual risk behavior in men. Sexual risk behavior was associated with HIV infection in men, but not women. Sexual violence exposure was not associated with HIV infection in women. Conclusions. Findings suggest that SMI exacerbates Ugandan women's sexual vulnerability. Public health practitioners, policymakers, and legislators should act to protect health and rights of women with SMI in resourcepoor settings.