title: Predictors of high and low levels of HIV risk behavior among adults with chronic mental illness.
abstract: OBJECTIVE
  Several recent studies confirm elevated rates of human immunodeficiency virus infection among acute and chronic mentally ill adults in large urban areas. This research sought to characterize risk for HIV infection among adults with chronic mental illness and to examine psychosocial factors predictive of risk.
  
  
  METHODS
  Two hundred and twenty-five adults with chronic mental illness who were sexually active in the past year outside of exclusive relationships were individually interviewed in community mental health clinics using a structured HIV risk assessment protocol.
  
  
  RESULTS
  More than 50 percent of the study participants were sexually active in the past month, and 25 percent had multiple sexual partners during that period. Fifteen percent of the men had male sexual partners. In more than 75 percent of occasions of sexual intercourse, condoms were not used. When participants were categorized as at either high or lower risk for HIV infection based on their pattern of condom use, psychosocial factors that predicted risk level included measures of participants' self-reported efficacy in using condoms, perceptions of social norms related to safer sex among peers and sexual partners, and expectations about outcomes associated with condom use, as well as participants' level of objectively assessed behavioral skills in negotiation and assertiveness in sexual situations.
  
  
  CONCLUSIONS
  Interventions aimed at prevention of HIV and AIDS are urgently needed in settings that provide services to persons with chronic mental illness.
authors.affiliation: Department of psychiatry and behavioral medicine, Medical College of Wisconsin, Milwaukee 53226, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Kelly
authors.forename: D A
authors.initials: DA
authors.lastname: Murphy
authors.forename: K J
authors.initials: KJ
authors.lastname: Sikkema
authors.forename: A M
authors.initials: AM
authors.lastname: Somlai
authors.forename: G W
authors.initials: GW
authors.lastname: Mulry
authors.forename: M I
authors.initials: MI
authors.lastname: Fernandez
authors.forename: J G
authors.initials: JG
authors.lastname: Miller
authors.forename: L Y
authors.initials: LY
authors.lastname: Stevenson
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000523:psychology / Q000635:transmission*; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology* / Q000534:rehabilitation; D008875:Middle Aged; D010353:Patient Education as Topic; D012725:Sexual Behavior