1. Sexual Risk Behaviors and Sexually Transmitted Infection (STI) Prevalence in an Outpatient Psychiatry Clinic LH Bachmann 1,2, J Feldman 1, Y Waithaka 1 and EW Hook III 1 1 University of Alabama at Birmingham, Birmingham, AL; 2 Birmingham Veterans Administration Medical Center, Birmingham, AL

2. Background 1 in 5 Americans will have a diagnosable mental disorder during the course of a year 5% of adults have serious mental illness Mental illness may result in behaviors that place patients at risk for STI acquisition Few data are available regarding sexual risk behavior and STI prevalence among patients receiving care for chronic mental illness

3. Objectives To determine sexual and substance use risk behaviors in patients receiving care at the University of Alabama at Birmingham (UAB) Community Care Psychiatric Outpatient Clinic To determine the prevalence of C. trachomatis, N. gonorrhoeae, and T. vaginalis in this population

4. Methods Beginning July 2003, male and female patients between 18 and 50 years of age were consecutively approached for study participation Consenting participants underwent an interviewer-administered survey Chart review was performed for DSM-IV diagnoses

5. Methods Urine (male) or self-obtained vaginal swabs (female) were obtained for nucleic acid amplification (GenProbe Aptima Combo 2) testing for C. trachomatis and N. gonorrhoeae Women submitted self-obtained vaginal swabs for T. vaginalis culture Patients identified with infection were treated according to the 2002 CDC STD Treatment Guidelines

6. Analyses Statistical analyses were performed using SAS version 9. For categorical variables, Mantel-Haentszel chi- squared analysis and Fisher’s Exact tests were used as appropriate. For continuous variables, t tests were used to compare means between groups. P<0.05 was considered significant

7. Study Population N = 275 Female N = 126, No (%) Male N = 149, No (%) P value Age (Mean)39.737.40.05 Race White35 (28)44 (30)0.75 African- American Other 87 (69) 4 (3) 98 (66) 7 (4) Marital Status SNM51 (40)109 (73) <.0001 Married12 (10)13 (9) Div./Sep.53 (42)27 (18) Widowed/Other10 (8)0 (0)

8. Study Population N = 275* (Cont’d) Female N = 126, No (%) Male N = 149, No (%) P value Education (Mean Years)12.211.90.40 Insurance Status Medicaid91 (73)98 (67)0.37 None30 (24)40 (28) Private Non-psychiatric medical care/12 mo* History of imprisonment 4 (3) 83 (66) 46 (37) 8 (5) 69 (48) 90 (61) 0.003 <0.0001 *Denominators include those who answered question

9. DiagnosisFemale N = 121, No (%) Male N = 138, No (%) P value Psychotic Disorder56 (46)110 (80)<0.0001 Depression43 (36)20 (14)<0.0001 Substance Abuse15 (12)24 (17)0.26 Bipolar19 (16)11 (8)0.05 Personality Disorder11 (9)8 (6)0.31 Anxiety Disorder9 (7)3 (2)0.04 DSM-IV Diagnosis by Gender N=259*

10. Stability Indicators Psychiatric hospitalization since last visit – 18 (7%) Emergency Department since last visit – 34 (13%) Jail since last visit – 7 (3%)

11. Reported Sexual Behaviors N=259 Female N = 121 Male N = 138 P value Type partner Male114 (95)3 (2) Female3 (2)128 (93) Both4 (3)7 (5) History of STD68 (56)40 (29)<0.0001 Sex for drugs11 (9)9 (7)0.45 Number partners/6mo / Median (range)1 (0-70)1 (0-40) Sex in last 30 days63 (52)51 (37)0.01 New partner/30d+5 (8)15 (29)0.04 Condom use Any52 (43)78 (57)0.03 100%21 (18)42 (31)0.01 +Denominator includes those reporting sexual activity in last 30 days

12. Substance Use Behavior Female N=121 No; (%) Male N=138 No;(%) P value Alcohol Use/30 days 46 (38)58 (42)0.48 >5 drinks/30d11 (9)19 (14)0.24 Use of alcohol or drugs during sex 10 (8)30 (22)0.003 Illicit Drugs/6mo*44 (36)47 (34)0.70 *Sedatives, pot, ecstasy, ghb, poppers, speed, hallucinogens, cocaine or IV drugs

13. STI Prevalence Female N = 121 No (%) Male N = 138 No (%) C. Trachomatis4 (3.4)4 (2.9) N. Gonorrhoeae2 (1.7)0 T. Vaginalis19 (16.2)N/A

14. Infected Not Infected OR (95% CI) Race African-American251516.71(1.49- 49.05);P=0.004 White/Other281 Care 12 mo Yes13129.70 (.32-1.57); P = 0.39 No1498 Genitourinary Symptoms Present Female Yes10232.50(.97–6.47); P = 0.05 No1375 Male Yes06P = 0.67 No4128

15. Infected Not Infected OR (95% CI) Sex in last 6 mo Yes211462.06 (.80-5.31); P = 0.13 No686 >5 Drinks/30d Yes5251.88 (0.65-5.41) P=0.23 No22207 Illicit Drugs/ 6mo Yes11801.31 (0.58-2.95) P=0.52 No16152 Use During Sex Yes337.65 (0.19-2.28) P=0.50 No24193

16. Conclusions Sexual behavior was heterogeneous in this chronically mental ill population 1 in 10 patients were infected with an STI, with almost a quarter of cases in patients who denied sexual activity in more than 6 mo Symptoms were not predictive of STI in men

17. Conclusions Race was the only significant predictor of infected status Routine STI screening in this setting may reach a group of individuals not captured through other methods

18. Acknowledgements jRosalyn Mallory jPrashant Tayshetye jCoretta Thomas jOlivio Clay jSharron Hagy jMarga Jones