Prevalence and Factors Associated with Risky Sexual Behaviors among Patients with Severe Mental Illness in Uganda: A Descriptive Cross Sectional Study

Background: Persons living with severe mental illness (SMI) which includes schizophrenia, bipolar affective disorder and recurrent major depressive disorder are predisposed to risky sexual behavior (RSB). There is a paucity of data on this problem in sub-Saharan Africa and where research has been undertaken, only a limited range of risk factors have been considered and most of it was undertaken before antiretroviral therapy was universally available, hence the need for this study. The objective of this study was to determine the prevalence and factors associated with risky sexual behavior among individuals with SMI attending care in central and south western Uganda. Methods: A cross sectional study was conducted among 393 persons with SMI attending two psychiatric out-patient facilities in Uganda. Psychiatric disorder was confirmed using MINI International Neuropsychiatric Interview version 7.2. RSB was defined as engaging in at least one of four risky sexual behaviours that have been associated with HIV infection in the Ugandan psychosocial environment in the last three months using an 8 item RSB questionnaire used for assessment of RSB. Prevalence of RSB and associated correlates were determined using multiple logistic regression. Results: The Prevalence of RSB in last 3 months’ periods was 24.2% (95% CI: 20.2% - 28.7%). The factors that were independently significantly associated with RSB were: trauma related (history of childhood trauma, past and current sexual abuse, past and current physical abuse) current psychosocial challenges (mental health stigma) and psychiatric illness factors (history of a past manic episode, current psychotic episode, severity of depressive symptoms and severity of manic symptoms). Conclusions: One quarter of clinic attending respondents with severe mental illness in Uganda practice risky sexual behaviour. Factors associated with risky sexual behaviour fall under the domains of past and present trauma, current psychosocial challenges and psychiatric illness factors. This calls for a multi-sectoral approach that includes community awareness about the nature of SMI and the rights of persons with SMI and measures to improve Psychiatric symptom management.

Sexual Behaviour of Congolese Teenagers

Introduction: Sexual risk behaviour among adolescents is a public health problem worldwide. Widely studied in the Western countries, this problem has only been addressed partially in Brazzaville. Thus, 12 years later, we conducted this study with the aim of analysing the sexual behaviour of adolescents in Congo. Patients and Methods: This was a cross-sectional and analytical study from January to August 2019 (8 months). It involved 2000 adolescents residing in the departments of Brazzaville and Pointe-Noire constituting the urban population, and those of Cuvette and Bouenza, the rural population. Results: A total of 1167 adolescents reported being sexually active. The mean age at first sexual intercourse differed between the two sexes (p < 0.0005). Of the adolescents surveyed 96.1% (n = 1122) claimed to have ever heard of HIV/AIDS infection and 8.7% (n = 101) to have ever contracted sexually transmitted infections. The main channel of information was school in 57.7%. Condoms were the only means of protection (85.5%). The factors associated with risky sexual behaviour were, on the one hand, those related to the adolescent (lack of schooling, orphan status, alcohol and tobacco consumption, paid employment and possession of a mobile phone). On the other hand, those related to parents (low level of education, mother’s employment status and single-parent household structure). The frequency of sexually active adolescents was similar in both settings (p < 0.05). The rates of adolescents having ever heard of HIV/AIDS were almost similar with a slight predominance in urban areas (p < 0.09). Early sexual intercourse (72.6%) and/or multiple partners (24.9%) were more frequent in rural areas (p > 0.05). Homosexuality was found in 4.6% in urban areas and 3.8% in rural areas (p > 0.05). Extra-vaginal sex accounted for 16.4% in urban areas and 7.9% in rural areas (p = 0.001). Non-consensual sex was more common in urban areas (17.4%) than in rural areas (5.8%) (p = 0.001). Incestuous sex was reported in 6.2% of cases (urban) and 4.2% (rural) (p > 0.05). Conclusion: Sexual risk behaviour is real among adolescents in the Congo. The advanced modernization marked by the abundance of mass media in urban areas favours the predominance of these behaviours in the city. The consequences are serious and can compromise the future of adolescents;hence the importance of prevention.