Abstract
We wish to congratulate the authors for their recent article regarding this important public health, mental health and sexual health problem [1].
HIV infection, in particular, has been known to be a major problem for patients with severe mental illness (SMI), for at least the last 10 years [2]. As stated in the review, there has only been recent research identifying hepatitis infections as also problematic for patients with severe mental illness [3].
However, there are suggestions that other notifiable sexually transmissible infections (STIs) such as chlamydia, gonorrhoea and syphilis may also be prevalent [4, 5]. Assessments for HIV should always review STIs and other Blood Borne Viruses (BBVs) because of the recognized synergy [6, 7].
Both STI and BBV infections are related to behavioural factors that affect the chance of exposure to an infection and biological factors that affect acquisition. Behaviours may be sexual such as anal sex, drug use such as sharing injecting equipment or health care such as delaying medical care.
Most research in this patient group has been related to identifying risk behaviours for patients with SMI, although this has been hampered by methodological problems. There have been two Australian studies looking at risk behaviours for patients with SMI [8, 9]. When we compared findings from these studies with the recent Australian behavioural phone survey [10-13], we found that patients with SMI were more likely to indulge in risky sexual and drug behaviours [10] overall, but some behaviours were more consistent for patients with SMI such as of condom use with last sexual contact [11] and HIV testing [12].
The STI and BBV infections from risk activities are mostly preventable. Analysis of the extent of problems and solutions is required. Epidemiological research and implementation of programs that are appropriate for patients with severe mental illness are needed. The STI and BBV infections should not add to the health burden of patients with SMI.