A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the speciality of Psychiatry.
Johannesburg, September 2015 / BACKGROUND
Human Immunodeficiency virus infection remains a fearsome health condition and South Africa remains the epicentre of the pandemic. The relationship between HIV and psychiatric disorders is clearly established. Patients in mental institutions fit into the definition of key populations due to the higher incidence of the condition in relation to the general population. Whereas the prevalence in the general population has been thoroughly researched over the years, the magnitude and distribution of HIV/AIDS in psychiatric patients is not consistently studied and little is known about the sub-group of forensic patients in South Africa. The aim is to determine the prevalence of HIV and describe the socio-demographic characteristics of inpatients in a forensic unit in a psychiatric hospital in South Africa.
OBJECTIVES
The objectives of this research study are:
To describe the socio-demographic characteristics of the forensic inpatients.
To describe the psychiatric disorders of forensic inpatients.
To describe the types of crime necessitating admission to the forensic unit.
To ascertain the HIV seroprevalence of forensic inpatients.
METHODS
A cross-sectional study design was employed. Data was extracted retrospectively from inpatient records on socio-demographic characteristics and health status, including HIV status, using a standardised data collection tool. The study population consisted of all adult patients admitted at Sterkfontein Hospital from 01 January 2007 - 31 December 2011 on forensic grounds, in terms of Section 42 of the Mental Health Act 17 of 2002, with a concomitant psychiatric disorder and undergoing care at the forensic unit. Ethical clearance was obtained from the Human Research Ethics Committee of the University of the Witwatersrand and the Hospital Research Committee.
RESULTS
A total of 137 subjects were studied. The study subjects comprised of mainly males (92%), a large number of unmarried people (84.7%) and people who were unemployed (89.8%) at the time of admission. The mean age was 36 years with 75% of the inpatients aged less than 43 years on admission.
Two diagnoses accounted for over 80% of the patients with an Axis l diagnoses, namely: schizophrenia (49.1%) and psychosis secondary to GMC (31.2%). Axis II diagnoses were made in 67 patients and the conditions were mainly Mental Retardation (MR) and Anti-social Personality Disorder (ASPD), both accounting for 94.2% of the diagnoses made.
Multiple crimes were committed by 21% of study subjects and serious offences included: rape (45.3%); assault with grievous bodily harm (32.9%); theft (19.7%) and murder (19%). These accounted for almost 90% of the crimes that led to admission.
Serological test for HIV were done on 124 (90%) of the patients and the HIV seroprevalence proportion was 21.8%. The highest prevalence of 37.5% was found in patients with bipolar mood disorder followed by mood/psychosis secondary to GMC and psychosis NOS at 35.3%. However, there was no statistically significant association between HIV status and Axis l diagnoses. Further analysis also revealed no statistically significant association, at p<0.05, between HIV status and Axis II diagnosis, gender, age, marital status, educational status, employment status, access to disability grants and substance use. However, previous crime was statistically significantly associated with HIV status.
CONCLUSION AND RECOMMENDATION
The seroprevalence of HIV in the Sterkfontein Hospital Forensic Unit is higher than the general population and justifies recognition of forensic psychiatric patients as a key population. With the exception of previous crime, there is no clinical (DSM Axis I and II diagnoses) nor socio-demographic factor associated with HIV status.
Furthermore, HIV test was not done for 10% of the patients. Efforts should be made to make an early diagnosis among all patients, and manage the condition appropriately, with treatment offered to all eligible patients.
Policies and procedures should be formalised to obtain 100% diagnostic testing of all patients. A comprehensive programme of action should be instituted and maintained to prevent transmission within the institution and break the cycle of transmission within the general society.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/19534 |
| Date | January 2015 |
| Creators | Beke, Masase G |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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