Factors associated with HIV transmission risk in people with a severe mental illness. A narrative review

Background. People with a severe mental illness (SMI) are a highly vulnerable group for the transmission risk of the human immunodeficiency virus (HIV). They have a higher seroprevalence compared with the general population and their life expectancy is shorter than those of people without the disease. This narrative review describes individual factors or those inherent to a person's characteristics and the sociocultural factors conditioning sexual behaviour and prevention norms. Objective. The purpose of this narrative review is to describe individual and sociocultural factors associated with the risk of HIV in people with a severe mental illness. Method. 82 empirical studies published between 1981 and 2015, addressing HIV transmission risk factors and sociocultural dimensions related to vulnerability were selected. Four indexes were used for this purpose: ISI Web of Knowledge, Redalyc, SciELO, and PUBMED; and four multidisciplinary electronic databases: Ebscohost Web, ProQuest, Sage Publications and ScienceDirect. Results. The analysis based on coding and systematic categorization shows that people with SMI are more vulnerable to risk than the general population, with differentials based on the severity of the disease symptomatology and economic and sociocultural characteristics associated with HIV-related risk practices. Discussion and conclusion. The need to design longitudinal studies with mixed methodology is proposed to attain a deeper understanding of the interaction of factors associated and processes conditioning risk. In this population group, structural preventive programs that take into account social and gender inequality must be implemented.