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33. Gender Differences in Hepatitis C and Associated Risks in Persons with Severe Mental Illness

MI Butterfield, Durham VA, Center for Health Services Research in Primary Care, Department of Psychiatry, Duke University Medical Center; HB Bosworth, Durham VA, Center for Health Services Research in Primary Care, Departments of Psychiatry and Medicine, Duke University Medical Center; KG Meador, Durham VA, Center for Health Services Research in Primary Care, Department of Psychiatry, Duke University Medical Center; KM Stechuchak, Durham VA, Center for Health Services Research in Primary Care; LA Bastian, Durham VA, Center for Health Services Research in Primary Care, Department of Medicine, Duke University Medical Center; JW Swanson, Department of Psychiatry, Duke University Medical Center; MS Swartz, Durham VA, Center for Health Services Research in Primary Care, Department of Psychiatry, Duke University Medical Center; RD Horner, Epidemiologic Research and Information Center, Durham VA, Departent of Medicine, Duke University Medical Center; 5 Site SMI HIV Study Group, New Hampshire-Dartmouth Psychiatric Research Center, University of Maryland, Mount Siani School of Medicne

Objectives: Persons with severe mental illness (SMI) are likely to engage in high-risk behaviors for hepatitis C (HCV) infection. Injection drug use is a known risk factor, but the risk of sexual transmission is less clear. Gender differences in rates and risks may also exist. Thus, we assessed gender differences in HCV seroprevalence and risks among persons with SMI.

Methods: From June 1997 - December 1998, SMI persons from 5-sites inclusive of large, small, and non-metropolitan areas (n = 969, 340 women, 629 men) were enrolled in the study. Criteria for inclusion were diagnoses of schizophrenia, schizoaffective disorder, bipolar disorder, depression, or posttraumatic stress disorder. HCV seroprevalence was assessed by the Abbott enzyme immunoassay for HCV antibodies and by supplemental verification of positives. Substance-use and sexual risk behaviors were assessed by a validated structured risk interview, the Aids Risk Inventory.

Results: The observed prevalence rate of HCV in SMI persons was 16.2%. This is much higher than the estimated rate of 1.8% in the general population. The rate in men (19.3%) was twice that of women (9.8%). The following lifetime substance-use risks were significantly associated with HCV seropositive status: IV drug use (OR=35.72; CI=20.42, 64.63), sharing needles (OR=30.75;CI=16.88, 58.57), and smoking crack cocaine (OR=5.88;CI=3.58, 9.91). Among lifetime unprotected sex-risk behaviors, anal sex (OR=1.72;CI=1.08, 2.72), oral sex (OR=1.69,CI=1.07, 2.71), sex for drugs (OR=2.77;CI=1.63, 4.66), and sex for money-gifts (OR=1.63;CI=1.01, 2.56) were significantly associated with HCV seropositive status. Significant gender differences in risk behaviors were observed. For drug risks, women were less likely than men to have ever used IV drugs (OR=0.47; CI=0.29, 0.75), shared needles (OR=0.39; CI=0.21, 0.67), and smoked crack cocaine (OR=0.64;CI=0.44, 0.93). Women were more likely than men to have lifetime unprotected sex-risk behaviors of anal sex (OR=1.65;CI=1.14, 2.38), sex for drugs (OR=2.34; CI=1.41, 3.89), and sex for money-gifts (OR=2.47;CI=1.65, 3.70).

Conclusions: Men and women with SMI have high prevalence rates of HCV. Men were more likely than women to be HCV-infected. Lifetime injection drug use was a significant risk factor for HCV infection among men and women with SMI. Gender differences in HCV risk behaviors were observed, with women being less likely to have drug-risk behaviors and more likely to have sex-risk behaviors than men. The significance of the gender differences in sex-risk behaviors and drug-risk behaviors and the relationship to HCV transmission is unclear and warrants further study.

Impact: The VA strategic initiative on HCV calls for epidemiological screening. Persons with SMI, including veterans, constitute a high risk group that should be routinely screened for HCV. Gender differences in risk behaviors among SMI persons exist. Prevention strategies may benefit from an increased emphasis on drug risks for men and sex risks for women. With increasing numbers of women veterans using VA health services, further research to understand gender differences in risks for HCV is warranted.