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Background: Persons with mental health issues are more likely to engage in risky sexual behaviors - like sex without a condom, substance abuse, and multiple partners - significantly increasing their risk of contracting an STD. The Southeast STD Clinic piloted mental health and substance abuse screening to assess the feasibility of expanding services beyond the identification and treatment of infections.
Methods: From August 1 through September 30, 2012 all clients were screened using the Global Appraisal of Individual Needs – Short Screener (GAIN-SS). Clients with high scores – which depended on the severity, quantity, and timing of symptoms – were counseled and linked to services, if needed. Pearson’s chi-squared statistics were used to analyze associations between selected risk factors and need for referral.
Results: We screened 1,212 patients for mental health and substance abuse issues, 967 (79.8%) had scores that warranted additional assessment and 652 (67.4%) were counseled. Of those, 64 (9.8%) were already in care and 200 (30.7%) needed a referral for services. Of those, only 21 (10.5%) reported always using a condom, 121 (60.5%) reported >=2 sex partners in the last 90 days, 80 (40.0%) reported a new sex partner within 90 days, 39 (19.5%) had >=3 visits during the previous year, 141 (70.5%) self-reported a history of an STD, and 32 (16.0%) were diagnosed with an STD during that visit. When comparing these patients to those 245 who didn’t need counseling, new sex partner (p=0.0039), >=2 sex partners (p<0.0001), and self-reported STD (p=0.0046) were all significantly associated with a need for additional services.
Conclusions: Focusing on the physical, mental, emotional and spiritual elements of clients may improve their sexual health and aid in STD prevention. To sustain and further evaluate this important initiative, we will begin targeted screening of patients who are at highest risk of needing additional services.