Introduction
Human Immunodeficiency Virus (HIV). the virus that causes Acquired Immunodeficiency Syndrome (AIDS) has become one of the most serious healths and development challenges (Kaiser 2009). In spite of the enormous work carried out on its etiology, mode of transmission and treatment, HIV infection has continued its global spread. There were 33.4 million people living with HIV/AIDS (PLWHA) in 2008, up from 29 million in 2001 (UNAIDS /WHO, 2008).
Behavioural risk factors for HIV identified in people with mental illness include low rates of condom use during sexual activity (Sacks, Silberstein, Weiler, Perry, 1990; Jeffrey, Debra, Bahr et al.,1999), having multiple/same sex partners and sex in exchange for drugs, shelter or basic survival needs (Kalichman et aI., 1994; Kelly, Murphy & Sikkerna., 1995), coercion into unwanted sexual activity (Weinhardt, Carey, Carey, & Verdecias, 1999; Coverdale & Turbott, 2000), living in impoverished inner city areas with high rates of drug use and sexually transmitted disease (Jeffrey et al., 1991), coexisting substance use patterns (Blanchard, Brown, Horan, & Sherwood, 2000; Carey, Chandra, Carey, & Neal, 2003) especially the use of alcohol, cannabis and crack cocaine (Carey, Carey, & Kalichman, 1997). Intravenous drug use and needle sharing has also been reported (Grassi, Pavanati, & Cardelli, 1999; Carey, Carey, Maisto, Gordon, & Vanable, 2001).
Use of psychoactive substances also plays a major role in HIV transmission among non-injecting drug users (Jeffrey, 2002). Excessive use of alcohol (intoxication, binge drinking) has been associated with the development of neuro—psychiatric conditions, physical injuries, unsafe sexual behaviour and the use of other psychoactive drugs (Odejide, 2006). Similarly, like people with schizophrenia, injecting drug users are particularly vulnerable to HIV as a result of sharing of contaminated injecting equipment and high-risk sexual behaviours. lt has been documented that psychiatric patients particularly those with a diagnosis of schizophrenia may be at high risk of HIV infection (Gray & Brewin, 2002). The risk behaviours include sharing injection needles during intravenous drug use, promiscuity associated with unprotected sex and high-risk sexual activity after using drugs.