Cocaine Use and Sexual Risk Among Individuals With Severe Mental Illness

Objective: Rates of HIV remain elevated in select populations such as those with severe mental illness and also among those who abuse cocaine, a vehicle through which risky sexual behavior may occur. The objective of the present narrative review was to synthesize the literature regarding stimulant use and its association with sexual risk among individuals with severe mental illness. Methods: This narrative review of the literature utilized Boolean search logic and the PsycINFO and PsycARTICLES databases to identify articles that explored the relationships among stimulant use, risky sexual behavior, and severe mental illness. Only one article was identified that examined a stimulant other than cocaine. Thus, the review was further limited to the impact that cocaine has on risky sexual behavior among those with severe mental illness. Results: Of the 87 abstracts obtained, 58 underwent a full text review and eight were included in the final review. Studies had a mean sample size of 110 and predominantly consisted of male (64%) outpatients. Study designs were largely cross-sectional and almost exclusively relied on retrospective participant report of sexual behavior and drug use. The extant literature indicates a positive association between cocaine and risky sexual behavior among those with a diagnosed severe mental illness. Risky behaviors associated with cocaine included reporting a greater number of partners as well as a higher degree of involvement in the sex trade. The positive association observed between cocaine and partner-related risk, however, did not extend to condom use. Conclusions: Further research that utilizes better defined and operationalized constructs to investigate relationships among stimulant use, severe mental illness, and sexual risk, particularly condom use, is warranted and is necessary to advance the field.