Hutton H E, Treisman G J, Hunt W R, Fishman M, Kendig N, Swetz A, Lyketsos C G
AIDS Psychiatry Service, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Psychiatr Serv. 2001 Apr;52(4):508-13. doi: 10.1176/appi.ps.52.4.508.
This study assessed HIV risk behaviors and their association with psychiatric disorders among women prisoners.
HIV risk behaviors practiced in the five years before incarceration were ascertained with the Risk Behavior Assessment interview for 177 inmates at the Maryland Correctional Institution for Women. The Structured Clinical Interview for the DSM-IV was used to determine the occurrence of posttraumatic stress disorder (PTSD), major depression, and dysthymic disorder among the women. Regression models were used to determine the association between HIV risk behavior and psychiatric disorders.
HIV risk behaviors in the five years before incarceration included never or rarely having used condoms (56 percent of the women), injection drug use (42 percent), sexual intercourse with a partner who used injection drugs (42 percent), prostitution (30 percent), needle sharing (30 percent), receptive anal sex (19 percent), and having more than 100 sex partners (7 percent). After the analysis adjusted for age, education, race, HIV status, and addictive disorders, a lifetime occurrence of PTSD was associated with the practice of anal sex (odds ratio=1.7; 95 percent confidence interval=1.26 to 2.16; p<.02) and prostitution (OR=1.56; 95% CI=1.17 to 1.95; p<.03).
HIV risk behaviors before incarceration were highly prevalent among the women in this study. Rates of PTSD, depression, and dysthymic disorder were also high. PTSD was associated with prostitution and receptive anal sex, and the disorder may contribute to high rates of risky sexual behavior. Targeted HIV risk reduction efforts among women prisoners should include evaluation for PTSD; conversely, women prisoners with a diagnosis of PTSD should be evaluated for prior HIV sexual risk behaviors.
本研究评估了女性囚犯中的艾滋病毒风险行为及其与精神障碍的关联。
通过对马里兰州女子惩教所的177名囚犯进行风险行为评估访谈，确定了入狱前五年内实施的艾滋病毒风险行为。使用《精神疾病诊断与统计手册》第四版的结构化临床访谈来确定这些女性中创伤后应激障碍（PTSD）、重度抑郁症和心境恶劣障碍的发生情况。采用回归模型来确定艾滋病毒风险行为与精神障碍之间的关联。
入狱前五年内的艾滋病毒风险行为包括从未或很少使用避孕套（56%的女性）、注射吸毒（42%）、与注射吸毒的伴侣发生性行为（42%）、卖淫（30%）、共用针头（30%）、接受肛交（19%）以及有超过100个性伴侣（7%）。在对年龄、教育程度、种族、艾滋病毒感染状况和成瘾性障碍进行分析调整后，终生患创伤后应激障碍与肛交行为（优势比=1.7；95%置信区间=1.26至2.16；p<0.02）和卖淫（优势比=1.56；95%置信区间=1.17至1.95；p<0.03）有关。
在本研究中，入狱前的艾滋病毒风险行为在这些女性中非常普遍。创伤后应激障碍、抑郁症和心境恶劣障碍的发生率也很高。创伤后应激障碍与卖淫和接受肛交有关，这种障碍可能导致高风险性行为的发生率升高。针对女性囚犯开展的降低艾滋病毒风险的工作应包括对创伤后应激障碍的评估；反之，被诊断患有创伤后应激障碍的女性囚犯应评估其既往的艾滋病毒性风险行为。
