Smit J, Myer L, Middelkoop K, Seedat S, Wood R, Bekker L-G, Stein D J
Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
Public Health. 2006 Jun;120(6):534-42. doi: 10.1016/j.puhe.2006.01.009. Epub 2006 May 8.
Despite the high prevalence of both mental illness and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in developing countries, there are few data on the association between different forms of mental illness and sexual risk behaviours in resource-poor settings. The objective of this study was to examine the association between mental illness and HIV risk behaviours in a South African township.
A cross-sectional study was performed among 645 individuals living in households selected at random.
A self-administered translated questionnaire investigated sexual risk behaviours [including sexual partners, condom use, casual sexual contacts, and sex in exchange for money, drugs or a place to stay (transactional sex)], depression (measured using the Center for Epidemiological Studies Depression Scale), alcohol abuse (from the Alcohol Use Disorders Identification Test), and post-traumatic stress disorder (based on the Life Event Checklist).
Of the 645 individuals who completed the survey, 33% reported depression, 17% reported alcohol abuse, and 15% reported post-traumatic stress disorder. After adjusting for demographic characteristics, the presence of any of these three conditions was strongly associated with experiences of forced sex [adjusted odds ratio (AOR) 2.53; 95% confidence intervals (CI) 1.60-4.02], transactional sex (AOR 2.88; 95% CI 1.29-6.48) and increased condom use (AOR 2.07; 95% CI 1.32-3.25).
These findings emphasize the substantial burden of mental illness in this setting, and its association with forced and transactional sex. The temporal nature of these associations is not always clear from this cross-sectional study, and additional prospective research is required. Public health interventions are needed to address the dual burden of HIV/AIDS and mental illness in this and similar settings.
尽管发展中国家精神疾病与人类免疫缺陷病毒（HIV）/获得性免疫缺陷综合征（AIDS）的患病率都很高，但在资源匮乏地区，关于不同形式的精神疾病与性风险行为之间关联的数据却很少。本研究的目的是调查南非一个城镇中精神疾病与HIV风险行为之间的关联。
对随机选取的家庭中的645名个体进行了一项横断面研究。
通过一份自行填写的翻译问卷来调查性风险行为[包括性伴侣、避孕套使用情况、偶然的性接触以及以钱、毒品或住所交换性行为（交易性性行为）]、抑郁（使用流行病学研究中心抑郁量表进行测量）、酒精滥用（依据酒精使用障碍识别测试）以及创伤后应激障碍（基于生活事件清单）。
在完成调查的645名个体中，33%报告有抑郁，17%报告有酒精滥用，15%报告有创伤后应激障碍。在对人口统计学特征进行调整后，这三种情况中的任何一种与强迫性行为经历[调整后的优势比（AOR）为2.53；95%置信区间（CI）为1.60 - 4.02]、交易性性行为（AOR为2.88；95% CI为1.29 - 6.48）以及避孕套使用增加（AOR为2.07；95% CI为1.32 - 3.25）都密切相关。
这些发现强调了该环境中精神疾病的沉重负担及其与强迫性行为和交易性性行为的关联。从这项横断面研究中，这些关联的时间性质并不总是清晰的，需要更多的前瞻性研究。在这种及类似环境中，需要公共卫生干预措施来应对HIV/AIDS和精神疾病的双重负担。
