Newville Howard, Haller Deborah L
Yeshiva University, Bronx, NY, USA.
AIDS Care. 2010 Oct;22(10):1259-68. doi: 10.1080/09540121003615111.
The role of psychiatric and substance use disorders in HIV transmission has not been fully elucidated, particularly among those living with the virus. We compared sex and drug risk behaviors for 228 HIV+ patients in four diagnostic groups: (1) no diagnosis; (2) psychiatric only; (3) substance dependence only; and (4) co-morbid psychiatric and substance dependence. Significant group differences were observed for having multiple sex partners, condom use, and injection drug use (IDU), but not for sharing of injection equipment. Patients with co-morbid psychiatric and substance disorders reported multiple sex partners most frequently, while substance dependence contributed to irregular condom use and IDU. Analysis by substance use subgroup (no dependence, alcohol dependence only, drug dependence only, co-morbid alcohol, and drug dependence) showed that alcohol dependence contributed to having multiple sex partners, while alcohol and drug dependence both contributed to irregular condom use. Meanwhile, only drug dependence contributed to drug risk. HIV+ patients should be screened for psychopathology, with risk reduction interventions tailored to diagnostic group to achieve maximum effect.
精神疾病和物质使用障碍在HIV传播中的作用尚未完全阐明，尤其是在病毒感染者中。我们比较了四个诊断组中228名HIV阳性患者的性行为和毒品风险行为：（1）无诊断；（2）仅患有精神疾病；（3）仅患有物质依赖；（4）同时患有精神疾病和物质依赖。在拥有多个性伴侣、使用避孕套和注射吸毒（IDU）方面观察到显著的组间差异，但在共用注射设备方面未观察到差异。同时患有精神疾病和物质障碍的患者报告多个性伴侣的频率最高，而物质依赖导致避孕套使用不规律和注射吸毒。按物质使用亚组（无依赖、仅酒精依赖、仅药物依赖、同时患有酒精和药物依赖）进行分析表明，酒精依赖导致拥有多个性伴侣，而酒精和药物依赖均导致避孕套使用不规律。与此同时，只有药物依赖导致毒品风险。应对HIV阳性患者进行精神病理学筛查，并针对诊断组量身定制降低风险的干预措施，以实现最大效果。
