Pettes Tyler, Kerr Thomas, Voon Pauline, Nguyen Paul, Wood Evan, Hayashi Kanna
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
Sex Health. 2015 Jun;12(3):224-30. doi: 10.1071/SH14200.
Background Although many people who inject drugs (PID) contend with comorbidities, including high rates of mental illness, limited attention has been given to the differences in comorbidities among men and women or the potential links between psychiatric disorders and HIV risk behaviours. We sought to longitudinally examine associations between depression and HIV-related sexual risk behaviours among PID, stratified by gender.
Data were derived from a prospective cohort of PID in Vancouver, Canada between December 2005 and November 2009. Using generalised estimating equations, we examined the relationship between depressive symptoms and two types of sexual HIV risk behaviours: engaging in unprotected sex; and having multiple sexual partners. All analyses were stratified by self-reported gender.
Overall, 1017 PID participated in this study, including 331 (32.5%) women. At baseline, women reported significantly higher depressive symptoms than men (P<0.001). In multivariate generalised estimating equations analyses, after adjustment for potential social, demographic and behavioural confounders, more severe depressive symptomology remained independently associated with engaging in unprotected sex [adjusted odds ratio (AOR)=1.62, 95% confidence interval (CI): 1.18-2.23] and having multiple sexual partners (AOR=1.54, 95% CI: 1.09-2.19) among women, but was only marginally associated with having multiple sexual partners among men (AOR=1.18, 95% CI: 0.98-1.41).
These findings call for improved integration of psychiatric screening and treatment services within existing public health initiatives designed for PID, particularly for women. Efforts are also needed to address sexual risk-taking among female PID contending with clinically significant depression.
背景 尽管许多注射毒品者（PID）存在合并症，包括高比例的精神疾病，但对于男性和女性合并症的差异或精神障碍与艾滋病毒风险行为之间的潜在联系关注有限。我们试图纵向研究按性别分层的PID中抑郁症与艾滋病毒相关性风险行为之间的关联。
数据来自2005年12月至2009年11月在加拿大温哥华的一个PID前瞻性队列。使用广义估计方程，我们研究了抑郁症状与两种性艾滋病毒风险行为之间的关系：进行无保护性行为；以及拥有多个性伴侣。所有分析均按自我报告的性别分层。
总体而言，1017名PID参与了本研究，其中包括331名（32.5%）女性。在基线时，女性报告的抑郁症状明显高于男性（P<0.001）。在多变量广义估计方程分析中，在调整了潜在的社会、人口和行为混杂因素后，更严重的抑郁症状在女性中仍与进行无保护性行为[调整后的优势比（AOR）=1.62，95%置信区间（CI）：1.18 - 2.23]和拥有多个性伴侣（AOR = 1.54，95% CI：1.09 - 2.19）独立相关，但在男性中仅与拥有多个性伴侣有微弱关联（AOR = 1.18，95% CI：0.98 - 1.41）。
这些发现呼吁在现有的针对PID的公共卫生举措中，特别是针对女性，改善精神科筛查和治疗服务的整合。还需要努力解决患有临床显著抑郁症的女性PID中的性冒险行为。
