药物使用、暴力行为和抑郁症状与酒精滥用女性的性风险行为之间的关联。
Associations of Drug Use, Violence, and Depressive Symptoms with Sexual Risk Behaviors Among Women with Alcohol Misuse.
机构信息
Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
Department of Psychology, Johns Hopkins University, Baltimore, Maryland.
出版信息
Womens Health Issues. 2018 Jul-Aug;28(4):367-374. doi: 10.1016/j.whi.2018.04.004. Epub 2018 May 18.
BACKGROUND
Alcohol misuse is associated with increased human immunodeficiency virus sexual risk behaviors by women. Drug use, intimate partner violence (IPV), and depressive symptoms frequently co-occur, are well-recognized alcohol misuse comorbidities, and may interact to increase risk behaviors. Using a syndemic framework we examined associations between drug use, IPV, and depressive symptoms and sexual risk behaviors by 400 women with alcohol misuse attending an urban sexually transmitted infections clinic.
METHODS
Participants completed computer-assisted interviews querying drug use, IPV, and depressive symptoms and sexual risk behavior outcomes-unprotected sex under the influence of alcohol, sex for drugs/money, and number of lifetime sexual partners. We used multivariable analysis to estimate prevalence ratios (PR) for independent and joint associations between drug use, IPV, and depressive symptoms and our outcomes. To investigate synergy between risk factors we calculated the relative excess prevalence owing to interaction for all variable combinations.
RESULTS
In multivariable analysis, drug use, IPV, and depressive symptoms alone and in combination were associated with higher prevalence/count of risk behaviors compared with women with alcohol misuse alone. The greatest prevalence/count occurred when all three were present (unprotected sex under the influence of alcohol [PR, 2.6; 95% confidence interval, 1.3-4.9]), sex for money or drugs [PR, 2.6; 95% confidence interval, 1.7-4.2], and number of lifetime partners [PR, 3.2; 95% confidence interval, 1.9-5.2]). Drug use, IPV, and depressive symptoms did not interact synergistically to increase sexual risk behavior prevalence.
CONCLUSIONS
A higher prevalence of sexual risk behaviors by women with alcohol misuse combined with drug use, IPV, and depressive symptoms supports the need for alcohol interventions addressing these additional comorbidities.
背景
酒精滥用与女性中艾滋病毒的性风险行为增加有关。药物使用、亲密伴侣暴力（IPV）和抑郁症状经常同时发生，这些是公认的酒精滥用合并症，并且可能相互作用增加风险行为。我们使用综合征理论框架，检查了 400 名在城市性传播感染诊所就诊的酒精滥用女性中，药物使用、IPV 和抑郁症状与性风险行为之间的关联。
方法
参与者完成了计算机辅助访谈，询问了药物使用、IPV 和抑郁症状以及性风险行为结果——在酒精影响下发生无保护性行为、为了钱或毒品发生性行为以及一生中的性伴侣数量。我们使用多变量分析来估计药物使用、IPV 和抑郁症状与我们的结果之间独立和联合关联的患病率比（PR）。为了研究风险因素之间的协同作用，我们计算了所有变量组合的交互归因于超额流行率。
结果
在多变量分析中，单独和联合使用药物、IPV 和抑郁症状与酒精滥用女性相比，与更高的风险行为发生率/数量相关。当所有三种情况同时存在时，发生率/数量最高（受酒精影响的无保护性行为[PR，2.6；95%置信区间，1.3-4.9]），为了钱或毒品发生性行为[PR，2.6；95%置信区间，1.7-4.2]，以及一生中的性伴侣数量[PR，3.2；95%置信区间，1.9-5.2]）。药物使用、IPV 和抑郁症状没有协同作用来增加性风险行为的流行率。
结论
酒精滥用女性的性风险行为发生率更高，再加上药物使用、IPV 和抑郁症状，支持需要针对这些额外合并症进行酒精干预。
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