Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
AIDS Behav. 2023 Jul;27(7):2079-2088. doi: 10.1007/s10461-022-03940-x. Epub 2022 Dec 7.
Female sex workers (FSW) have worse HIV outcomes in part due to lower anti-retroviral therapy (ART) adherence. Substance use and depression are important barriers to ART adherence, yet few studies have assessed these relationships among FSW in longitudinal studies. Cross-Lagged Panel Models and autoregressive mediation analyses assessed substance use (illicit drug use and alcohol use disorders) in relation to ART non-adherence and the mediation role of depressive symptoms among 240 FSW living with HIV in the Dominican Republic. In annual visits (T1, T2, T3), the majority (70%, 66%, and 53%) reported at-risk drinking and 15%, 13% and 9% used illicit drug during the past 6 months. Most FSW (70%, 62% and 46%) had mild-to-severe depression. Illicit drug use predicted later ART non-adherence. This relationship was not mediated via depressive symptoms. Integrated substance use and HIV care interventions are needed to promote ART adherence and viral suppression among FSW.
女性性工作者（FSW）的 HIV 结局较差，部分原因是抗逆转录病毒治疗（ART）的依从性较低。物质使用和抑郁是影响 ART 依从性的重要障碍，但很少有研究在纵向研究中评估这些关系。交叉滞后面板模型和自回归中介分析评估了物质使用（非法药物使用和酒精使用障碍）与 ART 不依从的关系，以及在多米尼加共和国与 HIV 共存的 240 名 FSW 中抑郁症状的中介作用。在年度访视（T1、T2、T3）中，大多数（70%、66%和 53%）报告存在高危饮酒，15%、13%和 9%在过去 6 个月中使用过非法药物。大多数 FSW（70%、62%和 46%）有轻度至重度抑郁。非法药物使用预测随后的 ART 不依从。这种关系并没有通过抑郁症状来介导。需要整合物质使用和 HIV 护理干预措施，以促进 FSW 的 ART 依从性和病毒抑制。
