Lee Krystal Chi Kei, Chung Albert Kar Kin, Wong Bonnie Chun Kwan
Department of Psychiatry, The University of Hong Kong, Pok Fu Lam, Hong Kong.
Special Preventive Programme, Centre for Health Protection, HKSAR Government, Hong Kong.
Subst Use Misuse. 2023;58(7):841-850. doi: 10.1080/10826084.2023.2177970. Epub 2023 Apr 7.
: Psychotropic substance use, for chemsex in particular, is common in gay or bisexual men (GBM) with HIV infection. This case-control study examined the association between Axis I psychiatric disorders and active psychotropic substance use, and identified factors affecting the prevalence of psychiatric disorders in HIV-infected GBM. : Participants were 62 HIV-infected self-identified GBM who reported psychotropic substance use in the past 1 year (cases), and 55 HIV-infected self-identified GBM without psychotropic substance use in the past 1 year and had negative toxicology tests at recruitment (controls). The Chinese-bilingual Structured Clinical Interview for DSM-IV (Axis I, Patient version) was followed to establish the psychiatric diagnoses. Socio-demographic data, level of social support, HIV-related data, and pattern of psychotropic substance use were collected. : Cases had lower level of social support, more depressive disorders (AOR 3.4, 95% CI 1.3-8.7, p=0.01) and psychotic disorders (AOR 7.2, 95% CI 1.2-41, p=0.03) but not anxiety disorders. Significant difference in the prevalence of psychiatric disorders was only evident for disorders with onset after HIV diagnosis. Methamphetamine dependence, weekly methamphetamine use for 2 years or more, using methamphetamine beyond chemsex, duration of HIV diagnosis were significant predictors for psychiatric disorders in the cases. : Active psychotropic substance use in HIV-infected gay or bisexual men was associated with an overall 3-fold increase in Axis I psychiatric disorders. Coordinated efforts from HIV, psychiatric and substance use services are needed to prevent harms arising from chemsex and to identify those in need and facilitate treatment access.
精神活性物质的使用，尤其是在化学性行为中，在感染艾滋病毒的男同性恋或双性恋男性（GBM）中很常见。这项病例对照研究调查了轴I精神障碍与当前精神活性物质使用之间的关联，并确定了影响感染艾滋病毒的GBM中精神障碍患病率的因素。：参与者为62名自我认定为GBM且在过去1年中报告有精神活性物质使用的艾滋病毒感染者（病例组），以及55名自我认定为GBM且在过去1年中无精神活性物质使用且在招募时毒理学检测呈阴性的艾滋病毒感染者（对照组）。按照《精神疾病诊断与统计手册》第四版（轴I，患者版）的中文双语结构化临床访谈来确定精神疾病诊断。收集了社会人口学数据、社会支持水平、艾滋病毒相关数据以及精神活性物质使用模式。：病例组的社会支持水平较低，抑郁症（调整后比值比3.4，95%置信区间1.3 - 8.7，p = 0.01）和精神障碍（调整后比值比7.2，95%置信区间1.2 - 41，p = 0.03）较多，但焦虑症无差异。仅在艾滋病毒诊断后发病的疾病中，精神障碍患病率存在显著差异。甲基苯丙胺依赖、连续2年或更长时间每周使用甲基苯丙胺、在化学性行为之外使用甲基苯丙胺、艾滋病毒诊断时长是病例组中精神障碍的显著预测因素。：感染艾滋病毒的男同性恋或双性恋男性中当前的精神活性物质使用与轴I精神障碍总体增加3倍相关。需要艾滋病毒、精神科和物质使用服务部门共同努力，以预防化学性行为带来的危害，并识别有需要的人并促进其获得治疗。
