Levintow Sara N, Serrano Pedro A, Maierhofer Courtney N, French Audrey L, Hosek Sybil, Powers Kimberly A
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Ruth M. Rothstein CORE Center, Cook County Health, Chicago, IL, USA.
AIDS Behav. 2025 Mar;29(3):1028-1037. doi: 10.1007/s10461-024-04584-9. Epub 2025 Jan 9.
Substance use and depression are prevalent in sexual and gender minorities (SGM), but evidence about their impacts on HIV pre-exposure prophylaxis (PrEP) use is mixed. We assessed these impacts in a US-based cohort of 3,330 young SGM who tested negative for HIV and completed baseline and semiannual assessments on substance use (cocaine, methamphetamine, or heroin), depression, and PrEP use and adherence. We estimated prevalence differences (PDs) to compare baseline and 12-month PrEP use and adherence between participants with and without substance use and depression, separately and jointly. At baseline, 8% of participants reported substance use and depression, 7% reported substance use only, 38% reported depression only, and 47% reported neither. PrEP use was reported by 22%, with 78% reporting prior-day adherence. Compared to participants without depression or substance use, participants with substance use alone were more likely to report PrEP use at baseline (PD = 18.9; 95% CI: 7.6, 30.2) and 12 months (PD = 15.9, 95% CI: 5.1, 26.7), without adherence differences. Depression alone was associated with lower baseline PrEP use (PD=-3.6, 95% CI: -6.7, -0.4) and adherence (PD=-10.0, 95% CI: -18.4, -1.6), but associations attenuated over 12 months. Those with both substance use and depression (vs. neither) reported higher baseline PrEP use (PD = 6.5, 95% CI: -0.6, 13.5) and lower adherence (PD=-12.9, 95% CI: -26.2, 0.5), with associations weakening over 12 months. Substance use and depression had opposing relationships with PrEP use and adherence. In addition to its mental health benefits, depression treatment may improve PrEP uptake and adherence in young SGM.
物质使用和抑郁在性少数群体和性别少数群体（SGM）中很普遍，但关于它们对艾滋病毒暴露前预防（PrEP）使用的影响的证据不一。我们在美国一个由3330名年轻SGM组成的队列中评估了这些影响，这些人艾滋病毒检测呈阴性，并完成了关于物质使用（可卡因、甲基苯丙胺或海洛因）、抑郁以及PrEP使用和依从性的基线和半年评估。我们估计了患病率差异（PDs），以分别和联合比较有和没有物质使用及抑郁的参与者在基线和12个月时的PrEP使用和依从性。在基线时，8%的参与者报告有物质使用和抑郁，7%仅报告有物质使用，38%仅报告有抑郁，47%两者均未报告。22%的人报告使用了PrEP，其中78%报告前一天有依从性。与没有抑郁或物质使用的参与者相比，仅使用物质的参与者在基线时（PD = 18.9；95% CI：7.6，30.2）和12个月时（PD = 15.9，95% CI：5.1，26.7）更有可能报告使用PrEP，依从性无差异。仅抑郁与较低的基线PrEP使用（PD = -3.6，95% CI：-6.7，-0.4）和依从性（PD = -10.0，95% CI：-18.4，-1.6）相关，但在12个月内这种关联减弱。同时有物质使用和抑郁的人（与两者均无的人相比）报告的基线PrEP使用较高（PD = 6.5，95% CI：-0.6，13.5），依从性较低（PD = -12.9，95% CI：-26.2，0.5），且在12个月内关联减弱。物质使用和抑郁与PrEP使用和依从性存在相反的关系。除了对心理健康有益外，抑郁治疗可能会提高年轻SGM中PrEP的接受率和依从性。
