Depression, alcohol use, and intimate partner violence among outpatients in rural Uganda: vulnerabilities for HIV, STIs and high risk sexual behavior.
Depression, alcohol use, and intimate partner violence among outpatients in rural Uganda: vulnerabilities for HIV, STIs and high risk sexual behavior.
复制标题
乌干达农村门诊患者之间的抑郁症，饮酒和亲密伴侣暴力：艾滋病毒，性传播感染和高风险性行为的脆弱性。
DOI：
10.1186/s12879-016-2162-2
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发表时间：
2017-01-19
影响因子：
3.7
通讯作者：
Wanyenze RK
中科院分区：
文献类型：
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作者：
Kiene SM;Lule H;Sileo KM;Silmi KP;Wanyenze RK
亲密伴侣暴力（IPV），酒精使用和抑郁症是乌干达艾滋病毒的主要脆弱性，并结合在一起可能对风险产生协同效应。我们的目的是调查抑郁症，IPV，饮酒和艾滋病毒风险指标之间的关联，在乌干达农村的门诊病人的样本，以及这些因素的共同发生对艾滋病毒风险指标的影响。在一次结构化访谈中，我们收集了关于高危性行为、抑郁症状、情绪和身体IPV、饮酒的数据，以及用于HIV和梅毒检测的血液样本和用于衣原体和淋病检测的尿液样本，这些样本来自乌干达农村一家公立医院门诊接受提供者发起的HIV检测和咨询（PITC）的325名男性和女性门诊患者。我们使用逻辑回归和广义线性模型来测试抑郁症，IPV和酒精使用与HIV风险指标之间的独立关联，以及共同发生对HIV风险指标的影响。12%的男性和15%的女性有以下两种或两种以上的情况：抑郁症，IPV和饮酒;另外29%的男性和33%的女性有一种情况。每种情况都与男性和女性的艾滋病毒风险行为独立相关，对于女性来说，抑郁症与艾滋病毒或性传播感染（STI）检测阳性相关。有一种疾病（AOR 2.32，95% CI 1.95-2.77）和两种或两种以上疾病（AOR 12.77，95% CI 7.97-20.47）的男性报告的高风险性行为比没有潜在并发症的男性多。对于男性来说，经历两种或两种以上的疾病比单独经历一种疾病增加了风险性行为（χ 224.68，p < 0.001）。经历一种疾病（AOR 3.33，95% CI 137-8.08）和两种并存疾病（AOR 5.87，95% CI 1.99-17.35）的女性更有可能检测出HIV或STI阳性，同时患有两种并存疾病的女性发生危险性行为的风险也增加（AOR 2.18，95% CI 1.64-2.91）。我们还发现了初步证据，表明抑郁症和情绪IPV之间以及饮酒和抑郁症之间存在协同效应。这项研究表明，在乌干达农村的门诊设置的男性和女性抑郁症，IPV和酒精使用的共同发生。这些因素的同时出现与艾滋病毒风险的增加有关，突出表明需要对艾滋病毒预防和护理研究及方案拟订采取更全面的办法。
Intimate partner violence (IPV), alcohol use, and depression are key vulnerabilities for HIV in Uganda, and taken together may have a synergistic effect on risk. Our objective was to investigate the associations between depression, IPV, and alcohol use and HIV-risk indicators among a sample of outpatients in rural Uganda, and the effect of co-occurrence of these factors on HIV-risk indicators. In a structured interview we collected data on high-risk sexual behavior, depression symptoms, emotional and physical IPV, and alcohol use, as well as a blood sample for HIV and syphilis tests and a urine sample for chlamydia and gonorrhea tests from 325 male and female outpatients receiving provider-initiated HIV testing and counseling (PITC) at a public hospital outpatient clinic in rural Uganda. We used logistic regression and generalized linear modeling to test independent associations between depression, IPV, and alcohol use and HIV-risk indicators, as well as the effect of co-occurrence on HIV-risk indicators. Twelve percent of men and 15% of women had two or more of the following conditions: depression, IPV, and alcohol use; another 29% of men and 33% of women had 1 condition. Each condition was independently associated with HIV risk behavior for men and women, and for women, depression was associated with testing positive for HIV or a sexually transmitted infection (STI). Men with one condition (AOR 2.32, 95% CI 1.95–2.77) and two or more conditions (AOR 12.77, 95% CI 7.97–20.47) reported more high risk sex acts compared to those with no potential co-occurring conditions. For men, experiencing two or more conditions increased risky sex more than one alone (χ 2 24.68, p < 0.001). Women experiencing one condition (AOR 3.33, 95% CI 137–8.08) and two co-occurring conditions (AOR 5.87, 95% CI 1.99–17.35) were more likely to test positive for HIV or an STI and women with two co-occurring conditions were also at increased risk for risky sex (AOR 2.18, 95% CI 1.64–2.91). We also found preliminary evidence suggesting synergistic effects between depression and emotional IPV and between alcohol use and depression. This study demonstrates the co-occurrence of depression, IPV, and alcohol use in men and women in an outpatient setting in rural Uganda. The co-occurrence of these factors was associated with greater HIV risk, highlighting the need for a more holistic approach to HIV prevention and care research and programming.