Poverty matters: contextualizing the syndemic condition of psychological factors and newly diagnosed HIV infection in the United States.
Poverty matters: contextualizing the syndemic condition of psychological factors and newly diagnosed HIV infection in the United States.
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DOI：
10.1097/qad.0000000000000491
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发表时间：
2014-11-28
期刊：
影响因子：
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通讯作者：
Reisner SL
中科院分区：
文献类型：
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作者：
Oldenburg CE;Perez-Brumer AG;Reisner SL
背景：“综合症因素”被定义为同时发生的心理状况，包括重度抑郁症、物质和酒精使用以及亲密伴侣暴力，已被证明会增加美国 MSM 中的艾滋病毒发病率。然而，这种关系在一般人群中尚未得到很好的表征，特别是在贫困背景下。 设计：前瞻性队列研究，包括国家酒精和相关疾病流行病学调查第 1 波（2001-2002 年）和第 2 波（2004-2005 年）中具有全国代表性的 34 427 名男性和女性样本。方法：使用加权多变量逻辑回归模型来评估流行病因素与新冠病毒之间的关联。诊断出 HIV 感染，并评估生活在贫困线以下（基于 2001 年美国贫困线）如何改变这种关系。 结果：过去一年中报告新诊断出 HIV 的参与者比例为 0.22%，从没有综合症因素的个体中的 0.19% 增加到有四种综合症因素的个体中的 5.1%。调整潜在的混杂因素后，每增加一个综合症因素，HIV 感染几率就会增加 47% [调整后的优势比 (aOR) 1.47，95% 置信区间 (CI) 1.30–1.65]。与生活在贫困线以上的人（aOR 1.21，95% CI 1.07-1.36）相比，生活在联邦贫困线以下的个人（aOR 1.96，95% CI 1.57-2.44）中，同步流行病因素的影响更强。结论：在美国普通人群中，在贫困环境下，并发流行病因素与艾滋病毒感染事件之间的关联更强。应考虑采取心理健康干预措施，特别是在社会经济弱势地区，以减少艾滋病毒的传播。
Background:‘Syndemic factors’, defined as co-occurring psychological conditions including major depressive disorder, substance and alcohol use, and intimate partner violence, have been shown to increase HIV incidence among MSM in the United States. However, this relationship has not been well characterized in the general population, particularly in the context of poverty.Design:Prospective cohort study including a nationally-representative sample of 34 427 men and women in the National Epidemiologic Survey on Alcohol and Related Conditions wave 1 (2001–2002) and wave 2 (2004–2005).Methods:Weighted multivariable logistic regression models were used to assess the association between syndemic factors and newly diagnosed HIV infection, and to assess how living below the poverty line (based on 2001 US Poverty Guidelines) modified this relationship.Results:The proportion of participants reporting new HIV diagnosis in the past year was 0.22%, increasing from 0.19% among individuals with no syndemic factor to 5.1% among those with four syndemic factors. Adjusting for potentially confounding factors, each additional syndemic factor was associated with a 47% increase in odds of HIV infection [adjusted odds ratio (aOR) 1.47, 95% confidence interval (CI) 1.30–1.65]. The effect of syndemic factors was stronger among individuals living below federal poverty guidelines (aOR 1.96, 95% CI 1.57–2.44) compared to those living above poverty guidelines (aOR 1.21, 95% CI 1.07–1.36).Conclusions:Among the US general population, the association between co-occurring syndemic factors and incident HIV infection was stronger in the setting of poverty. Mental health interventions, particularly in socioeconomically disadvantaged areas, should be considered to reduce transmission of HIV.