Home > High prevalence of syndemic health problems in patients seeking post-exposure prophylaxis for sexual exposures to HIV.

Morrison, Steven A and Yoong, Deborah and Hart, Trevor A and MacPherson, Paul and Bogoch, Isaac and Sivarajah, Vishalini and Gough, Kevin and Naccarato, Mark and Tan, Darrell H S [PLOS One] . (2018) High prevalence of syndemic health problems in patients seeking post-exposure prophylaxis for sexual exposures to HIV. Public Library of Science. PLoS ONE, 13 (5)

URL: http://journals.plos.org/plosone/article?id=10.137...

INTRODUCTION: The standard clinical approach to non-occupational HIV post-exposure prophylaxis (nPEP) focuses on biomedical aspects of the intervention, but may overlook co-occurring or 'syndemic' psychosocial problems that reinforce future vulnerability to HIV. We therefore sought to determine the prevalence of syndemic health problems in a cohort of Ontario nPEP patients, and explored the relationship between syndemic burden and HIV risk.

METHODS: Between 07/2013-08/2016, we distributed a self-administered questionnaire to patients presenting to three clinics in Toronto and Ottawa seeking nPEP for sexual HIV exposures. We used validated screening tools to estimate the prevalence of depression (CES-D score ≥16), harmful alcohol use (AUDIT ≥8), problematic drug use (DUDIT ≥6 men/≥2 women), and sexual compulsivity (SCS ≥24) among men who have sex with men (MSM) respondents. In exploratory analyses, we examined the relationships between syndemic conditions using univariable logistic regression models, and the relationship between syndemic count (total number of syndemic conditions per participant) and HIV risk, as estimated by the HIRI-MSM score, using linear regression models.

RESULTS: The 186 MSM included in the analysis had median age 31 (IQR = 26-36), including 87.6% having a college/undergraduate degree or higher. Overall, 53.8% screened positive for depression, 34.4% for harmful alcohol use, 30.1% for problematic drug use, and 16.1% for sexual compulsivity. Most participants (74.2%) had at least one syndemic condition and 46.8% had more than one. Exploratory analyses suggested positive associations between depression and harmful alcohol use (OR = 2.11, 95%CI = 1.13, 3.94) and between harmful alcohol use and problematic drug use (OR = 1.22, 95%CI = 0.65, 2.29). Syndemic count was associated with increased HIRI-MSM risk scores in univariable (2.2, 95%CI = 1.0, 3.3 per syndemic condition) and multivariable (2.1, 95%CI = 0.6, 3.6) linear regression models.

CONCLUSIONS: The prevalence of syndemic conditions in MSM seeking nPEP for sexual exposure is alarmingly high, and is associated with underlying HIV risk. Routine screening for these conditions may identify opportunities for intervention and could alleviate future vulnerability to HIV.


Item Type:Evidence resource
Publication Type:Report
Drug Type:Opioid, New psychoactive substance
Intervention Type:AOD disorder harm reduction
Source:PLOS One
Date:May 2018
Page Range:e0197998
Publisher:Public Library of Science
Volume:13
Number:5
EndNote:View
Subjects:A Substance use, abuse, and dependence > Prevalence > Problem substance use
B Substances > Alcohol
F Concepts in psychology > Specific attitude and behaviour > risk-taking behaviour
G Health and disease > State of health
G Health and disease > Substance use disorder > Alcohol use > Alcohol dependence
G Health and disease > Disorder by cause > Communicable disease > HIV
J Health care, prevention and rehabilitation > Health related prevention > Health information and education > Communicable disease control
J Health care, prevention and rehabilitation > Health related prevention > Health information and education > Communicable disease control > HIV prevention
J Health care, prevention and rehabilitation > Health related prevention > Health information and education > Communicable disease control > Safe sex
T Demographic characteristics > Homosexual, gay, bisexual or lesbian, LGBTI
VA Geographic area > Canada

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