Depression, Alcohol Use, and Sexual Behaviors by HIV Infection Stage and Diagnosis Timing Among STI Clinic Patients in Lilongwe, Malawi

Abstract

Understanding depression, alcohol use, and sexual behaviors according to HIV infection stage and diagnosis timing is important for HIV prevention efforts. We enrolled persons with recent infection and diagnosis (i.e., acute HIV infection (AHI) (n = 92) persons newly diagnosed seropositive (n = 360)) and persons previously diagnosed with HIV (n = 190) into a randomized controlled trial in Lilongwe, Malawi (N = 641) and estimated the prevalence of probable depression (Patient Health Questionnaire-9 ≥ 5), hazardous alcohol use (Alcohol Use Disorder Identification Test-C: men ≥ 4; women ≥ 3), and sexual behaviors (transactional sex, condomless sex). Compared with previously diagnosed participants, participants newly seropositive and those with AHI reported a higher proportion of probable depression (7%, 27%, 38%; AHI/Previous: Table Probability: 0.02, p < 0.01; AHI/New: Table Probability: <0.01, p < 0.01), hazardous alcohol use (8%, 18%, 29%; AHI/Previous and AHI/New: Table Probability: <0.01, p < 0.01), and transactional sex (5%, 14%, 20%; AHI/Previous: Table Probability: <0.01, p < 0.01; AHI/New: Table Probability: 0.06, p = 0.24), respectively. HIV prevention services addressing mental health and alcohol misuse may be particularly beneficial for persons with recent HIV infection and or diagnosis.

Keywords: Depression; Hazardous alcohol use; Secondary HIV prevention; Sexual behaviors.

Figure 1.. Prevalence Ratios And 95% Confidence Intervals Comparing the Prevalence of Condomless Sex in the Past 4 Weeks Between Participants With vs. Without Probable Depression (Panel A) and Participants With vs. Without Hazardous Alcohol Use (Panel B)

All models adjusted for sex and age.

Figure 2.. Prevalence Ratios And 95% Confidence Intervals Comparing the Prevalence of Transactional Sex in the Past 4 Weeks Between Participants With vs. Without Probable Depression (Panel A) and Participants With vs. Without Hazardous Alcohol Use (Panel B)

All models adjusted for sex and age