Depression, alcohol use, and intimate partner violence among outpatients in rural Uganda: vulnerabilities for HIV, STIs and high risk sexual behavior

Abstract

BackgroundIntimate 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.MethodsIn 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.ResultsTwelve 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.ConclusionsThis 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.

Associations with Unprotected Sexual Behavior Among HIV-Infected Drinkers in Western Kenya

“…Our findings related to depression are consistent with other research in sub-Saharan Africa [31, 32]; more depression may signify less self-care or less hope about the future. Protective factors were condom use self-efficacy and drinking-and-protected-sex days.…”

“…In a study of outpatients in rural Uganda, Kiene and colleagues examined the associations between depression, partner violence, and alcohol use and HIV-risk indicators. They found that depression was associated with sexual risk behaviors for men and women and with HIV infection and STI for women [31]. In a study of 738 patrons of alcohol establishments in South Africa, Sikkema and colleagues found that unprotected sex was associated with depression, anxiety and alcohol use among women [32].…”

Epidemiology of Alcohol Misuse and Illicit Drug Use Among Young People Aged 15–24 Years in Fishing Communities in Uganda

“…Concurrent with the apparent increase in substance use in SSA, human immunodeficiency virus (HIV) remains a major public health problem, with young women aged 15-24 years and people who inject drugs disproportionately affected [7]. In a recent systematic review, we showed that in SSA, information on the burden of alcohol misuse and illicit drug use is limited, especially among young people belonging to certain occupational groups (i.e., sex workers, miners, truckers, fishing communities, uniformed personnel and motorcycle taxi riders) known to be at increased risk of HIV acquisition [8][9][10][11][12][13].…”

Injection and sexual risk among people who use or inject drugs in Kampala, Uganda: An exploratory qualitative study

“…HIV prevalence in Uganda is among the highest in the world, with national prevalence estimated at 6.2% [1] and prevalence among high risk populations such as fisherfolk and female sex workers at 30% [2] and 33% [3] respectively. While Uganda has been the site of abundant HIV prevention and research efforts, it is one of only two countries in Sub-Saharan Africa (SSA) in which HIV incidence is increasing, particularly in the general population [4]. There is some indication that unaddressed factors including injection and non-injection drug use may be impairing Uganda's HIV prevention efforts [5,6].…”