Depression, injecting drug use, and risky sexual behavior syndemic among women who inject drugs in Kenya: a cross-sectional survey

Abstract

Background Injecting drug use (IDU) is a key driver of the HIV epidemic particularly when individuals experience psychosocial conditions and risky sexual behavior in a syndemic manner. This study sets out to assess evidence of a syndemic pattern of psychosocial conditions (IDU, depression, intimate partner violence (IPV)) on one the hand and risky sexual behavior on the other while accounting for the socio-economic disadvantage among women who inject drugs (WWID) in low-income urban settings in Kenya. Methods Using a cross-sectional study design, this study recruited 306 WWIDs from two sites in Nairobi between January 2017 and July 2017. Multiple methodologies including descriptive analyses of co-occurrences of psychosocial conditions at the individual level, standard logistic regression analyses to examine relationships and interactions within and between psychosocial conditions and risky sexual behavior, and classification trees algorithm for predictive modeling via machine learning were employed. Results The prevalence of the psychosocial conditions was as follows: IDU, 88%; depression, 77.1%; and IPV, 84%. The prevalence of risky sexual behavior was 69.3%. IDU and depression were related to each other ( P < 0.05) and each of them with risky sexual behavior ( P < 0.05). The highest 2-way and 3-way co-occurrence of conditions were reported in IDU and depression (72%) and in IDU, depression, and risky sexual behavior (62%), respectively, indicating clustering of the conditions at the individual level. Further, each additional psychosocial condition (IDU and depression) was associated with sixfold odds ( P = 0.000) of having risky sexual behavior suggesting a dose-response relationship. Logistic regression analyses incorporating multiplicative interactive effects returned three significant variables ( P < 0.05): IDU*depression interaction effect, “Age when delivered the first child,” and “Income.” Classification tree modeling represented a 5-level interaction analysis with IDU and depression predicted to have the highest influence on risky sexual behavior. Conclusion Findings provide possible evidence of a syndemic pattern involving IDU, depression, and risky sexual behavior suggesting the need for an integrated approach to the implementation of harm reduction interventions among WWID in low-income urban settings in Kenya. This work highlights the need for further studies to authenticate the findings and to characterize pathways in the syndemic development in WWID.

Challenges of sexually transmitted infections and sexual health among people who inject drugs

“…Pettes et al [31] found that after adjustment for potential social, demographic, and behavioral confounders, women with more severe depression were more likely to engage in unprotected sex and have multiple sexual partners, although in men this association was marginal. This finding was consistent with another study among women who inject drugs (WWID) in Kenya [32]. A detailed study among MSM demonstrated the relationship between depression and sexual risk may be nonlinear.…”

“…Women engaged in sex work may practice more regular condom use, as shown by a studies of women with opioid use disorder [56,57] but, on the other hand, they may have elevated injection risk, such as the higher number of injections per day and receptive syringe sharing [58]. Studies from Kenya [32] and Vietnam [59 & ] confirmed that depressive symptomatology among PWID has an adverse effect on sexual and injection risk behaviors.…”

Socioeconomic status, individual behaviors and risk for mental disorders: A Mendelian randomization study

“…Among the risky behaviors, an increase in the number of sexual partners was strongly associated with susceptibility to MDD and SCZ. Promiscuity has been noted in patients with mental disorders [ 65 – 67 ]. However, these findings were unable to distinguish between sexual promiscuity causing mental disorders and mental disorders causing sexual promiscuity.…”

Undiagnosed HIV, hepatitis B, and hepatitis C infections in people with severe psychiatric disorders in Ethiopia

“…Even though there are not enough supportive data on the prevalence estimate of undiagnosed viral infections among people with severe psychiatric disorders, it is assumed that the prevalence rates of undiagnosed HIV, HBV, and HCV believed to be considerably higher in patients with severe psychiatric disorders as compared to general population rates due to the nature of the illness which impairs their decision-making capacity [23,24], makes them to involve in risky sexual behaviors [25,26], and the reported higher magnitude of undiagnosed medical conditions (up to 80%) in people with mental illness [27,28].…”