High Levels of Concomitant Behavioral Health Disorders Among Patients Presenting for HIV Non-occupational Post-exposure Prophylaxis at a Boston Community Health Center Between 1997 and 2013

Abstract

A paucity of information regarding mental health exists for patients presenting for HIV non occupational post-exposure prophylaxis (nPEP). We reviewed electronic medical records of 894 adult nPEP patients seen at a large Boston community health center between 1997 and 2013. Of 821 patients with consensual sexual exposures, 88.3% were men who have sex with men, and 40.0% had a mental health diagnosis. Diagnoses included: depression (24.4%), anxiety (21.9%), attention deficit disorder (7.8%), post-traumatic stress disorder (3.3%), and psychotic disorders (3.3%). Of 129 patients with substance use disorders, alcohol dependence (65.9%) and crystal methamphetamine (43.4%) predominated. Unprotected receptive anal intercourse was associated with psychotic disorders (aOR=4.86;95%CI:1.76–13.5) and substance use disorders (aOR=1.89;95%CI:1.28–2.80). Substance use at the time of exposure was associated with: depression (aOR=1.95;95%CI:1.36–2.80), anxiety (aOR=2.22;95%CI:1.51–3.25), attention deficit disorder (aOR=1.96;95%CI:1.18–3.27), and substance use disorder (aOR=4.78;95%CI:3.30–6.93). Mental illness should be screened for and addressed at nPEP visits to optimize HIV risk-reduction.

Longitudinal Analysis of Syndemic Psychosocial Problems Predicting HIV Risk Behavior Among a Multicity Prospective Cohort of Sexually Active Young Transgender Women in the United States

“…Much of the empirical research applying syndemic theory to HIV risk among sexual and gender minority populations has largely been conducted with MSM. 26,[28][29][30][31][32][33][43][44][45] These studies have shown that overlapping depression, polydrug use, stimulant use, heavy alcohol use, IPV, and CSA, which were all positively correlated with each other, additively increase the odds of sexual risk, increase the hazard of HIV-infection, and, may potentiate the odds of transmission to sexual partners among those living-with-HIV. While transgender woman may face some of the same social stressors as MSM, they also experience unique stressors due to their gender minority status.…”

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

“…Syndemic theory posits that the individual conditions not only predict future adverse outcomes, but that they are clustered, and mutually reinforcing. In our cohort of nPEP patients, as in the above-mentioned Boston cohort,[ 17 ] there were several positive bivariable associations between the individual syndemic conditions observed. However, an interesting point of contention in the literature is whether the effects of individual conditions on HIV risk among MSM are truly multiplicative (implying synergy) or simply additive in nature.…”

“…To our knowledge, only a single other study has previously examined the burden of syndemic conditions among nPEP patients, in a cohort of 894 adults in Boston. [ 17 ] The authors found that the prevalence of pre-existing mental health conditions was high at 40.0%, including depression (24.4%), anxiety (21.9%), substance use disorders (14.4%), attention deficit disorder (7.8%), post-traumatic stress disorder (3.3%) and psychotic disorders (3.3%). Of note, that study classified participants as having mental health issues based on medication use and/or referrals for treatment, which may have underestimated the prevalence of conditions that were undiagnosed.…”

“…To our knowledge, only a single study has previously examined the burden of syndemic conditions in nPEP patients, and found a high prevalence of pre-existing mental health diagnoses through retrospective case review. [ 17 ] We therefore sought to prospectively estimate the prevalence of depression, harmful alcohol use, problematic drug use, and sexual compulsivity in patients seeking nPEP at our institutions. We hypothesized that these syndemic conditions would be common, and reasoned that documenting a high prevalence would support efforts to systematically screen for them in the future.…”

Immediate PrEP after PEP: Results from an Observational Nurse-Led PEP2PrEP Study

“…Other studies have similarly found elevated rates of mood disorders among patients who use PEP and PrEP. 30 - 32 Although no significant correlation was identified between anxiety or depression and PrEP discontinuation, previous studies have identified this relationship. 33 As such, mood disorders may be the reason PrEP is needed (in that sexual practices that can transmit HIV could be the manifestation of depression or anxiety) and might be reason it is not used in an ongoing fashion (in that these illnesses undermine retention in care).…”