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

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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.

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Funding

NLB, SER, WCM, KAP, CNM, and JSC were supported by the National Institute of Allergy and Infectious Diseases (T32AI007001 (NLB, SER), R01AI114320 (WCM, KAP), T32AI070114 (CNM, JSC). MM was supported by the Fogarty International Center (D43 TW010060). The STI Clinic at Bwaila District Hospital is co-funded by the Lilongwe District Health Office, the Malawi Ministry of Health and UNC Project, Malawi.

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Authors and Affiliations

  1. RTI International, Research Triangle Park, NC, USA

    Nivedita L. Bhushan & Sam Phiri

  2. University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Jane S. Chen, Courtney N. Maierhofer, Sarah E. Rutstein, Irving F. Hoffman & Kimberly A. Powers

  3. UNC Project Malawi, Lilongwe, Malawi

    Mitch Matoga, Edward Jere, Cecilia Massa, Beatrice Ndalama, Naomi Bonongwe & Esther Mathiya

  4. The Ohio State University, Columbus, OH, USA

    Elli Schwartz, William C. Miller & Kathryn E. Lancaster

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  1. Nivedita L. Bhushan
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Bhushan, N.L., Chen, J.S., Maierhofer, C.N. et al. Depression, Alcohol Use, and Sexual Behaviors by HIV Infection Stage and Diagnosis Timing Among STI Clinic Patients in Lilongwe, Malawi. AIDS Behav 27, 3612–3622 (2023). https://doi.org/10.1007/s10461-023-04075-3

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