Estimating the Effect of Depression on HIV Transmission Risk Behaviors Among People Who Inject Drugs in Vietnam: A Causa
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ORIGINAL PAPER
Estimating the Effect of Depression on HIV Transmission Risk Behaviors Among People Who Inject Drugs in Vietnam: A Causal Approach Sara N. Levintow1 · Brian W. Pence1 · Kimberly A. Powers1 · Teerada Sripaipan2 · Tran Viet Ha3 · Viet Anh Chu3 · Vu Minh Quan4 · Carl A. Latkin5 · Vivian F. Go2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The burden of depression and HIV is high among people who inject drugs (PWID), yet the effect of depression on transmission risk behaviors is not well understood in this population. Using causal inference methods, we analyzed data from 455 PWID living with HIV in Vietnam 2009–2013. Study visits every 6 months over 2 years measured depressive symptoms in the past week and injecting and sexual behaviors in the prior 3 months. Severe depressive symptoms (vs. mild/no symptoms) increased injection equipment sharing (risk difference [RD] = 3.9 percentage points, 95% CI −1.7, 9.6) but not condomless sex (RD = −1.8, 95% CI −6.4, 2.8) as reported 6 months later. The cross-sectional association with injection equipment sharing at the same visit (RD = 6.2, 95% CI 1.4, 11.0) was stronger than the longitudinal effect. Interventions on depression among PWID may decrease sharing of injection equipment and the corresponding risk of HIV transmission. Clinical trial registration ClinicalTrials.gov NCT01689545. Keywords People who inject drugs · HIV transmission · Depressive symptoms · Sexual behavior · Injecting behavior · Marginal structural models
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10461-020-03007-9) contains supplementary material, which is available to authorized users. * Sara N. Levintow [email protected] 1
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, 2101 McGavran‑Greenberg Hall, CB #7435, Chapel Hill, NC 27599‑743, USA
2
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
3
UNC Project Vietnam, University of North Carolina, Hanoi, Vietnam
4
Centers for Disease Control and Prevention, Atlanta, GA, USA
5
Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Despite global progress in combating the HIV epidemic, people who inject drugs (PWID) remain disproportionately at risk of HIV infection in southeast and central Asia and eastern Europe [1–5]. Sharing injection equipment is one of the most efficient means of HIV transmission [6, 7], and in these regions, PWID have limited access to and suboptimal use of harm reduction services and antiretroviral therapy (ART) [8, 9]. The persistence of injection drug use and viremia, without adequate preventive services, results in a high risk of HIV transmission to injecting or sexual partners [10]. The burden of depression is high among PWID and may further interfere with HIV prevention efforts. Up to 50% of
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