Abstract
Background: Psychotropic substance use is common in HIV-infected gay or bisexual men (GBM). This study examined the association between Axis I psychiatric disorders and active psychotropic substance use, and identified factors affecting the prevalence of psychiatric disorders in HIV-infected GBM.Methods: This is a cross-sectional case-control study taken place in an HIV clinic and community organisations serving people living with HIV or GBM in Hong Kong. Participants were 62 HIV-infected self-identified GBM who reported psychotropic substance use in the past 1 year (cases), and 55 HIV-infected self-identified GBM without psychotropic substance use in the past 1 year and had negative toxicology tests at recruitment (controls).The Chinese-bilingual Structured Clinical Interview for DSM-IV (Axis I, Patient version) was followed to establish the psychiatric diagnoses. Socio-demographic data, level of social support, HIV-related data, and pattern of psychotropic substance use were collected. Results: Cases had lower level of social support (p=0.02), more depressive disorders (AOR 3.4, 95% CI 1.3-8.7, p=0.01) and psychotic disorders (AOR 7.2, 95% CI 1.2-41, p=0.03) but not anxiety disorders. Significant difference in the prevalence of psychiatric disorders was only evident for disorders with onset after HIV diagnosis. Methamphetamine dependence (AOR 6.63, 95% CI 1.53-228.72, p<0.01), weekly methamphetamine use for 2 years or more (AOR 18.6, 95% CI 1.26-274.69, p=0.03), using methamphetamine beyond chemsex (AOR 4.76, 95% CI 1.17-19.41, p=0.03) were significant predictors for psychiatric disorders in the cases in separate logistic regression models. Duration of HIV diagnosis was a significant independent predictor in all three models. Conclusions: Active psychotropic substance use in HIV-infected gay or bisexual men was associated with a 3-fold increase in Axis I psychiatric disorders. This increase in psychiatric disorders was predicted by the severity, duration and context of methamphetamine use and the duration of HIV diagnosis.
Bulimic Behaviors and Early Substance Use: Findings from a Cotwin-Control Study