The relationship between substance abuse, health status and health behaviours of patients attending HIV clinics

[摘要] ENGLISH ABSTRACT: HIV infection, substance abuse, and psychiatric disorders are major public healthissues in South Africa. Psychiatric disorders and substance-use disorders togetherhave a negative impact on the health outcomes of people living with HIV and AIDS(PLWHA), such as poor adherence to anti-retrovirals (ARVs), HIV diseaseprogression, lower CD4 counts, vulnerability to opportunistic infections, high viralloads, possible drug resistance, and an earlier onset of death. The overall aim of thisstudy was to investigate the relationship between substance abuse practices and thehealth status and health behaviour of patients attending HIV clinics in the CapeMetropole.The study used a cross-sectional study design for collecting data on hazardous orharmful use of alcohol and problematic drug use, demographic information andhealth status among patients attending eight HIV clinics in the Cape Metropole. Asub-sample of patients were assessed on the following domains: depression,psychological distress, psychopathology, post-traumatic stress disorder (PTSD),risky sexual behaviour, adherence to ARVs, levels of resilience, levels of socialsupport and patient's work, family and social functioning. Of the 608, 10% ofconsecutively selected patients completed an additional psychiatric diagnosticinterview (Mini International Neuropsychiatric Interview).The main findings to emerge from this study are:1. Patients reporting hazardous or harmful use of alcohol and/or drug use aresignificantly more likely to be non-adherent to ARVs and have lower CD4 countsthan their non-substance abusing counterparts 2. Hazardous or harmful use of alcohol has a direct influence on CD4 countresulting in lower CD4 counts and participants being less likely to be on ARVs.3. Hazardous or harmful use of alcohol has a direct relationship in predictingtuberculosis (TB).4. Hazardous or harmful users of alcohol and/or problematic drug users are morelikely to report psychological distress (anxiety and depression), depression andlow levels of family support than their non-using counterparts.5. Participants who met the criteria for major depression are significantly more likelyto be non-adherent to ARVs.6. Gender, depression, psychological distress, and PTSD were found to besignificant determinants of hazardous or harmful use of alcohol.7. Psychological distress (anxiety and depression) is significant in directly predictingARV non-adherence.8. Male participants and those who stopped taking their ARVs were more likely tohave lower CD4 counts than female participants and those who did not stop.9. PTSD was found to predict psychological distress indicating that participants whoexperienced trauma were more likely to suffer from psychological distress(anxiety and depression) compared to those who did not experience any PTSD.Participants with lower levels of family support were more likely to suffer frompsychological distress than those with high levels of family support.

[发布机构] Stellenbosch University