背景:女性性工作者(FSWs)面临患心理健康障碍和酒精使用障碍(AUD)的风险增加,这反过来又增加了他们对艾滋病毒和其他性传播感染(STIs)和其他负面结果的脆弱性。为了有效解决这两个健康问题,了解这些疾病背后的共同关键决定因素至关重要,这是埃塞俄比亚和世界其他地方的巨大知识差距。因此,本研究旨在使用双变量多变量序数逻辑模型确定埃塞俄比亚FSW中抑郁和AUD的共同关键决定因素.
方法:我们使用受访者驱动的抽样(RDS)技术分析了2020年从埃塞俄比亚16个城市和主要城镇收集的横截面生物行为数据,总共涉及6,085个FSW。在研究期间之前在研究地点居住至少一个月的FSW被认为有资格招募。使用患者健康问卷(PHQ9)和酒精使用障碍鉴定测试(AUDIT)筛查重度抑郁症(DD)和AUD,分别。我们使用描述性统计来总结研究人群的特征,并使用双变量多变量序数逻辑回归(BMOLR)来确定DD和AUD组合的共同决定因素及其非正态相关性。
结果:在对DD和AUD进行筛查的6085个FSW中,13.5%和4.0%符合中度和重度抑郁障碍的标准,分别,20.3%和34.7%符合有害或危险行为和酒精依赖的审计标准,分别。有避孕套使用不一致经验的FSW,避孕套失效,暴力,移动性,使用任何药物,非付费合伙人,流产,和卖性超过五年与两种疾病的严重程度增加有关。出售性行为的高平均收入和付费伴侣的数量减少了抑郁症的严重程度,并增加了酒精依赖程度。HIV阳性和曾经有过肛交仅与抑郁症的增加有关。
结论:主要DD和AUD在埃塞俄比亚的FSW中普遍存在。研究结果表明,共同的关键决定因素,这加剧了两种疾病的严重程度,也是艾滋病毒和其他性传播感染的危险因素。因此,综合性传播感染策略在筛查中至关重要,转介,和治疗抑郁症和AUD。干预方案应包括抑郁症和AUD的决定因素,包括避孕套的使用,吸毒,在城镇之间的流动性,流产,暴力,和咨询服务。此外,应纳入确保经济安全的战略。
BACKGROUND: Female sex workers (FSWs) face an elevated risk of developing mental health disorders and alcohol use disorders (AUD), which in turn increase their vulnerability to HIV and other sexually transmitted infections (STIs) and other negative outcomes. To effectively address both of these health issues, it is crucial to understand the shared key determinants underlying these illnesses, which is a substantial knowledge gap in Ethiopia and elsewhere in the world. Therefore, this study aimed to identify the common key determinants of depression and AUD among FSWs in Ethiopia using a bivariate multivariable ordinal logistic model.
METHODS: We analyzed cross-sectional biobehavioral data collected in 2020 from 16 cities and major towns in Ethiopia using the respondent-driven sampling (
RDS) technique, which involved a total of 6,085 FSWs. FSWs who had lived at the study sites for at least a month before the study period were deemed eligible for recruitment. Major depressive disorder (DD) and AUD were screened using the Patient Health Questionnaire (PHQ9) and alcohol use disorder identification test (AUDIT), respectively. We used descriptive statistics to summarize study population characteristics and bivariate multivariable ordinal logistic regression (BMOLR) to identify common determinants of DD and AUD combined and their nonnormal correlation.
RESULTS: Among 6085 FSWs screened for DD and AUD, 13.5% and 4.0% have met the criteria for moderate and severe depressive disorder, respectively, and 20.3% and 34.7% have met the AUDIT criteria for harmful or hazardous behavior and alcohol dependence, respectively. FSW with experience of inconsistent condom use, condom failure, violence, mobility, use of any drugs, non-paying partners, abortion, and selling sex for more than five years were associated with an increase in the severity of both disorders. A high average income from selling sex and the number of paying partners reduced the severity of depression and increased the level of alcohol dependence. Being HIV positive and ever having anal sex were associated only with an increase in depression.
CONCLUSIONS: Major DD and AUD are prevalent among FSWs in Ethiopia. The findings revealed that common key determinants, which exacerbated the severity of both disorders, were also risk factors for HIV and other STIs. Consequently, integrated STI strategies are essential in the screening, referral, and treatment of depression and AUD. Intervention packages should encompass determinants of depression and AUD, including condom utilization, drug use, mobility between towns, abortion, violence, and counseling services. Additionally, strategies to ensure economic security should be incorporated.