Docstoc

05

Document Sample
05 Powered By Docstoc
					Post-traumatic stress, depression,
  alcohol use and HIV/AIDS risk
     among Angolan soldiers




    Charles R. Drew University of Medicine and Science & the
                     Angolan Armed Forces
                    Collaborators
United States: Eric G Bing; Karen G Cheng, Daniel J Ortiz,
  Ricardo Ovalle-Bahamón
  Charles R. Drew University of Medicine and Science, Los Angeles

Angola: Col. Francisco Ernesto, Col. Francisco João de
  Deus
  Angolan Armed Forces, Luanda

Funding: National Institute of Mental Health (R01-MH64883-01), US
         Department of Defense (GC-3482-132-01-009)
                       Background
   Poor mental health and alcohol use are
    associated with poor sexual decision-
    making (e.g., Kelly, et al., 1995; Strathdee, et al., 1998;
    Thompson, Kao &, Thomas, 2005)


   Post-conflict militaries have unique HIV
    prevention needs
    – Impact of war on mental health
    – Role of alcohol
         Coping mechanism
         Increased strength in fighting
    Angola
 27-year civil war ended in 2002
 Emphasizing HIV prevention
  now while the infection rate still
  low (3.7%; UNAIDS, 2006)
              Goals of study
1) Assess frequency of post-traumatic stress,
   depression and alcohol use among soldiers

2) Assess HIV-related risk

3) Assess relationship between mental health and
   alcohol use and HIV risk
                 Procedure
 Randomly selected soldiers
  from 12 military bases
  in the capital and in the
  northern and southern
  regions
 Interviewed by trained civilian interviewers
 Conducted Feb 2005 – May 2005
                         Procedure
   Dimensions assessed were
    Mental Health
         War-related traumatic events
         Post-traumatic stress (Impact of Event Scale-Rev)
         Depression (MHI-5)
    Alcohol
         AUDIT: Problem drinking
         Alcohol use before sex (past month)
    HIV/AIDS risk
         Number of partners (past 3 months)
         Sex with occasional or commercial partners (past 3 months)
         STI symptoms (past year)
    Characteristics of sample
   568 men (total sample)
   Average age = 28.9 years
   Rank
        Privates 33.5%
        Sergeants 59.5%
        Officers 7.0%
   Average number of years in military = 10.6
     97% were enlisted during civil war
    Characteristics of sample
   Average years of education = 6.0

   Cultural groups
       Ovimbundo 37.5%
       Kimbundo 30.9%
       Bakongo 8.0%
       Other 23.6%

   Married = 27.6%
   Have children = 81.3%
              Mental health

Number of       None                   21.7%
traumatic       1-2                    21.7%
events          3-5                    47.0%
                6+                     9.7%


  Witnessed death of friends            58%

  Witnessed mutilation of friends       40%
  Witnessed military execution          51%
  Experienced severe physical injury    20%
                 Mental health

Post-traumatic   PTSD (≥32)        19.9%
stress           Not PTSD          80.1%
Depression       Depressed (≤52)   12.3%
                 Not depressed     87.7%
                Alcohol use
Choice of Alcohol   Beer                     51.7%
                    Wine                     50.4%
                    Spirits                  29.0%
                    Home-brewed              17.6%

AUDIT               Mild/No drinking         65.0%
                    Problem drinking (> 8)   35.0%

Alcohol before      Never                    84.4%
sex in past month   Sometimes/Always         15.6%
  Indicators of HIV/AIDS risk

Number of partners   0            10.2%
(past 3 months)      1            47.3%
                     2            25.0%
                     3+           17.5%

Had sex with occasional partner   17.5%
or CSW (past 3 months)

Had STI symptom(s) in past        16.5%
year
                             Analyses
Hierarchical mixed linear/logistic models*
   Outcomes:
     number of partners (log) past 3 mo.
     sex with occasional or commercial partner past 3 mo.
     STI symptoms past year
   Predictors
     Sample characteristics
     Mental health (traumatic events, post-traumatic stress,
      depression)
     Alcohol use (alcohol before sex)

* To account for nesting of participants in bases
Predictors of number of sexual
partners (log) in past 3 months

                        Coeff.      p
Has children            -0.0004    ns

Number of traumatic     0.004      ns
events
Post-traumatic stress    0.01      ns
(10 pt increase)
Depression (10 pt       0.007      ns
increase)
Alcohol before sex       0.13     <.001
Predictors of sex with occasional or
commercial partner (past 3 months)
                           Odds Ratio     p      Conf. Int.
Married                     0.72         ns      0.38-1.36
Has children                0.58         ns      0.31-1.09
Rank
  Privates                  1.00
  Sergeants                 0.76         ns      0.41-1.26
  Officers                  4.39        <.01    1.66-11.64
Number of traumatic         1.15         ns      0.98-1.35
events
Post-traumatic              1.23        <.05    1.001-1.04
stress (10 pt. incr.)
Depression (10 pt incr.)    1.03         ns      0.98-1.01

Alcohol before sex          3.96        <.001   0.14-0.44
Predictors of STI symptoms (past year)
                            Odds Ratio    p     Conf. Int.
Married                      1.75        <.05   1.04-2.97
Rank
  Privates                   1.00
  Sergeants                  0.74         ns    0.44-1.22
  Officers                   0.67         ns    0.99-1.99
Number of traumatic          1.09         ns    0.94-1.26
events
Post-traumatic stress (10    1.13         ns    0.95-1.37
pt increase)
Depression (10 pt incr.)     1.14        <.05   0.77-0.98
Alcohol before sex           2.00        <.05   1.05-3.34
                 Summary

   Problematic alcohol use consistently
    predicted increase in HIV/AIDS risk among
    soldiers

   Other predictors were poor mental health,
    higher rank, and being married
                   Implications
   Post-conflict militaries in resource-limited
    countries face unique challenges
     Very few providers trained in mental health or
      substance abuse

   Need creative solutions
     Structural interventions & policy changes
        E.g., reduce accessibility to alcohol near base
     HIV prevention designed for higher ranks and married
      people
     Mental health?
            Contact us

Karen Cheng   kacheng@cdrewu.edu

Eric Bing     eric.g.bing@gmail.com

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:0
posted:1/25/2013
language:English
pages:20