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ost-traumatic stress, depression, alcohol use and HIVAIDS risk

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					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 decisionmaking (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 traumatic events None 1-2 3-5 6+ 21.7% 21.7% 47.0% 9.7% 58% 40% 51% 20%

Witnessed death of friends Witnessed mutilation of friends Witnessed military execution Experienced severe physical injury

Mental health
Post-traumatic stress
Depression

PTSD (≥32) Not PTSD
Depressed (≤52) Not depressed

19.9% 80.1%
12.3% 87.7%

Alcohol use
Choice of Alcohol Beer Wine Spirits Home-brewed 51.7% 50.4% 29.0% 17.6%

AUDIT

Mild/No drinking Problem drinking (> 8)
Never Sometimes/Always

65.0% 35.0%
84.4% 15.6%

Alcohol before sex in past month

Indicators of HIV/AIDS risk
Number of partners (past 3 months) 0 1 2 3+ 10.2% 47.3% 25.0% 17.5% 17.5% 16.5%

Had sex with occasional partner or CSW (past 3 months) Had STI symptom(s) in past 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.
Has children Number of traumatic events Post-traumatic stress (10 pt increase) Depression (10 pt increase) Alcohol before sex -0.0004 0.004 0.01 0.007 0.13

p
ns ns ns ns <.001

Predictors of sex with occasional or commercial partner (past 3 months)
Odds Ratio
Married Has children 0.72 0.58 1.00 0.76

p
ns ns

Conf. Int.
0.38-1.36 0.31-1.09

Rank
Privates Sergeants ns 0.41-1.26

Officers
Number of traumatic events

4.39
1.15

<.01
ns

1.66-11.64
0.98-1.35

Post-traumatic stress (10 pt. incr.)
Depression (10 pt incr.)

1.23
1.03

<.05
ns

1.001-1.04
0.98-1.01

Alcohol before sex

3.96

<.001

0.14-0.44

Predictors of STI symptoms (past year)
Odds Ratio
Married Rank Privates Sergeants Officers Number of traumatic events Post-traumatic stress (10 pt increase) Depression (10 pt incr.) 1.75 1.00 0.74 0.67 1.09 1.13 1.14

p
<.05

Conf. Int.
1.04-2.97

ns ns ns ns <.05

0.44-1.22 0.99-1.99 0.94-1.26 0.95-1.37 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
Eric Bing

kacheng@cdrewu.edu
eric.g.bing@gmail.com


				
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posted:5/23/2008
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