title: High Levels of Concomitant Behavioral Health Disorders Among Patients Presenting for HIV Non-occupational Post-exposure Prophylaxis at a Boston Community Health Center Between 1997 and 2013.
abstract: A paucity of information regarding mental health exists for patients presenting for HIV non-occupational post-exposure prophylaxis (nPEP). We reviewed electronic medical records of 894 adult nPEP patients seen at a large Boston community health center between 1997 and 2013. Of 821 patients with consensual sexual exposures, 88.3 % were men who have sex with men, and 40.0 % had a mental health diagnosis. Diagnoses included: depression (24.4 %), anxiety (21.9 %), attention deficit disorder (7.8 %), post-traumatic stress disorder (3.3 %), and psychotic disorders (3.3 %). Of 129 patients with substance use disorders, alcohol dependence (65.9 %) and crystal methamphetamine (43.4 %) predominated. Unprotected receptive anal intercourse was associated with psychotic disorders (aOR = 4.86; 95 %CI:1.76-13.5) and substance use disorders (aOR = 1.89; 95 %CI:1.28-2.80). Substance use at the time of exposure was associated with: depression (aOR = 1.95; 95 %CI:1.36-2.80), anxiety (aOR = 2.22; 95 %CI:1.51-3.25), attention deficit disorder (aOR = 1.96; 95 %CI:1.18-3.27), and substance use disorder (aOR = 4.78; 95 %CI:3.30-6.93). Mental illness should be screened for and addressed at nPEP visits to optimize HIV risk-reduction.
authors.affiliation: Division of Infectious Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, USA. sajain@montefiore.org.
authors.forename: Sachin
authors.initials: S
authors.lastname: Jain
authors.affiliation: The Fenway Institute, Fenway Health, Boston, USA.|Department of Epidemiology, Harvard School of Public Health, Boston, USA.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Oldenburg
authors.affiliation: The Fenway Institute, Fenway Health, Boston, USA.|Department of Epidemiology, Harvard School of Public Health, Boston, USA.|Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Mimiaga
authors.affiliation: The Fenway Institute, Fenway Health, Boston, USA.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D001900:Boston / Q000453:epidemiology; D003151:Community Health Centers; D017280:Condoms / Q000706:statistics & numerical data; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control* / Q000523:psychology; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D008694:Methamphetamine / Q000009:adverse effects*; D008875:Middle Aged; D056990:Post-Exposure Prophylaxis; D012725:Sexual Behavior; D012747:Sexual Partners / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data*
chemical_list: D008694:Methamphetamine
keywords: HIV; Mental illness; PEP; Syndemic; nPEP