title: Depression and sexual risk behaviours among people who inject drugs: a gender-based analysis.
abstract: Background Although many people who inject drugs (PID) contend with comorbidities, including high rates of mental illness, limited attention has been given to the differences in comorbidities among men and women or the potential links between psychiatric disorders and HIV risk behaviours. We sought to longitudinally examine associations between depression and HIV-related sexual risk behaviours among PID, stratified by gender.
  
  
  METHODS
  Data were derived from a prospective cohort of PID in Vancouver, Canada between December 2005 and November 2009. Using generalised estimating equations, we examined the relationship between depressive symptoms and two types of sexual HIV risk behaviours: engaging in unprotected sex; and having multiple sexual partners. All analyses were stratified by self-reported gender.
  
  
  RESULTS
  Overall, 1017 PID participated in this study, including 331 (32.5%) women. At baseline, women reported significantly higher depressive symptoms than men (P<0.001). In multivariate generalised estimating equations analyses, after adjustment for potential social, demographic and behavioural confounders, more severe depressive symptomology remained independently associated with engaging in unprotected sex [adjusted odds ratio (AOR)=1.62, 95% confidence interval (CI): 1.18-2.23] and having multiple sexual partners (AOR=1.54, 95% CI: 1.09-2.19) among women, but was only marginally associated with having multiple sexual partners among men (AOR=1.18, 95% CI: 0.98-1.41).
  
  
  CONCLUSIONS
  These findings call for improved integration of psychiatric screening and treatment services within existing public health initiatives designed for PID, particularly for women. Efforts are also needed to address sexual risk-taking among female PID contending with clinically significant depression.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
authors.forename: Tyler
authors.initials: T
authors.lastname: Pettes
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
authors.forename: Pauline
authors.initials: P
authors.lastname: Voon
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Nguyen
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
authors.forename: Kanna
authors.initials: K
authors.lastname: Hayashi