Abstract
Psychiatric co-morbidity and sex trade were tested as correlates of sexually transmitted infections (STIs) among 76 pregnant heroin- or cocaine-dependent women. Participants were recruited from a drug treatment programme and attended a clinician-administered assessment including the Structured Clinical Interview for DSM-IV (SCID-IV-TR) and self-report questionnaires about lifetime histories of sex trade and STIs (i.e. gonorrhoea, syphilis, chlamydia, herpes, genital warts or trichomonas). Lifetime and six month rates of STIs were 53.9% and 18.4%, respectively. The majority of women also had lifetime histories of psychiatric co-morbidity (61.8%) and/or sex trade (60.5%). Participants with psychiatric co-morbidity (adjusted odds ratio [AOR] 3.9; 95% confidence interval [CI] 1.3–11.6) and/or sex trade (AOR 3.2; 95% CI 1.1–9.5) were more likely to report STIs during their lifetime compared with those without such histories while controlling for age, education and race/ethnicity. Results suggest that as many as one-in-five pregnant heroin- or cocaine-dependent women in treatment have one or more STIs that are concurrent with their pregnancy and may contribute to risk for contracting HIV and pregnancy complications; psychiatric co-morbidity and/or sex trade were associated with greater STI risk. Findings underscore the importance of identifying and addressing co-morbid psychiatric disorders and sex trade behaviour in this population.
BACKGROUND
Pregnant heroin- or cocaine-dependent women are at high risk for contracting sexually transmitted infections (STIs), 1 which contribute to their risk for contracting HIV 2 and pregnancy complications. 3 While sex trade and psychiatric co-morbidity have both been associated with STIs, 4,5 no studies to date have examined these variables in relation to STIs among pregnant women in drug dependence treatment. Yet, investigation into correlates of STIs among pregnant drug-dependent women may ultimately serve to inform the development of prevention interventions to reduce risk for STIs in this population of women. Therefore, this study tested psychiatric co-morbidity and sex trade as correlates of STIs among pregnant heroin- or cocaine-addicted women in drug treatment.
METHOD
From March 2006 until December 2008, 76 HIV-seronegative, pregnant heroin- or cocaine-dependent women were recruited from a drug treatment programme to participate in an HIV prevention intervention. Exclusionary criteria were as follows: (1) complications of pregnancy; (2) evidence of fetal malformation; (3) significant maternal health problems that were unrelated to pregnancy; (4) psychosis; and/or (5) acute suicidal ideation. Clinician-administered assessments included self-report measures of sex trade and STIs (i.e. gonorrhoea, syphilis, chlamydia, herpes, genital warts or trichomonas) and the Structured Clinical Interview for DSM-IV (SCID-IV-TR). 6
RESULTS
Participants were between 18 and 43 years of age (mean = 31.99; SD = 5.62) and predominately African-American (56.6% African-American; 39.5% white and 3.9% other). The majority had less than a high school education (53.9%) and a lifetime history of a psychiatric co-morbidity (61.8%) and sex trade (60.5%). Forty-one women (53.9%) had an STI during their lifetime, 24 women (31.6%) had a lifetime history of more than one STI and 14 (18.4%) had an STI during the previous six months overlapping with their pregnancies. Lifetime rates were as follows: 30.3% for chlamydia, 27.6% for gonorrhoea, 22.4% for trichomoniasis, 11.8% for syphilis, 9.2% for genital warts and 5.3% for herpes. Results for the univariable and multivariable regressions are presented as the unadjusted and adjusted odds ratios and 95% confidence intervals (CI) in Table 1. Sex trade and psychiatric co-morbidity were statistically significant correlates of STIs in univariable and multivariable models.
Logistic regression model testing correlates of lifetime sexually transmitted infections (n = 76)
STI = sexually transmitted infection
**P < 0.01; *P < 0.05
DISCUSSION
Results suggest that as many as one-in-five pregnant heroin- or cocaine-dependent women in treatment have one or more STIs that are concurrent with their pregnancy and may contribute to risk for contracting HIV and pregnancy complications; 2,3 psychiatric co-morbidity and/or sex trade were associated with greater STI risk. However, these findings are preliminary and the span of some CI indicates some instability in the models due to small sample size. Self-reports of STIs may also be viewed as a suboptimal STI assessment method; however, evidence suggests they are viable and comparable to objective sources including medical record reviews and state health department reports. 7 Study strengths include examination of a high-risk population for STIs that is hard to access and use of the SCID-IV-TR 6 to assess co-morbid psychiatric diagnoses. Findings underscore the importance of identifying and addressing co-morbid psychiatric disorders and sex trade behaviour in this population.
Footnotes
ACKNOWLEDGEMENTS
This research was funded by Grants 2T32DA007292 and R01DA020929 from the National Institute on Drug Abuse. We would like to thank the Johns Hopkins Center for Addiction and Pregnancy, including Hendree Jones PhD, Michelle Tuten PhD and Heather Fitzsimons BA, for their collaboration with this study as well as April Lawson, Christina Salama, Jonathon Rose and Evonda Hill for their assistance and contributions to this study. All authors have made significant contributions to the manuscript and there are no conflicts of interest.