Estimating the Effect of Depression on HIV Transmission Risk Behaviors Among People Who Inject Drugs in Vietnam: A Causal Approach

AIDS Behav. 2021 Feb;25(2):438-446. doi: 10.1007/s10461-020-03007-9.


The burden of depression and HIV is high among people who inject drugs (PWID), yet the effect of depression on transmission risk behaviors is not well understood in this population. Using causal inference methods, we analyzed data from 455 PWID living with HIV in Vietnam 2009-2013. Study visits every 6 months over 2 years measured depressive symptoms in the past week and injecting and sexual behaviors in the prior 3 months. Severe depressive symptoms (vs. mild/no symptoms) increased injection equipment sharing (risk difference [RD] = 3.9 percentage points, 95% CI -1.7, 9.6) but not condomless sex (RD = -1.8, 95% CI -6.4, 2.8) as reported 6 months later. The cross-sectional association with injection equipment sharing at the same visit (RD = 6.2, 95% CI 1.4, 11.0) was stronger than the longitudinal effect. Interventions on depression among PWID may decrease sharing of injection equipment and the corresponding risk of HIV transmission.Clinical trial registration NCT01689545.

Keywords: Depressive symptoms; HIV transmission; Injecting behavior; Marginal structural models; People who inject drugs; Sexual behavior.

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Depression / epidemiology*
  • HIV Infections* / complications
  • HIV Infections* / epidemiology
  • HIV Infections* / psychology
  • Humans
  • Male
  • Middle Aged
  • Pharmaceutical Preparations
  • Risk-Taking
  • Substance Abuse, Intravenous* / complications
  • Substance Abuse, Intravenous* / epidemiology
  • Substance Abuse, Intravenous* / psychology
  • Vietnam / epidemiology
  • Young Adult


  • Pharmaceutical Preparations

Associated data