Page 178 - HIVMED_v21_i1.indb

Page 2 of 5 Original Research

Although studies of condom use have been conducted in diagnosis, route of transmission, concurrent hepatitis B and
various countries, the generalisability of these to Iranian C and tuberculosis infections and duration of ART.
PLWH is uncertain in view of significant cultural, social and Participants were asked about condom use during the past
economic differences. Furthermore, Iranian studies of year. The response was divided into three parts: people who
condom use in PLWH and other at-risk groups with mood never used a condom, people who used it sometimes and
disorders are few. 14,15,16 Given the importance of condoms in people who always used a condom.
preventing STIs, this study aimed to identify associations
between depression, sleep quality and condom use in this Our inclusion criteria were (1) confirmation of HIV infection
cohort of PLWH. by rapid and enzyme-linked immunosorbent assay HIV
tests, (2) a history of sexual intercourse at least once over
Materials and methods the past 12 months, (3) age 18 years or older and (4)
informed consent to participate in the study. Participants
This study was performed as a cross-sectional study on 298 whose condom use status was unclear (n = 8) were excluded
PLWH referred to voluntary counselling and testing centres from the sample. Other participants were included in the
(VCTs) in Tehran, the capital of Iran, from October to study.
November 2019. We evaluated depression, sleep quality and
condom use in PLWH and assessed the presence of Questions were asked in face-to-face, one-on-one interviews
independent associations between these factors. by eight trained interviewers (psychologists). The
interviewers provided participants with an explanation of
As Tehran is a large city, to ensure the random selection of the study and its objectives and invited participants
VCTs from all regions of the city, it was divided into four to consider enrolling. Participants were assured of
geographical areas – north, south, east and west. After that, a confidentiality and an ‘opt-out option’ if they did not wish
list of these centres was prepared separately for each of the to continue with the study. Informed consent was obtained
four regions. In each area, two VCTs were randomly selected, from participants prior to the study.
for a total of eight centres. Finally, the existing files in each
centre were randomly selected, and people were invited to
participate in the study. Statistical analysis
For quantitative data, mean and standard deviation (SD)
A demographic questionnaire, the Depression Anxiety Stress were used; frequency and percentage were reported for the
Scale (DASS) and the Pittsburgh Sleep Quality Index qualitative variables. One-way analysis of variance and t-test
Questionnaire (PSQI) were used for data collection. The were used to evaluate the differences between depressed and
DASS questionnaire is designed to address depression and non-depressed individuals in terms of age, BMI, duration
anxiety overlap. This scale has two different versions. In the since the HIV diagnosis, CD4 count and duration of ART. We
main version, which has 42 questions, each of the used a chi-square test to evaluate differences between
psychological structures (depression, anxiety and stress) is depressed and non-depressed individuals in terms of gender,
evaluated by 14 different questions, but in its abbreviated educational level, marital status, condom use status, sleep
version, there are 21 questions, and each psychological quality, anxiety, stress, route of HIV transmission and
structure is measured by seven questions. Each question can coinfections.
be answered by ‘never’, ‘sometimes’, ‘often’ or ‘almost
always’. Various studies indicate that the DASS questionnaire The multinomial logistic regression method was used to
provides valid assessments of the three structures of determine the relationship between depression, age, sex,
depression, anxiety and stress and can significantly marital status, duration since the diagnosis of HIV and the
differentiate between different contexts. 17 use of condoms, and people who always used condoms were
defined as a reference. All analyses were performed with
In this study, the Persian translation of the abbreviated Stata software, and a p-value of less than 0.05 was considered
version of the questionnaire was used. The validity and significant.
reliability of the Persian version have been confirmed in
several studies. 18,19 To assess the quality of sleep in patients in Ethical consideration
the last month, the PSQI was used. This questionnaire has This study was approved by the ethical committee of Tehran
seven components: quality of sleep, sleep delay, sleep University of Medical Sciences (ethics approval number,
duration, sleep efficiency, sleep disorders, sleeping pill use IR.TUMS.VCR.REC.1398.312).
and daily dysfunction. Many studies have confirmed the
validity and reliability of this questionnaire. 20,21 Each Results
component can be scored from 0 to 3, and an overall score of
5 and above indicates inappropriate or poor quality of sleep. A total of 298 HIV-positive patients, including 96 women
22
Background demographic data also collected included (32.2%) and 202 men (67.8%), participated in the study. The
gender, age, education, marital status, body mass index average age of participants was 39.81 (SD = 9.67) years. More
(BMI), employment status, CD4 count, time since HIV than half were married. About half of the participants were

http://www.sajhivmed.org.za 170 Open Access