Depression, Drug Use and HIV Risk Behavior in a Probability Sample of Urban MSM

Objective: Since most studies on risky sexual behavior (RSB) of men having sex with men (MSM) rely on convenience samples, they have limited generalizability to the larger population. Moreover, few of these studies have simultaneously investigated the effect of depression and substance use on RSB. Using a probability sample, the current study examines the impacts of these two factors on RSB of MSM controlling for other explanatory variables. Participants: The sample included 216 men who were self-identified as being homosexual or bisexual or as having had consensual sex with another man. Methods: We employed multinomial logistic regression (accounting for the design effect of the cluster sample) to predict a four-category RSB measure. The substance use variable measures the use of alcohol or drugs in the last 3 days. Our depression measure is derived from a short version of the CESD. Results: The respondents having the lowest level of depressive symptoms as compared to those with the highest level were less likely (OR=0.17) to report both receptive and insertive anal intercourse (the reference category being neither receptive nor insertive anal intercourse without a condom). The same was true for the respondents who did not use alcohol or drug within the last three days as compared to those who did (OR=0.26). Conclusions: Recent depression and drug use are significant positive predictors of RSB. These findings reinforce the notion that HIV prevention strategies for gay and bisexual men need to address both mental health and substance use treatment needs.