Depressive symptoms are differentially associated with unprotected receptive and insertive anal sex (and masked as a combined risk variable) among HIV-positive and HIV-negative, substance-using men who have sex with men in the US
Methods: Data are from a convenience sample of MSM (n=1203) reporting substance use during sex (Project MIX - in Chicago, Los Angeles, New York City, San Francisco). 2005-06 baseline survey assessed self-reported depressive symptoms (past week) using a CES-D short version; average score per respondent was dichotomized to symptoms “rarely or sometimes” (0) vs. more than “sometimes” (1).
Results: HIV-positive (vs. -negative) MSM were more likely to report depressive symptoms (45% [n=271/604] vs. 39% [n=232/599] respectively, p<.05). In multivariate analyses for HIV-negative MSM, depressive symptoms were associated with unprotected receptive anal (URA) sex (adjusted Odds Ratio [OR]=1.58, 95% Confidence Interval [CI]=1.07-2.33). Similarly, among HIV-positive MSM, depressive symptoms were associated with URA (OR=1.61, CI=1.13-2.29). Alternatively, depressive symptoms were inversely associated with unprotected insertive anal (UIA) sex among HIV-positive MSM (OR=0.61, CI=0.47-0.97) but not among HIV-negative MSM (p>.05). Analyses of associations of depressive symptoms and combined unprotected anal (UA) sex were non-significant for HIV negative (p>.05) and significant for HIV-positive (OR=1.57, CI=1.06-2.31) men.
Conclusions: Depressive symptoms are associated with URA for both HIV-negative and -positive MSM, and inversely associated with UIA for HIV-positive MSM, among substance-using men; these differential findings are masked for depressive symptoms and a combined UA variable. Future research and programs should address this differential link to better understand and intervene on the comorbid associations of negative affect and risk behavior.
Public health or related research
Social and behavioral sciences
Describe differential/divergent associations of depressive symptoms with specific unprotected receptive and insertive anal sex by HIV-status among high-risk, substance-using MSM Describe the masking effect found in the association of depressive symptoms and sexual risk behavior by HIV-status among substance-using MSM when a combined unprotected receptive and insertive dependent variable is used versus when receptive and insertive anal sex are analyzed independently
Keyword(s): HIV Risk Behavior, Depression
Qualified on the content I am responsible for because: I developed the analysis concept, conducted background literature review, co-analyzed the data, and wrote the abstract while a student intern at CDC under the mentorship and leadership of Dr Gordon Mansergh.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.