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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.
Learning Areas:
EpidemiologyPublic health or related research
Social and behavioral sciences
Learning Objectives:
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.