142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

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

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 8:30 AM - 8:45 AM

Kayla Hanson, BA , Division of HIV/AIDS Prevention, CDC, atlanta, GA
Gordon Mansergh, PhD , Division of HIV/AIDS Prevention, CDC, Atlanta, GA
Beryl Koblin, PhD , Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY
David McKirnan, PhD , Department of Psychology, University of Illinois at Chicago, Chicago, IL
Stephen Flores, PhD , Prevention Research Branch, Centers for Disease Control and Prevention; Division of HIV/AIDS Prevention, Atlanta, GA
Sharon M. Hudson, PhD , Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, CA
Grant Colfax, MD , AIDS Office, HIV Prevention Section, San Francisco Department of Public Health, San Francisco, CA
Background:  Previous findings are mixed for the association of depression and risk behavior among MSM.  More analyses are needed that stratify by HIV serostatus for specific behaviors (unprotected receptive, insertive anal sex), especially among high-risk groups (e.g., substance-using MSM).

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:

Public 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

Presenting author's disclosure statement:

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.

Back to: 3045.0: HIV/AIDS and Mental Health