Linking Mental Health and Substance Use, and Their Subsequent Associations with HIV Risk Behavior Among Gay, Bisexual, and Other Men Who Have Sex With Men (MSM) in Vancouver, British Columbia, Canada
Methods:Sexually active MSM aged ≥16 years were recruited using respondent-driving sampling (RDS). Participants completed a self-administered computer-based survey, including doctor-diagnosed mental health conditions, Alcohol Use Disorders Identification Test (AUDIT) to assess problem drinking, Hospital Anxiety and Depression Scale (HADS) to assess depression and anxiety, and substance use (<6 months). All analyses used RDS-generated weights. Manual backward-stepwise multivariate logistic regression was used to examine independent associations with 1) any doctor-diagnosed mental health condition and 2) sexual HIV risk behavior (unprotected anal intercourse with a known serodiscordant or unknown serostatus partner in <6 months).
Results: Of 719 participants, 23.4% were HIV-positive, 68.0% were White, and median age was 33 years (IQR 26-47). Half (52.1%) of MSM reported a mental health diagnosis (46.1% of whom were receiving treatment), which after controlling for significant demographics and sexual behaviours, was associated with increased scores on HADS-Anxiety (AOR=1.09[95%CI:1.03-1.15]), HADS-Depression (AOR=1.13[95%CI:1.04-1.22]), and AUDIT (AOR=1.07[95%CI:1.03-1.11]), and greater odds of substance use: tobacco daily (AOR=1.75[95%CI:1.10-2.80]), erectile dysfunction drugs (EDD) (AOR=2.30[95%CI:1.32-4.02]), and heroin (AOR=11.14[95%CI:1.24-100.31]). In the HIV risk multivariate model, none of mental health diagnoses, HADS, nor AUDIT were associated, but the following substances were positively associated: crystal methamphetamine monthly or less (AOR=2.57[95%CI:1.49-4.43]), poppers at least weekly (AOR=3.45[95%CI:1.67-8.11]), and EDD (AOR=3.01[95%CI:1.88-4.81]).
Conclusions: Though associated with substance use, mental health conditions did not contribute independently to sexual HIV risk. Substance use alone provides a better explanation of HIV risk behavior in MSM.
Learning Areas:Diversity and culture
Planning of health education strategies, interventions, and programs
Public health or related research
Social and behavioral sciences
Describe the relationship between mental health conditions and substance use amongst MSM Differentiate between the independent contribution of mental health conditions and substance use on sexual HIV risk behavior amongst MSM
Keyword(s): HIV/AIDS, Drug Abuse
Qualified on the content I am responsible for because: I have been the co-principal or co-investigator of multiple federally or provincially funded grants focusing on the epidemiology and prevention of HIV among gay, bisexual, and other men who have sex with men in Canada and New Zealand. Among my scientific interests has been the development of strategies for preventing HIV and STDs with consideration of proximal behavioural factors and more up-stream determinants.
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.