Depressive symptoms and unprotected sex in St. Petersburg, Russia

Correlates of Unmet Need for Modern Contraception Among Reproductive-Aged Women Involved in New York City Criminal Legal Systems

Introduction

The population of women involved in criminal legal systems (WICL), a majority of whom are reproductive-aged, has risen steadily in the United States. They contend with numerous barriers to sexual and reproductive health services resulting in high rates of unmet need for contraception and unintended pregnancy.

Materials and Methods

This study included 132 non-pregnancy seeking reproductive-aged WICL enrolled in the baseline assessment of the HIV prevention intervention, "Women on the Road to Health" (WORTH). A multivariate generalized linear logistic regression model with robust estimation examined effects of past 6-month intimate partner violence (IPV; sexual and physical/injurious), past 3-month substance use (binge drinking, cannabis, other illegal drug use), and lifetime mental health diagnoses (anxiety, depression, bipolar disorder) on women's unmet need for modern contraception, adjusting for significant demographic and socioeconomic factors.

Results

Women who were younger in age (odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.63-0.88) and reporting lifetime diagnoses of anxiety disorders (OR: 13.64; 95% CI: 2.71-68.34) were significantly more likely to meet the criteria for unmet need for modern contraception. Women with a regular gynecologist (OR: 0.11; 95% CI: 0.01-0.86) reporting lifetime diagnoses of bipolar disorder and past 6-month sexual IPV histories (OR: 0.04; 95% CI: 0.002-0.86) were significantly less likely to meet the criteria for unmet need for modern contraception.

Conclusions

Distinct mental health diagnoses and experiences of IPV may uniquely impact unmet need for modern contraception among WICL. These findings emphasize the need for a more nuanced comprehension of these relationships to deliver comprehensive and holistic health services that address the intersecting needs of this population.

Trial registration: ClinicalTrials.gov NCT01784809. Registered 6 February 2013.

The Associations of Mental Health Disturbances, Self-Esteem, and Partner Violence Victimization with Condom Use in Spanish Adolescents

Risky sexual behaviors, such as not using a condom for preventing sexually transmittable diseases and unwanted pregnancies, are associated with emotional and psychological problems in adolescence, including higher levels of depression, anxiety, stress, and low self-esteem. Adolescents with a history of violence victimization are also at increased risk of engaging in sexual risk behaviors. In this study, we examined the associations between mental health disturbances and partner violence victimization and the non-use of condoms among young people in Spain. We also examined self-esteem as a mediator of mental health problems and unprotected sexual relationships. A cross-sectional study was conducted on a sample of 831 adolescents randomly selected from 25 high schools in Spain. From the initial sample, 285 students (144 men and 141 women) from high schools in Alicante (Spain) who reported having experienced sexual activity with at least one partner were approached. The results showed that one in three adolescents between 14 and 19 years old did not use condoms during sexual intercourse. The factors associated with the non-use of condoms in the estimated models of Poisson robust variance were having a history of physical, psychological, or sexual violence; having been expelled from school because of behavioral problems; and having higher levels of depression, anxiety, and stress and lower levels of self-esteem. Self-esteem was independently associated with the non-use of condoms. Having lower levels of self-esteem increased the risk of not using a condom during participants’ last sexual intercourse. These findings suggest the importance of developing public health strategies for mental health promotion to increase condom use among adolescents.

Sexual and reproductive health knowledge, sexual attitudes, and sexual behaviour of university students: Findings of a Beijing-Based Survey in 2010-2011

BACKGROUND

Although several studies have attempted investigating sex-related knowledge, attitudes, and practices among young people in China, deeper insights were still needed to further understand how this population could be supported to make healthy and safe sexual choices. Against this background, this study used a large set of secondary data to examine associations among sexual and reproductive health (SRH) knowledge, sexual attitudes, and sexual behaviour.

METHODS

A cross-sectional study was employed to explore the associations among SRH knowledge, sexual attitudes, and sexual behaviour with a publicly available survey data among the 1196 university students from freshmen to Ph.D. candidates. Descriptive analysis was used to describe the sociodemographic characteristics of the university students by gender. Associations of sociodemographic factors with sources and categories of SRH knowledge, categories of contraceptive knowledge, sexual attitudes, and sexual behavior were explored with Poisson regressions and logistic regressions, respectively. The mediating effects of sociodemographic factors on the associations between SRH knowledge and sexual behavior, observed sexual attitudes on the associations of SRH knowledge with sexual behavior, and latent sexual attitudes on the relationship between SRH knowledge and sexual behavior were analyzed in order.

RESULTS

Descriptive analysis showed that the sample was dominated by age group (18 to 24 years), undergraduates, females, limited contraceptive knowledge, unfavorable sexual attitudes, and insufficient knowledge sources. Regression analyses showed that sociodemographic factors had significant associations with SRH knowledge, sexual attitudes, and sexual behavior. Subsequently, the mediating effects of sociodemographic factors on the associations of SRH knowledge and sexual attitudes with sexual behavior were confirmed. Controlling for sociodemographic factors, the effects of sexual attitudes on the associations between SRH knowledge and sexual behaviour could be verified. Structural equation modeling indicated that the linear sequence of sources and categories of SRH knowledge → sexual attitudes → sexual behaviour model and the triangle mediating effects of sexual behaviour → sexual attitudes → SRH knowledge model existed.

CONCLUSIONS

Sociodemographic factors and observed sexual attitudes mediated the associations between SRH knowledge and sexual behaviour. The sequence relationship: sources and categories of SRH knowledge → sexual attitudes → sexual behavior and the mediating relationship: sexual behavior → sexual attitude → sources and categories of SRH knowledge & sexual behavior → sources and categories of SRH knowledge and sexual behavior → sexual attitude → categories of contraceptive knowledge & sexual behavior → categories of contraceptive knowledge were confirmed in the sample. This study also identified an urgent need for the university students to access to SRH comprehensive knowledge.

Associations of depression and anxiety symptoms with sexual behaviour in women and heterosexual men attending sexual health clinics: a cross-sectional study

Objective

To assess the association of symptoms of depression and anxiety with sexual risk behaviour and history, among women and heterosexual men attending genitourinary medicine (GUM) clinics.

Methods

Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) was a cross-sectional, self-administered questionnaire study recruited from 20 GUM clinics in England, 2013–2014. This analysis included women and heterosexual men. The prevalence of depression and anxiety symptoms was assessed. Modified Poisson regression was used to produce adjusted prevalence ratios (aPR) for the association of t demographic, socioeconomic and lifestyle factors with depression and anxiety, adjusted for gender, age, ethnicity, education level and study region. Among individuals reporting sex in the past 3 months, associations of depression and anxiety with sexual risk behaviour and history were assessed separately by gender, adjusted for age, ethnicity, study region, education and relationship status.

Results

Questionnaires were completed by 676 women and 470 heterosexual men. Depression symptoms were reported by 100 (14.8%) women and 33 men (7.0%). Anxiety symptoms were reported by 79 women (11.7%) and 21 men (4.5%). Among women reporting recent sex, those with depression symptoms were more likely to report condomless sex with a non-regular partner, aPR 1.38 (1.07–1.77) and recent condomless sex with two or more partners, 1.80 (1.25–2.59). Women with anxiety symptoms more likely to report recent condomless sex with two or more partners, 1.68 (1.13–2.50), low self-efficacy for condom use, 1.54 (1.02–2.31) and STI diagnosis in the last year 1.51 (1.04–2.20). Among heterosexual men reporting recent sex, depression and anxiety symptoms were associated with low self-efficacy with condom use, 2.32 (1.29–4.19) for depression and 2.23 (1.26–3.94) for anxiety, but not with measures of condomless sex.

Discussion

The associations between psychological symptoms and sexual risk behaviours highlight the importance of holistic assessment of need by both general and sexual health clinicians. We highlight the challenge in delivering holistic care associated with fragmentation of sexual health services.

Awareness and Interest in HIV Pre-Exposure Prophylaxis Among Street-Based Female Sex Workers: Results from a US Context

Pre-exposure prophylaxis (PrEP) has the potential to be an empowering HIV prevention tool among female sex workers (FSW), yet little is known about PrEP awareness and interest in this population. Sex workers and Police Promoting Health in Risky Environments (SAPPHIRE) is a prospective cohort study of street-based FSW in Baltimore, MD. A cross-sectional analysis explored awareness and interest in PrEP among HIV-negative FSW. Multivariable Poisson regressions modeled associations between individual, interpersonal, and structural variables and PrEP awareness and interest. Of n = 232 FSW, 66% were white, half were less than 35 years old, 59% injected drugs daily, and 66% sold sex daily. Only 21% of FSW were aware of PrEP, though 74% were interested. PrEP awareness was associated with experiencing client condom coercion [adjusted incidence rate ratio (aIRR) = 0.50, 95% CI: 0.28-0.90] and condomless sex with an intimate partner (aIRR = 0.54, 95% CI: 0.30-0.98). PrEP interest was associated with perceiving PrEP as "very easy" to take (aIRR = 1.91, 95% CI: 1.49-2.45) and moving to an unfamiliar geographic area to sell sex (aIRR = 1.20, 95% CI: 1.04-1.39). Women who had a current gonorrhea or chlamydia infection were less likely to be interested in PrEP (aIRR = 0.75, 95% CI: 0.59-0.95). Though PrEP awareness among FSW is low, there are FSW who are significantly more likely to express interest in PrEP and outreach efforts should target these women. Results suggest that women-controlled HIV prevention methods may be important for reducing incidence among FSW.

Changes in Anxiety and Depression Symptoms Predict Sexual Risk Behaviors Among Young Men Living in Dar es Salaam, Tanzania

Young men are important targets in HIV prevention in Tanzania and throughout sub-Saharan Africa. Anxiety and depression are common among youth and may be important predictors of HIV risk behaviors; evidence of these relationships in high-risk populations is needed. Using baseline and 1 year follow-up assessments from an HIV prevention trial we assessed the association between changes in symptoms of anxiety and depression and follow-up sexual risk behaviors (condom use and sexual partner concurrency) controlling for baseline sexual risk behaviors among 1113 male members of social groups known as "camps" in Dar es Salaam, Tanzania. Anxiety and depression were measured using the HSCL-25 and condom use and sexual partner concurrency were assessed through self-report. In separate models, increases in anxiety and depression were associated with sexual partner concurrency and with lower levels of condom use. In a combined model, both anxiety and depression appeared to independently affect concurrency but only depression was independently associated with condom use, with the association between anxiety and condom use being likely attributable to covariance with depression symptoms. The results of this study indicate the importance of screening and providing treatment for depression and anxiety disorders in high HIV-prevalence contexts, and the need to develop effective HIV prevention interventions targeting young men living with anxiety and depression.

Association Between Depression and Condom Use Differs by Sexual Behavior Group in Patients with HIV

Identifying a relationship between depression and sexual risk behavior in HIV-infected patients could establish a mechanism to enhance prevention efforts. We conducted a cross-sectional analysis using data from the University of Pennsylvania Center for AIDS Research and used ordinal logistic regression to measure the association between depression and non-condom use. 716 men who have sex with men (MSM), 262 heterosexual men and 277 heterosexual women were included. The association between depression and non-condom use was strongest in heterosexual men with and without HIV-infected regular partners (OR 8.53, 95% CI 1.18-61.89 and OR 2.30, 95% CI 0.99-5.36 respectively), but absent in heterosexual women regardless of partner. Although the OR was low in MSM overall, an association was detected in MSM without HIV-infected regular partners (OR 2.44, 95% CI 1.39-4.31). In conclusion, we demonstrated an association between depression and non-condom use driven by heterosexual men and MSM without HIV-infected regular partners. Sexual risk should be addressed when intervening on depressive symptoms in these subgroups.

Social capital - a mixed blessing for women? A cross-sectional study of different forms of social relations and self-rated depression in Moscow

BACKGROUND

Depression is a major health problem worldwide, especially among women. The condition has been related to a number of factors, such as alcohol consumption, economic situation and, more recently, to social capital. However, there have been relatively few studies about the social capital-depression relationship in Eastern Europe. This paper aims to fill this gap by examining the association between different forms of social capital and self-rated depression in Moscow. Differences between men and women will also be examined, with a special focus on women.

METHODS

Data was obtained from the Moscow Health Survey, which was conducted in 2004 with 1190 Muscovites aged 18 years or above. For depression, a single-item self-reported measure was used. Social capital was operationalised through five questions about different forms of social relations. Logistic regression analysis was undertaken to estimate the association between social capital and self-rated depression, separately for men and women.

RESULTS

More women (48 %) than men (36 %) reported that they had felt depressed during the last year. An association was found between social capital and reported depression only among women. Women who were divorced or widowed or who had little contact with relatives had higher odds of reporting depression than those with more family contact. Women who regularly engaged with people from different age groups outside of their families were also more likely to report depression than those with less regular contact.

CONCLUSIONS

Social capital can be a mixed blessing for women. Different forms of social relations can lead to different health outcomes, both positive and negative. Although the family is important for women's mental health in Moscow, extra-familial relations across age groups can be mentally distressing. This suggests that even though social capital can be a valuable resource for mental health, some of its forms can be mentally deleterious to maintain, especially for women. More research is needed on both sides to social capital. A special focus should be placed on bridging social relations among women in order to better understand the complex association between social capital and depression in Russia and elsewhere.

Prevalence and associated factors of unprotected anal intercourse with regular male sex partners among HIV negative men who have sex with men in China: a cross-sectional survey

The HIV prevalence and incidence among men who have sex with men (MSM) in China are high. Unprotected anal intercourse (UAI) with a regular male sex partner (RP), a significant predictor of HIV sero-conversion, was high yet under-emphasized among MSM having RP (MSMRP). The present cross-sectional survey interviewed 307 HIV negative MSMRP recruited through convenient sampling from multiple sources, including venue-based outreaching, online recruitment, and referrals made by peers, in Beijing and Chengdu, China. Among MSMRP, the prevalence of UAI with RP in the last three months was 52.4%. The results of the multivariate analysis showed that trust and intimacy within the relationship with RP and presence of clinical depression symptoms were positively associated with UAI with RP in the last three months. Other associated scalar factors derived from the Theory of Planned Behavior were related to perceptions on condom use, including positive attitudes toward condom use (a negative association), subjective norm of the perception that MSM do not usually use condoms during anal intercourse with RP (a positive association), perceived behavioral control over condom use with RP (a negative association), and behavioral intention to use condoms with RP in the coming three months (a negative association). It is seen that MSMRP were at high risk of HIV/STD transmission. The associated factors hence involved those related to perceptions about condom use, mental health, and interpersonal relationship. Future interventions should take these multi-dimensional factors into account. In particular, future research to test the efficacy of couple-based interventions that include mental health elements needs to be conducted, as trust and intimacy within the relationship were associated with UAI among MSMRP, and mental health problems may exist for both the MSMRP and their RP.

Gender differences in depression and condom use among sexually active Canadians

BACKGROUND

Given the gendered distribution of depression, this paper aims at exploring the gender disparities in the effect of depression on condom use in last sexual intercourse in a nationally representative sample of sexually active Canadians.

METHODS

Data in this study came from the Canadian Community Health Survey 2009-2010 (n=124,188 aged ≥12 years). The analysis in this study was restricted to 7238 respondents aged 15-49 years who had sexual intercourse in the 12-months preceding the survey. Multivariable logistic regression, stratified by gender, was used to estimate the effect of depression on condom use adjusting for potential confounders.

RESULTS

Reported condom use was lower in females (46.9%) than in males (60.9%), while depression was more in females (13.5%) than in males (8.4%). Condom use was less among people with depression, in both males and females. However, condom use was far less frequent among females (41.2%) with depression than their male counterparts (58.1%). Depression was found to reduce the odds of condom use in last sexual intercourse both in males and females. However, the effect was statistically significant in females only (adjusted odds ratio: 0.81; 95% CI: 0.66-0.99).

LIMITATIONS

Cross-sectional data, and inability to capture socio-economic status and alcohol use rigorously are some of the limitations of this study.

CONCLUSIONS

Depression was found to reduce condom use significantly in females. Public health programs aimed at increasing condom use should address the issues of improving self-efficacy in condom negotiation skills in females, along with addressing mental health issues, especially depression, with a gender-sensitive perspective.

Alcohol and sexual risk reduction interventions among people living in Russia: a systematic review and meta-analysis

Russia has one of the highest rates of alcohol consumption and is experiencing one of the fastest-growing HIV epidemics in the world. Given these co-occurring health problems, we systematically reviewed combined alcohol and sexual risk interventions to reduce HIV among Russians. We completed comprehensive electronic searches to locate studies that (a) sampled people living in Russia, (b) used a behavioral intervention, and (c) assessed both alcohol and sexual risk behavior. These searches yielded 584 studies, of these, two were included. Compared with controls, intervention participants reported increasing their condom use (ds ranged from 0.12 to 0.85). Within-group improvements in sexual behaviors were found for both groups (ds ranged from 0.19 to 1.94); participants reported fewer sexual partners, more condom use, and reduced alcohol or drug use before sex. These findings support the need and potential benefits for alcohol and HIV interventions among Russians, and suggest directions for public policy.

The influence of depressive symptoms on alcohol use among HIV-infected Russian drinkers

BACKGROUND

Depressive symptoms have been linked to HIV progression through a number of biobehavioral mechanisms including increased alcohol use. Although research supports an association between alcohol use and depressive symptoms among HIV patients, there have been few studies that have examined whether depressive symptoms predict subsequent drinking, especially among heavy drinking HIV-infected patients.

METHOD

Heavy drinking Russian HIV-infected patients (n=700) were recruited from addiction and HIV care settings for a randomized controlled trial of a risk reduction intervention [HERMITAGE]. GEE overdispersed Poisson regression analyses were conducted to assess the association between depressive symptoms and alcohol consumption 6-months later.

RESULTS

In adjusted analyses, depressive symptom severity was significantly associated with drinks per day (global p=.02). Compared to the non-depressed category, mild depressive symptoms were significantly associated with more drinks per day [IRR=1.55, (95% CI: 1.14, 2.09)], while moderate [IRR=1.14, (95% CI: 0.83, 1.56)] and severe [IRR=1.48, (95% CI: 0.93, 2.34)] depressive symptoms were not. Associations between depressive symptom severity and heavy drinking days were not statistically significant (global p=.19). Secondary analyses using the BDI-II screening threshold (BDI-II>14) and the BDI-II cognitive subscale suggested an association between depressive symptoms and drinks per day over time but not heavy episodic drinking.

CONCLUSIONS

Among heavy drinking HIV-infected patients, elevated depressive symptoms were associated with greater subsequent alcohol use. These findings suggest that depressive symptoms may be important to address in efforts to reduce alcohol-related risks among HIV-infected populations.