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Jin Z, Cao W, Wang K, Meng X, Shen J, Guo Y, Gaoshan J, Liang X, Tang K. Mental health and risky sexual behaviors among Chinese college students: a large cross-sectional study. J Affect Disord 2021; 287:293-300. [PMID: 33812242 DOI: 10.1016/j.jad.2021.03.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND College students are at-risk populations of mental health problems and risky sexual behaviors. However, little literature focuses on the association between mental health problems and risky sexual behaviors. Our study examined the association between mental health problems (depressive symptoms, suicide, and mental disorders) and risky sexual behaviors among a large sample of Chinese college students. METHODS A total of 49,728 Chinese college students (47.5% male) eventually participated in the analysis. A self-administered questionnaire was used to measure mental health, risky sexual behaviors (casual sex, no condom use at last sexual intercourse, group-sex, and a high number of sexual partners), and other sociodemographic characteristics. Logistic regression analysis was used to explore the relationship between mental health and risky sexual behaviors. To ensure the data is representative of the nation's statistics, all analyses were weighed. RESULTS The prevalence of depressive symptoms, suicide ideation and suicide attempts, and mental disorders was 42.83%, 41.29%, and 7.74%, respectively. 26.13% of participants were sexually active in the previous twelve months. Nearly 35% of sexually active participants were engaged in risky sexual behaviors. Logistic regression results demonstrated that mental health problems were associated with risky sexual behaviors after adjusting confounders. LIMITATIONS cross-sectional analysis; The self-reported variables may be subject to recall bias and fraud. CONCLUSIONS There is a relatively high prevalence of mental health problems and risky sexual behaviors amongst Chinese college students. A significant association between mental health problems and risky sexual behaviors was suggested by our study. Our findings support the importance of advocating for mental and reproductive healthcare for college students.
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Affiliation(s)
- Zhao Jin
- Vanke School of Public Health, Tsinghua University, 30 Shuangqing Road, Haidian District, Beijing 100084, China; China-Japan Friendship Hospital, 2 Sakura Garden East Street, Chaoyang District, Beijing 100029, China.
| | - Wenzhen Cao
- Department of Information Management, Peking University, Haidian District, Beijing 100871, P. R. China.
| | - Kemerly Wang
- China-Japan Friendship Hospital, 2 Sakura Garden East Street, Chaoyang District, Beijing 100029, China.
| | - Xiangrui Meng
- Vanke School of Public Health, Tsinghua University, 30 Shuangqing Road, Haidian District, Beijing 100084, China.
| | - Jiashu Shen
- Vanke School of Public Health, Tsinghua University, 30 Shuangqing Road, Haidian District, Beijing 100084, China; School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China.
| | - Yueping Guo
- School of Journalism and Communication, Graduate School of Chinese Academy of Social Sciences, 11 Changyu Street, Fangshan District, Beijing, 102488, China.
| | | | - Xiao Liang
- China Family Planning Association, Beijing, China.
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, 30 Shuangqing Road, Haidian District, Beijing 100084, China.
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Fu H, Feng T, Wang T, Wu X, Cai Y, Yang T. Reported prevalence of depression or depressive symptoms among men who have sex with men in China, 2004-2018: A systematic review and meta-analysis. J Affect Disord 2020; 277:192-203. [PMID: 32829195 DOI: 10.1016/j.jad.2020.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Depression is a major mental disorder that imposes a considerable burden on health. Men who have sex with men (MSM) are at high risk for depression. Numerous studies have reported the prevalence of depression or depressive symptoms among MSM in China. However, the estimates have varied substantially between studies. This meta-analysis aimed to establish the pooled prevalence of depression or depressive symptoms among Chinese MSM to attract public attention. METHOD A systematic search of several electronic databases and a subsequent manual search was performed to identify relevant studies. A random effects model was adopted to calculate the pooled prevalence of depression or depressive symptoms. Heterogeneity between studies and publication bias was also assessed. RESULTS A total of 54 articles with a sample size of 21,950 MSM were analysed. The pooled prevalence of depression or depressive symptoms among MSM was 40.0% (95% CI: 37.9%-45.0%). Substantial heterogeneity was observed across individual studies. The pooled summary estimate stratified by screening instruments and cutoff scores ranged from 19.0% to 60.2%. Subgroup analysis indicated that survey dates, sampling method, HIV infection status and occupation can partially contribute to the between-study heterogeneity. LIMITATIONS The findings should be interpreted with caution because of several limitations related to the heterogeneity across studies, sampling method and quality assessment. CONCLUSIONS Overall, the reported prevalence of depression or depressive symptoms among Chinese MSM was fairly high. The study suggested that more attention and effective intervention programmes are urgently provided to prevent and improve mental health issues among Chinese MSM.
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Affiliation(s)
- Hanlin Fu
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, Hunan Province 410078, China; HIV/AIDS Prevention and Control Division, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province 518000, China
| | - Tiejian Feng
- HIV/AIDS Prevention and Control Division, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province 518000, China
| | - Tingting Wang
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, Hunan Province 410078, China
| | - Xiaobing Wu
- Department of STD control and prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong Province 518020, China
| | - Yumao Cai
- Department of STD control and prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong Province 518020, China
| | - Tubao Yang
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, Hunan Province 410078, China.
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Michael S, Soskolne V. Internalized homophobia and sexual risk behavior among HIV-infected men who have sex with men in Israel. SOCIAL WORK IN HEALTH CARE 2020; 59:709-724. [PMID: 33302820 DOI: 10.1080/00981389.2020.1859045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 06/12/2023]
Abstract
Sexual risk behaviors among men who have sex with men (MSM) have been linked to diverse demographic, psychosocial, and behavioral factors. This study assessed the association between internalized homophobia and sexual risk behavior among HIV-infected MSM and the mediating effects of safe-sex self-efficacy and depression on this association, using a theoretical framework based on the Theory of Social Action. Data were collected from 124 HIV-infected MSM attending an AIDS clinic in Israel. No significant association was found between internalized homophobia and sexual risk behavior (unprotected anal intercourse). Examination of mediation effects revealed full mediation by depression, but not by self-efficacy. Depression and self-efficacy were the only significant explanatory variables of sexual risk behavior. Diverse social work interventions with HIV-infected MSM aimed at reducing sexual risk behaviors should include routine screening of IH and its association with depression, and address depression and self-efficacy in CBT and other interventions.
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Affiliation(s)
- Shahar Michael
- Social Work Services, Sheba Medical Center , Ramat-Gan, Israel
| | - Varda Soskolne
- Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University , Ramat-Gan, Israel
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Fletcher JB, Clark KA, Reback CJ. Depression and HIV Transmission Risk among Methamphetamine-Using Men who have Sex with Men. ADDICTION RESEARCH & THEORY 2020; 29:263-270. [PMID: 34248451 PMCID: PMC8262401 DOI: 10.1080/16066359.2020.1807960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Methamphetamine use is associated with disproportionate risk of HIV infection and increased risk of depression among sexual minority men. The purpose of the study was to estimate the association between clinical depression diagnoses and sexual risk-taking among cisgender men who have sex with men (MSM) who use methamphetamine. METHOD From March 2014 through January 2016, 286 MSM who use methamphetamine but were not seeking treatment for methamphetamine use disorder were enrolled to participate in a technology-based randomized controlled trial to reduce methamphetamine use and HIV sexual risk behaviors; participants were assessed for major depressive episodes (MDE) and persistent depressive disorder (PDD) at baseline. Multivariate clustered zero-inflated negative binomial regression analyses of condomless anal intercourse (n=282; 1,248 visits) estimated the association between this baseline diagnostic result and engagement in sexual risk-taking over time. RESULTS Participants predominantly identified as non-white (80%), averaged 42 years of age, and reported a HIV prevalence rate of 46%. Engagement in sexual risk-taking consistently demonstrated a positive curvilinear relationship with clinical depression severity, such that, for example, participants without clinical depression (59% of the sample; coef.=1.16) and those with MDE (36% of the sample; coef.=1.45) both demonstrated elevated rates of condomless anal sex with anonymous partners relative to participants with PDD (5% of the sample; analytical reference category; both coef. p<0.05). Data also demonstrated a trend (p = 0.053) of reduced sexual risk-taking with main partners among participants diagnosed with MDE (coef.=-0.94). CONCLUSIONS Methamphetamine use among participants in this study inverted the functional form of the relationship between depression and sexual risk among MSM observed in prior studies. Whereas low-grade depression has been associated with increased sexual risk-taking in prior samples of MSM, methamphetamine upends this relationship, such that the greatest engagement in sexual risk-taking occurred among those diagnosed with MDE at baseline. Additional research is warranted to clarify how methamphetamine influences sexual risk-taking among MSM with/without comorbid depression.
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Affiliation(s)
| | - Kirsty A. Clark
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Cathy J. Reback
- Friends Research Institute, Inc., Los Angeles, CA
- Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles
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Prevalence of depression, anxiety and suicide among men who have sex with men in China: a systematic review and meta-analysis. Epidemiol Psychiatr Sci 2020; 29:e136. [PMID: 32536353 PMCID: PMC7303796 DOI: 10.1017/s2045796020000487] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Chinese men who have sex with men (MSM) are at high risk for depression, anxiety and suicide. The estimated prevalence of these problems is essential to guide public health policy, but published results vary. This meta-analysis aimed to estimate the prevalence of depressive symptoms, anxiety symptoms and suicide among Chinese MSM. METHODS Systematic searches of EMBASE, MEDLINE, PsycINFO, PubMed, CNKI and Wanfang databases with languages restricted to Chinese and English for studies published before 10 September 2019 on the prevalence of depressive symptoms, anxiety symptoms, suicidal ideation, suicide plans and suicide attempts among Chinese MSM. Studies that were published in the peer-reviewed journals and used validated instruments to assess depression and anxiety were included. The characteristics of studies and the prevalence of depression and anxiety symptoms, suicidal ideation, suicide plans and suicide attempts were independently extracted by authors. Random-effects modelling was used to estimate the pooled rates. Subgroup analysis and univariate meta-regression were conducted to explore potential sources of heterogeneity. This study followed the PRISMA and MOOSE. RESULTS Sixty-seven studies were included. Fifty-two studies reported the prevalence of depressive symptoms, with a combined sample of 37 376 people, of whom 12 887 [43.2%; 95% confidence interval (CI), 38.9-47.5] reported depressive symptoms. Twenty-seven studies reported the prevalence of anxiety symptoms, with a combined sample of 10 531 people, of whom 3187 (32.2%; 95% CI, 28.3-36.6) reported anxiety symptoms. Twenty-three studies reported the prevalence of suicidal ideation, with a combined sample of 15 034 people, of whom 3416 (21.2%; 95% CI, 18.3-24.5) had suicidal ideation. Nine studies reported the prevalence of suicide plans, with a combined sample of 5271 people, of whom 401 (6.2%; 95% CI, 3.9-8.6) had suicide plans. Finally, 19 studies reported the prevalence of suicide attempts, with a combined sample of 27 936 people, of whom 1829 (7.3%; 95% CI, 5.6-9.0) had attempted suicide. CONCLUSIONS The mental health of Chinese MSM is poor compared with the general population. Efforts are warranted to develop interventions to prevent and alleviate mental health problems among this vulnerable population.
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Javanbakht M, Shoptaw S, Ragsdale A, Brookmeyer R, Bolan R, Gorbach PM. Depressive symptoms and substance use: Changes overtime among a cohort of HIV-positive and HIV-negative MSM. Drug Alcohol Depend 2020; 207:107770. [PMID: 31841750 PMCID: PMC6981056 DOI: 10.1016/j.drugalcdep.2019.107770] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The objective of this study was to examine depressive symptoms overtime and quantify the variance in symptoms attributable to substance use among a cohort of HIV-positive and HIV-negative men. METHODS Participants were enrolled in an NIH/NIDA funded cohort, with 534 men resulting in 1,888 visits between August 2014 and June 2018. Participants were between 18 and 45 years, and half were HIV-positive. At baseline and semi-annual visits, information was collected on depressive symptoms, sexual behaviors, and substance use. Changes overtime in symptom scores were evaluated using individual growth curve modeling. RESULTS The average CES-D20 score was 19.5 (SD = 12.7). Depressive symptoms were highest among daily/weekly methamphetamine users (56% vs. 39% occasional users and 27% non-users; p value<.01). Factors independently associated with depressive symptoms included methamphetamine use (adjusted OR = 1.5; 95% CI 1.1-2.3) and transactional sex (adjusted OR = 1.8; 95% CI 1.4-2.5). Based on growth curve modeling, methamphetamine was the most influential predictor of depressive symptoms, accounting for 10% of individual variance (p value<.01). Declines in depressive symptoms were noted for heavy users of a number of drugs, except for methamphetamine. For instance, those reporting daily/weekly heroin had a 3.38 point decline in CESD20 scores overtime (p value = 0.01). However, heavy methamphetamine users had much higher CESD20 scores and their scores remained high overtime (p value for change = 0.91). CONCLUSIONS The prevalence of depressive symptoms among this cohort of HIV-negative and HIV-positive MSM was high, especially among frequent methamphetamine users. These findings suggest that reducing methamphetamine use may have the potential to reduce depressive symptoms.
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Affiliation(s)
- Marjan Javanbakht
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA, United States.
| | - Steven Shoptaw
- UCLA David Geffen School of Medicine, Department of Family Medicine, Los Angeles, CA
| | - Amy Ragsdale
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA
| | - Ron Brookmeyer
- UCLA Fielding School of Public Health, Department of Biostatistics, Los Angeles, CA
| | | | - Pamina M. Gorbach
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA
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Agnew-Brune CB, Balaji AB, Mustanski B, Newcomb ME, Prachand N, Braunstein SL, Brady KA, Hoots BE, Smith JS, Paz-Bailey G, Broz D. Mental health, social support, and HIV-related sexual risk behaviors among HIV-negative adolescent sexual minority males: three U.S. cities, 2015. AIDS Behav 2019; 23:3419-3426. [PMID: 31065922 DOI: 10.1007/s10461-019-02525-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We examined the association between mental health issues, social support, and HIV among adolescent sexual minority males (SMM), who are disproportionally affected by HIV. National HIV Behavioral Surveillance among Young Men Who Have Sex with Men (NHBS-YMSM) data among SMM aged 13-18 years were collected in three cities (Chicago, New York City, and Philadelphia). Separate log-linked Poisson regression models were used to estimate associations between mental health issues and social support (general and family), and 3 HIV-related sexual risk behavior outcomes: past-year condomless anal intercourse (CAI) with a male partner, past-year sex with ≥ 4 partners, and first vaginal or anal sex before age 13. Of 547 adolescent SMM, 22% reported ever attempting suicide and 10% reported past-month suicidal ideation. The majority (52%) reported depression and anxiety. Thirty-nine percent reported CAI, 29% reported ≥ 4 sex partners and 22% reported first sex before age 13. Ever attempting suicide, suicidal ideation, and depression and anxiety were associated with CAI. Separately, ever attempting suicide and lack of family support were associated with ≥ 4 sex partners. None of the mental health or support measures were associated with having sex before age 13. General social support was not associated with any sexual risk behaviors. Mental health issues are common among adolescent SMM and associated with sexual risk behaviors. Including mental health support in comprehensive HIV prevention for adolescent SMM could potentially reduce HIV risk in this population.
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Affiliation(s)
- Christine B Agnew-Brune
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-46, Atlanta, GA, USA.
| | - Alexandra B Balaji
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-46, Atlanta, GA, USA
| | - Brian Mustanski
- Department of Medical Social Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael E Newcomb
- Department of Medical Social Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nik Prachand
- Chicago Department of Public Health, Chicago, IL, USA
| | | | | | - Brooke E Hoots
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-46, Atlanta, GA, USA
| | - Justin S Smith
- Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-46, Atlanta, GA, USA
| | - Dita Broz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-46, Atlanta, GA, USA
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Ojikutu BO, Bogart LM, Klein DJ, Galvan FH, Wagner GJ. Neighborhood Crime and Sexual Transmission Risk Behavior among Black Men Living with HIV. J Health Care Poor Underserved 2019; 29:383-399. [PMID: 29503307 DOI: 10.1353/hpu.2018.0026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Here, we examined the association of exposure to neighborhood crime with sexual risk-taking behavior among Black men living with HIV. HIV-positive Black men on antiretroviral therapy in California completed an audio computer-assisted self-interview. Crime risk per census block group was derived from the Federal Bureau of Investigation's Uniform Crime Report. Among 193 men, the mean (SD) number of sexual partners among those who were sexually active was 2.7 (3.3). 49% reported condomless sex, and 23% reported sex with an HIV-negative or unknown-serostatus partner. In multivariate analysis, illicit drug use ([IRR=1.86; 95%CI: 1.20-2.89] p=.006), depressive symptoms ([IRR=1.59; 95%CI: 1.03-2.44] p=.03), an undetectable viral load ([IRR=1.91; 95%CI: 1.22-3.00] p=.005), and neighborhood total crime risk ([IRR=1.02; 95%CI: 1.01-1.04] p=.007) remained significant. Among Black men living with HIV, exposure to neighborhood crime is associated with having multiple sexual partners whose HIV status was negative or unknown.
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Babowitch JD, Mitzel LD, Vanable PA, Sweeney SM. Depressive Symptoms and Condomless Sex Among Men Who Have Sex with Men Living with HIV: A Curvilinear Association. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2035-2040. [PMID: 29110113 DOI: 10.1007/s10508-017-1105-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/19/2017] [Accepted: 10/21/2017] [Indexed: 06/07/2023]
Abstract
Depressive symptoms are highly prevalent among HIV-positive men who have sex with men (MSM) and may contribute to risky health behaviors. However, research linking depressed mood to condomless sex in HIV-positive MSM has yielded mixed findings and has focused primarily on testing for a linear association. In the current study, we tested both linear and curvilinear models to assess the association of depressive symptoms to condomless anal sex for the most recent sexual episode in a sample of MSM living with HIV (N = 96, M age = 44, 57% Caucasian). Participants completed the Center for Epidemiological Studies-Depression Scale and self-reported on their sexual behaviors. Findings confirmed a curvilinear association of depressive symptoms with condomless anal sex for encounters involving non-primary partner: MSM with moderate levels of depressed mood were more likely to report non-condom use compared to those with low and high levels of depressive symptoms. Future research should test whether treatment for depression can serve to enhance the impact of sexual health promotion interventions for MSM.
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Affiliation(s)
- Jacklyn D Babowitch
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13224, USA.
| | - Luke D Mitzel
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13224, USA
| | - Peter A Vanable
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13224, USA
| | - Shannon M Sweeney
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13224, USA
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Fletcher JB, Swendeman D, Reback CJ. Associations Between Major Depressive Episode, Methamphetamine Use Disorder Severity, and Engagement in Sexual Risk-Taking Among Methamphetamine-Using Men Who Have Sex with Men. AIDS Behav 2018; 22:1461-1466. [PMID: 29164354 PMCID: PMC5903963 DOI: 10.1007/s10461-017-1974-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Depression and methamphetamine use have been associated with increased sexual risk-taking among men who have sex with men (MSM). This study estimated associations between current major depressive episode and/or methamphetamine use disorder and engagement in condomless anal intercourse (CAI). From March 2014 thru January 2016, 286 methamphetamine-using MSM were enrolled into a RCT to reduce methamphetamine use and sexual risk-taking. Analyses revealed that current major depressive episode was associated with a 92% increase in the rate of engagement in CAI with casual male partners (IRR 1.92; 95% CI 1.12-3.31) and a 76% increase in the rate of engagement in CAI with anonymous male partners (IRR 1.76; 95% CI 1.00-3.09). Additionally, for each unit increase in diagnostic methamphetamine use disorder severity, rates of engagement in CAI with anonymous male partners increased by 44% (IRR 1.44; 95% CI 1.11-1.87) and rates of engagement in CAI with exchange male partners increased by 140% (IRR 2.40; 95% CI 1.39-4.13). Neither diagnosis was associated with CAI with main male partners. Depression and methamphetamine use influence sexual risk-taking in unique ways, and interventions working with MSM should assess participants for both depression and methamphetamine use, and may tailor intervention content based on diagnostic outcomes.
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Affiliation(s)
- Jesse B Fletcher
- Friends Research Institute, Inc., 1419 N. La Brea Ave, Los Angeles, CA, 90028, USA.
| | - Dallas Swendeman
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, Los Angeles, USA
- David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, USA
| | - Cathy J Reback
- Friends Research Institute, Inc., 1419 N. La Brea Ave, Los Angeles, CA, 90028, USA
- David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, USA
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Vu NTT, Holt M, Phan HTT, La LT, Tran GM, Doan TT, Nguyen TNN, de Wit J. Amphetamine-Type-Stimulants (ATS) Use and Homosexuality-Related Enacted Stigma Are Associated With Depression Among Men Who Have Sex With Men (MSM) in Two Major Cities in Vietnam in 2014. Subst Use Misuse 2017; 52:1411-1419. [PMID: 28436758 DOI: 10.1080/10826084.2017.1284233] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) are disproportionately affected by mental health concerns, including depression. Amphetamine-type-stimulants (ATS) use and homosexuality-related stigma and discrimination have been found associated with depression among MSM. OBJECTIVES To assess the prevalence of depression and its associations with ATS use and homosexuality-related stigma and discrimination among MSM in Vietnam. METHODS 622 MSM were conveniently recruited in Hanoi and Ho Chi Minh city, Vietnam, from September to December 2014. We collected information on demographic characteristics, ATS, alcohol and other drug use, sexual behaviors, homosexuality-related and discrimination stigma, and sexual sensation-seeking. Depression and suicidal thoughts were assessed by the Patient Health Questionnaire (PHQ-9). We assessed associations of depression with ATS use and homosexuality-related stigma and discrimination using logistic regression. RESULTS Of 622 sampled MSM, 11.3% were classified as having major depression, 9.8% reported any suicidal thoughts in the last two weeks, 30.4% ever had used any ATS, 88.8% ever ad drank alcohol and 21.5% had ever used any other drugs. In multivariate analysis, depression was significantly associated with ATS use (Adjusted Odds Ratio [AOR: 2.20; (95% Confidence Interval (CI): 1.32-3.67], younger age of sexual debut with another man (AOR: 0.09; 95% CI: 0.02-0.50), and greater enacted homosexuality-related stigma (AOR: 1.97; 95% CI: 1.19-3.26). CONCLUSIONS We found a moderate prevalence of depression among sampled MSM, which was associated with ATS use and enacted homosexuality-related stigma. We recommend integrating assessment and interventions regarding depression and methamphetamine use into gay-friendly, culturally adapted holistic HIV prevention for MSM in Vietnam.
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Affiliation(s)
- Nga Thi Thu Vu
- a Centre for Social Research in Health, University of New South Wales , Sydney , Australia.,b Institute of Preventive Medicine and Public Health, Hanoi Medical University , Hanoi , Vietnam
| | - Martin Holt
- a Centre for Social Research in Health, University of New South Wales , Sydney , Australia
| | - Huong Thi Thu Phan
- c Vietnam Administration for HIV/AIDS Prevention and Control, Ministry of Health , Hanoi , Vietnam
| | - Lan Thi La
- d Hanoi Centre of HIV/AIDS Prevention and Control , Hanoi , Vietnam
| | - Gioi Minh Tran
- e Center for Community Health Promotion , Hanoi , Vietnam
| | | | | | - John de Wit
- a Centre for Social Research in Health, University of New South Wales , Sydney , Australia
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12
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Millar BM, Starks TJ, Grov C, Parsons JT. Sexual Risk-Taking in HIV-Negative Gay and Bisexual Men Increases with Depression: Results from a U.S. National Study. AIDS Behav 2017; 21:1665-1675. [PMID: 27475943 PMCID: PMC5323369 DOI: 10.1007/s10461-016-1507-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The link between depression and sexual risk-taking has received mixed findings in the literature. The current study analyzed the links between depression and recent condomless anal sex (CAS) with casual partners among 1033 HIV-negative, non-PrEP-using, gay and bisexual men. When CAS was dichotomized as either none or some, depression was not associated with the odds of CAS (with receptive and insertive combined) or insertive CAS only, but was positively associated with the odds of receptive CAS. When CAS was tallied as a count variable of events, depression was positively associated with total CAS, receptive CAS, and insertive CAS. With the addition of a quadratic term for depression, a positive quadratic effect was only found for total CAS and receptive CAS, but not for insertive CAS. These findings highlight the utility of using count data for CAS events and treating CAS separately with regard to receptive and insertive positioning when considering the role of depression among gay and bisexual men.
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Affiliation(s)
- Brett M Millar
- Center for HIV/AIDS Educational Studies & Training (CHEST), Hunter College of the City University of New York (CUNY), New York, NY, USA
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center (CUNY), New York, NY, USA
| | - Tyrel J Starks
- Center for HIV/AIDS Educational Studies & Training (CHEST), Hunter College of the City University of New York (CUNY), New York, NY, USA
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center (CUNY), New York, NY, USA
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave., New York, NY, 10065, USA
| | - Christian Grov
- Center for HIV/AIDS Educational Studies & Training (CHEST), Hunter College of the City University of New York (CUNY), New York, NY, USA
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Jeffrey T Parsons
- Center for HIV/AIDS Educational Studies & Training (CHEST), Hunter College of the City University of New York (CUNY), New York, NY, USA.
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center (CUNY), New York, NY, USA.
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave., New York, NY, 10065, USA.
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13
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Brickman C, Propert KJ, Voytek C, Metzger D, Gross R. Association Between Depression and Condom Use Differs by Sexual Behavior Group in Patients with HIV. AIDS Behav 2017; 21:1676-1683. [PMID: 27878639 DOI: 10.1007/s10461-016-1610-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Cristina Brickman
- Division of Infectious Diseases, University of California San Francisco, 513 Parnassus Ave Medical Room S380, San Francisco, CA, 94143, USA.
| | | | | | | | - Robert Gross
- University of Pennsylvania, Philadelphia, PA, USA
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14
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Cruess DG, Burnham KE, Finitsis DJ, Cherry C, Grebler T, Goshe BM, Strainge L, Kalichman MO, Kalichman SC. Online Partner Seeking and Sexual Risk Among HIV+ Gay and Bisexual Men: A Dialectical Perspective. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1079-1087. [PMID: 27671781 DOI: 10.1007/s10508-016-0833-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/09/2016] [Accepted: 08/08/2016] [Indexed: 06/06/2023]
Abstract
For almost two decades, researchers have explored the relationship between online partner seeking (OPS) and HIV/STI transmission risk behavior among men who have sex with men (MSM), including gay- and bisexual-identified men. A dichotomy has emerged with some findings that OPS is associated with greater sexual risk behavior, and a sparser but emerging literature that men may use OPS for sexual risk reduction. This study examined the association between proportion of partners met online and sexual risk behavior in a sample of 170 HIV-positive gay- and bisexual-identified men. Participants completed assessments including psychosocial factors and a comprehensive assessment of sexual behavior, including total number of male partners, and condomless insertive and receptive anal sex with HIV-negative/unknown serostatus partners or HIV-positive male partners. Our findings support taking a dialectical stance and indicate that OPS may impact risk differently given different individual and contextual circumstances.
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Affiliation(s)
- Dean G Cruess
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269, USA.
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA.
| | - Kaylee E Burnham
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269, USA
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA
| | - David J Finitsis
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269, USA
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA
| | - Chauncey Cherry
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA
| | - Tamar Grebler
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA
| | - Brett M Goshe
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269, USA
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA
| | - Lauren Strainge
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269, USA
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA
| | - Moira O Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269, USA
- Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA
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15
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Miltz AR, Rodger AJ, Sewell J, Speakman A, Phillips AN, Sherr L, Gilson RJ, Asboe D, Nwokolo NC, Clarke A, Gompels MM, Allan S, Collins S, Lampe FC. Clinically significant depressive symptoms and sexual behaviour among men who have sex with men. BJPsych Open 2017; 3:127-137. [PMID: 28507772 PMCID: PMC5421094 DOI: 10.1192/bjpo.bp.116.003574] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 01/13/2017] [Accepted: 03/06/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The relationship between depression and sexual behaviour among men who have sex with men (MSM) is poorly understood. AIMS To investigate prevalence and correlates of depressive symptoms (Patient Health Questionnaire-9 score ≥10) and the relationship between depressive symptoms and sexual behaviour among MSM reporting recent sex. METHOD The Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) is a cross-sectional study of UK genitourinary medicine clinic attendees without diagnosed HIV (2013-2014). RESULTS Among 1340 MSM, depressive symptoms (12.4%) were strongly associated with socioeconomic disadvantage and lower supportive network. Adjusted for key sociodemographic factors, depressive symptoms were associated with measures of condomless sex partners in the past 3 months (≥2 (prevalence ratio (PR) 1.42, 95% CI 1.17-1.74; P=0.001), unknown or HIV-positive status (PR 1.43, 95% CI 1.20-1.71; P<0.001)), sexually transmitted infection (STI) diagnosis (PR 1.46, 95% CI 1.19-1.79; P<0.001) and post-exposure prophylaxis use in the past year (PR 1.83, 95% CI 1.33-2.50; P<0.001). CONCLUSIONS Management of mental health may play a role in HIV and STI prevention. DECLARATION OF INTEREST A.N.P. has received payments for presentations made at meetings sponsored by Gilead in spring 2015. N.C.N. has received support for attendance at conferences, speaker fees and payments for attendance at advisory boards from Gilead Sciences, Viiv Healthcare, Janssen Pharmaceuticals and Bristol-Myers Squibb and a research grant from Gilead Sciences. D.A. served on the advisory board for Gilead in January 2016. M.M.G. has had sponsorship to attend conferences by Bristol-Myers Squibb, been on the BioCryst advisory board and run trials for Merck, Gilead, SSAT, BioCryst and Novartis. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Ada R. Miltz
- Ada R. Miltz, MSc, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
| | - Alison J. Rodger
- Alison J. Rodger, MD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
| | - Janey Sewell
- Janey Sewell, BNurs, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
| | - Andrew Speakman
- Andrew Speakman, PhD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
| | - Andrew N. Phillips
- Andrew N. Phillips, PhD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
| | - Lorraine Sherr
- Lorraine Sherr, PhD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
| | - Richard J. Gilson
- Richard J. Gilson, MBBS, Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, Mortimer Market Centre, University College London, London, UK
| | - David Asboe
- David Asboe, MBBS, John Hunter Clinic, London, UK
| | | | - Amanda Clarke
- Amanda Clarke, BM, Royal Sussex County Hospital, Brighton, UK
| | | | - Sris Allan
- Sris Allan, MBBS, City of Coventry Healthcare Centre, Coventry, UK
| | | | - Fiona C. Lampe
- Fiona C. Lampe, PhD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK, for the AURAH Study Group
| | - for the AURAH Study Group
- Ada R. Miltz, MSc, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
- Alison J. Rodger, MD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
- Janey Sewell, BNurs, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
- Andrew Speakman, PhD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
- Andrew N. Phillips, PhD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
- Lorraine Sherr, PhD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK
- Richard J. Gilson, MBBS, Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, Mortimer Market Centre, University College London, London, UK
- David Asboe, MBBS, John Hunter Clinic, London, UK
- Nneka C. Nwokolo, MBBS, 56 Dean Street, London, UK
- Amanda Clarke, BM, Royal Sussex County Hospital, Brighton, UK
- Mark M. Gompels, MBBS, Southmead Hospital, Bristol, UK
- Sris Allan, MBBS, City of Coventry Healthcare Centre, Coventry, UK
- Simon Collins, advocate, HIV i-Base, London, UK
- Fiona C. Lampe, PhD, HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, University College London, London, UK, for the AURAH Study Group
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16
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Miller CT, Solomon SE, Bunn JY, Varni SE, Hodge JJ. Psychological symptoms are associated with both abstinence and risky sex among men with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:453-65. [PMID: 25614050 PMCID: PMC4324502 DOI: 10.1007/s10508-014-0464-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 12/06/2014] [Accepted: 12/10/2014] [Indexed: 06/04/2023]
Abstract
Sexual abstinence is often deemed the "safest behavior" in HIV prevention, but is sometimes associated with psychological symptoms (e.g., depression) just as sexually risky behavior is. This study explored whether sexual abstinence and risky sexual behavior among men with HIV were associated with similar constellations of psychological symptoms. Prior research has not addressed this issue because abstinent people often are not included in the sample or, when data are analyzed, researchers combine abstinent people with sexually active people who practice safer sex. Past research also neglects the co-morbidity of psychological symptoms. A latent class analysis of the psychological symptoms (assessed with the Symptom Check List 90-R; Derogatis, 1994) of 140 men with HIV, mostly from rural New England, revealed three latent classes: men who were asymptomatic on all symptom domains (28.8 %), men who were symptomatic on all domains (34.1 %), and men who were symptomatic on internalizing domains (37.1 %), but were asymptomatic on the externalizing symptoms of hostility and paranoid ideation. Logistic regression showed that sexual behavior during the past 90 days of men in the all symptom class and the internalizing symptoms class was similar, with abstinence and risky sex predominating, and safer sex being relatively uncommon for both classes. The sexual behavior of men in the asymptomatic class differed, with safer sex being relatively more likely to occur compared to the symptomatic classes. These findings suggest that the psychological symptom profile of sexually abstinent people places them at risk for inconsistent condom use should they engage in sexual behavior.
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Affiliation(s)
- Carol T Miller
- Department of Psychological Science, University of Vermont, 360 John Dewey Hall, 2 Colchester Ave., Burlington, VT, 05405, USA,
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